An Unlikely Provider to Improve Maternal Health Outcomes and Reduce Disparities: Pharmacists
With more than 90% of Americans living within 5 miles of a community pharmacy, pharmacists are the most accessible healthcare providers.
The rate of preterm births in the United States continues to exceed 10% of all live births, and this number hasn’t changed much since 2007. Many social, personal, economic, and behavioral factors contribute to preterm birth, including young or high maternal age, black race, low maternal income or socioeconomic status, tobacco and alcohol use, substance abuse, stress, and late prenatal care.1 Sadly, many of these factors are also associated with an increased maternal mortality.
Maternal Health: Preconception to Post-Pregnancy
Maternal health includes preconception, pregnancy, and post-pregnancy and affects all women of child-bearing age, even those who are unable to or choose not to have children. Pharmacists can play a role in every phase of maternal health, which may decrease unintended pregnancies and improve outcomes for both mother and baby.
Preconception care is different for women who choose to prevent pregnancy compared to those who plan to become pregnant. According to a 2014 Guttmacher report, unintended pregnancies account for about half of all pregnancies in the United States.2 More recent Centers for Disease Control and Prevention (CDC) data shows more than 30% of live births are from unintended pregnancies, which includes those who did not want to become pregnant or wanted to become pregnant later.3 Improved access to contraception can reduce the incidence of unintended pregnancies. Whether or not a women desires pregnancy, all women in their child-bearing years need preconception care for their own health and wellbeing. In addition to preventing and treating for medical conditions that can impact maternal and infant health, routine screenings and monitoring are necessary for overall health and well-being.
Prenatal care should start as soon as the woman confirms her pregnancy, which is usually with an at-home pregnancy test weeks before the first prenatal visit. Initiating prenatal vitamins early and assessing chronic medications for teratogenic potential should be done sooner rather than later.
Post-partum care is equally important to the health of the mother and infant and for planning for future pregnancies. Evaluating over-the-counter (OTC) and prescription medications for appropriateness in breastfeeding women is essential. Contraception needs should also be assessed for pregnancy planning and spacing and to prevent unintended future pregnancies.
The Biden-Harris administration and multiple agencies within the Federal Government have made women’s health a priority. Funding for family planning services has been available since 1970 under Title X of the Public Health Service Act. The Affordable Care Act expanded access to family planning services. Initiatives, such as Healthy People 2010, Healthy People 2020, and Healthy People 2030, and the United States Preventive Services Task Force (USPSTF) recommendations also have placed an emphasis on improving women’s health and maternal-fetal outcomes. Preventative measures, such as immunizations, folic acid supplementation, blood pressure monitoring, and depression screening, are common themes across all initiatives to improve the health of women during their child-bearing years.
The Healthy People initiatives have been tracking metrics related to maternal health for decades. Early intervention and improving outcomes for both the mother and baby have been the primary focus. Some have made notable progress, while others continue to miss the target. Increasing the proportion of pregnant women who receive early and adequate prenatal care made minimal progress from 2016 to 2019. The incidence of preterm births showed a decrease from 10.4% in 2007 to 10.2% in 2019.4, 5 A lot of work still needs to be done to reach the Healthy People 2030 goals of 80.5% of women receiving early and adequate prenatal care and an incidence of preterm births of 9.4%.
Pharmacists are accessible to most Americans. In fact, 91% of all Americans live within 5 miles of a community pharmacy.6 The American Medical Association (AMA) predicts a shortage of up to 48,000 primary care physicians by 2034.7 If underserved populations used healthcare services at the same rate as those living in more affluent areas, this number would be even higher. Simply stated: The current healthcare system will not have the capacity to provide care to everyone who needs it.
Pharmacists in 19 U.S. jurisdictions may independently prescribe contraceptives. In 2019, pharmacists in Oregon—the first state to allow pharmacists to prescribe contraception—prescribed 10% of all new oral and transdermal contraceptive prescriptions. Of those prescriptions, 74% were to women who had not used the pill, patch, or ring in the previous month. Pharmacists may have prevented an unintended pregnancy in many of these women.8
Preconception care and early prenatal care include OTC supplements, such as folic acid and prenatal vitamins. Pharmacists can encourage women to incorporate these into their daily routine before they become pregnant or prior to the first obstetrical visit, as well as stressing the importance of establishing early prenatal care with a physician or mid-level practitioner.
