Focusing on Maternal and Infant Health in 2025

By Matt Phillion

The state of maternal and infant health in the U.S. remains alarming as mortality rates stand as the highest in all high-income nations. As many as 80% of maternal deaths, many of which occur in the first 42 days after giving birth, are preventable.

ProgenyHealth, a leader in maternity and NICU care management, has released its 2025 key trends and insight report, “Steep Challenges & Uneven Progress,” which identifies key areas within maternal and infant health to watch for in the year ahead for health plans, hospitals, and healthcare providers.

“The March of Dimes recently gave the country a D-Plus with regards to the state of maternal and infant health in the U.S., and I think that sums it up well. That’s what keeps me up at night,” says Susan Torroella, CEO of ProgenyHealth. “There’s so much we can do and are doing to impact this trajectory.”

Linda Genen, MD, MPH CMO of ProgenyHealth, notes that what troubles her most from the March of Dimes report is the lack of progress.

“I feel like I’ve been banging my head against the wall for the last decade. It’s shocking how we’re not making any progress. How are we in this position?” she says. “Everything we’re doing, and it still isn’t changing the numbers.”

The lack of progress doesn’t mean giving up, however.

“We have to think differently. What are the causes? How can we focus on being strategic?” Torroella says. “We have to think about the providers. The work they’re doing is really hard and they’re providing great care. But we’re not reaching all the women or solving the problems they face.”

Torroella also points to the need to acknowledge the impact of social determinants of health and how they impact negative outcomes.

“We have to acknowledge poor access to care. When you think about these OB deserts, we didn’t have those years ago,” she says. “Despite all the work we’re doing, steps backward keep happening.”

“We need to focus on some key factors,” says Genen. “We know access to care is a problem, so how can we change that? It’s not just a visit every few months, it’s what’s happening between those visits.”

The first big step is improving and increasing access to care.

“It’s helping women get to the OB office, or to meet with a midwife or doula,” says Genen. “Right care, right time is a phrase we hear a lot in population health, but if someone identifies as being pregnant it’s not easy to get an appointment. We need to help that person find care.”

This can also mean a change in mindset about what access to care means, Genen says.

“Does it have to be in person? Can telehealth fit in? Before the pandemic, 0.1% of care was through telehealth,” she says. “We had people conducting visits in parking lots, literally in their cars, and we said let’s turn to telehealth. We’ve swung back the other direction, but we can’t remove access to telehealth, especially in areas with OB deserts. We can provide care through phone, video, Facetime, and then identify women who you actually need to see in person. It’s really important we maintain that.”

You can’t know what you don’t track

The industry needs to do a better job of tracking the factors that impact maternal and infant mortality, Genen says.

“We’re not tracking this well, and if you don’t track it you don’t know,” says Genen. “How many women receive blood transfusions in labor and delivery? If you decrease transfusions needed during birth that’s a wonderful thing. If you decrease things like diabetes or hypertension…we have to track that.”

It’s particularly difficult to do this level of tracking in the U.S. health system because of the variety of EHRs used that don’t feed into each other.

“A typical evening for me in labor and delivery would be: the patient is with an OB practice that doesn’t feed into the EHR. She’s had prenatal care, but I don’t have access to her prenatal records because she’s outside of my health system,” says Genen. “Then I or a nurse has to reach out to get that information. Other countries have a standardized approach for electronic health record sharing.”

While Genen says a single electronic record for each American is a dream scenario—something that can be carried with the patient wherever they may need to access it—in the interim there is a great opportunity to educate the patient as the owner of their own healthcare and health information.

“This education is super important. We want her to know what she’s going to experience at every visit, so she goes in as an informed member of her own journey,” says Genen. “We say women are the CEO of their family, so it’s really important that moms, that women are healthy because if they’re not they can’t take care of others.”

Case managers such as those who work with ProgenyHealth can act as that educational resource, helping patients figure out the gaps in how they understand their care and barriers to their continued health.

“When it comes to maternal and infant health, we should be focusing on this advocacy and engagement,” says Torroella. “You can’t just launch some technology or initiative. You need proactive outreach and an approach to get a member to actually enroll in a maternity-focused program. You can’t just build and expect them to come onboard.”

Doing so requires trust, Torroella explains.

“When we reach a perspective pregnant person, 70% of the time they say yes, they want to be involved, and we can connect them to a dedicated case manager they trust,” she says. “They can build that relationship throughout the entire pregnancy and be guiding them even through the post-partem journey.”

There’s a great deal of self-determination involved, Torroella explains.

“We want them to know: here are the questions you can ask and that you should ask your physician. You can raise this concern at your next appointment, and here’s an effective way to phrase that question” says Torroella. “And then we can have a follow-up about the answer to that question. It’s self-efficacy, self-empowerment, and giving them the courage to ask questions during a busy appointment. And it becomes a muscle that can carry over into other things like how to engage with the pediatrician after your child is born.”

The barrier is trust

Helping with access to care is one step, but that in a way is just checking the box. It’s not helpful without the human relationship.

“That costs more,” says Torroella. “You’re providing a more robust solution.”

“The first word that comes to mind is ‘trust’ in big bold letters,” says Genen. “There has to be trust between the community, the patient, the provider. And that’s challenging. You’re seeing someone sporadically—even as we age, we’re going to see a doctor maybe once a year until we’re over 80, and then suddenly you’re in the doctor’s office a lot. How do you build trust with someone you don’t have a relationship with?”

Time in front of your physician is limited, and it can be hard for both sides to build that relationship.

“The physician has to make the time to hear the patient, and then the patient also has to be willing to open up. You’ve got two people who are not communicating as openly as they could to solve for other problems,” says Genen.

This is particularly important when it comes to discussing mental health, Genen points out, with 20% of new mothers experiencing mood and anxiety disorders and 7% of pregnancy-related deaths involving suicide.

“You can’t effect change if you don’t have trust,” says Torroella. “Having a trusted partner in your journey can make all the difference. That trust is built during the pregnancy but then carries on into your journey.”

Torroella says she is encouraged by the enthusiasm she’s seeing in healthcare partners in addressing clinical and social determinants of health.

“That gives me optimism,” she says. “We’re looking holistically at improving things for women and babies.”

Genen says she is seeing the needle move particularly in the NICU, where the line of viability continues to go lower and lower.

“It’s amazing to see that. There are challenges, but we’re making progress,” she says.

She is also interested in seeing the evolution of gene therapy and genomics and how it will impact maternal and infant health.

“I think in our lifetimes we’re going to see these things become game changing,” says Genen. “For more than a decade, we’ve seen that testing someone and being able to diagnose and treat them can really change a baby’s trajectory.”

“Thinking of these babies where there isn’t the option for genomic testing, and the stress and suffering involved,” says Torroella. “We have a sort of chaotic consumption of healthcare in this country, and if you see a challenge early, do testing early, it has such a clinical benefit, a humanitarian benefit, and an economic benefit because you can be more precise in how you treat the baby.”

If the industry takes the needed steps in the right direction, there’s opportunity to move the numbers in the right direction, Torroella and Genen explain.

“If we could make sure everyone has access to an individual touch by a person who can guide them on their journey, that could have a huge impact,” says Genen. “The health literacy factor is huge. The smartest people really may not have any education around their own health journey.”

“Investment in maternal and infant health yields so many downstream benefits,” says Torroella. “What happens to a baby in utero, what happens to the mom during that time, it can all have a profound impact on the baby. If we focus on that time there are profound downstream benefits to the individual, but also to our society. That’s a conversation we should be having in this country.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.