Pharmacists have been administering immunizations for more than 25 years, ensuring pregnant women receive the recommended tetanus, diphtheria, and pertussis (TDaP) vaccine between 27 and 36 weeks; annual influenza vaccines; and any other recommended immunizations, as well as providing education to pregnant women on the benefits of vaccinating other family members and caregivers.
Pharmacists provide disease state management for many chronic medical conditions and medication therapy management services in pharmacies across the country. They extend the reach of primary care providers by providing monitoring and medication adjustments for diseases, such as high blood pressure and diabetes, which improves medication adherence and leads to better patient outcomes. These services are valuable in all communities but are critical in our underserved communities where access to primary care providers is limited. These services can easily be tailored to pregnant and post-partum women: routine monitoring of blood pressure to identify need for early intervention and referral to potentially prevent complications, evaluating acute and chronic medications for appropriateness in pregnancy and breastfeeding, screening for acute and chronic medical conditions, counseling on tobacco cessation, and referring patients for follow-up care based on screening and assessment. Pharmacists are trained to provide many services that may positively impact maternal health for all women, specifically those in underserved communities, which are predominantly minorities. The goal is to identify the need for early intervention and get women the help they need sooner rather than later.
Time for Change
It’s beyond time to recognize the value pharmacists provide and better use them to deliver primary care services to women who deserve better outcomes for themselves and their children. The healthcare system has been providing services in the same manner for decades with minimal improvement. If we want to see progress in maternal and birth outcomes, improve the health of women and their newborn babies, and achieve health equity, we need a different approach. It’s time to meet people where they are instead of expecting them to come to us. Pharmacists are in almost every community in America and typically have extended hours compared to other healthcare providers. Use our expertise and get women the care they need in the communities where they live at a time that is convenient for them.
- Centers for Disease Control and Prevention. “Factors Associated with Preterm Birth.” N.D. https://www.cdc.gov/reproductivehealth/pdfs/pretermbirth-infographic.pdf
- Sonfield A, Hasstedt K and Gold RB, Moving Forward: Family Planning in the Era of Health Reform, New York: Guttmacher Institute, 2014.
- America’s Health Rankings. “Unintended Pregnancy.” United Health Foundation. Accessed 25 Feb 2022. https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/unintended_pregnancy/state/U.S
USDHHS. Office of Disease Prevention and Health Promotion. Healthy People 2020: Topics & Objectives – Maternal, Infant, and Child Health. Accessed 28 February 2022. https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives
USDHHS. Office of Disease Prevention and Health Promotion. Healthy People 2030: Reduce preterm births – MICH-07. Accessed 28 February 2022. https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/reduce-preterm-births-mich-07
National Association of Chain Drug Stores (NACDS). Face-to-Face with Community Pharmacists. N.D. https://www.nacds.org/pdfs/about/rximpact-leavebehind.pdf
Association of American Medical Colleges. “The Complexities of Physician Supply and Demand: Projections From 2019 to 2034.” June 2021. https://www.aamc.org/media/54681/download?attachment
- Harbarger M. “Oregon pharmacists wrote 10% of all birth control prescriptions since landmark law passed.” The Oregonian/OregonLive. 15 May 2019. https://www.oregonlive.com/health/2019/05/oregon-pharmacists-wrote-10-of-all-birth-control-prescriptions-since-landmark-law-passed.html?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_source=hs_email&utm_medium=email&utm_content=72746103&_hsenc=p2ANqtz-_cqqhGdsP82IJBCO0ka-qW9ccPsaQptcPhHyGKo6nIyfEn7a0oRJuKLj1HiJreasEFwzX-AibKm7k68xPLMMatcTHziA&_hsmi=72746103