Health disparities is a term used by public health officials and scholars to refer to the idea that when people are grouped into different demographic categories, their health outcomes may look different. For example, if people are grouped by income, those with lower incomes tend to have worse health outcomes due to low resources and lack of options for people with less resources in the United States. One area where health disparities are well documented is the different health care experience and outcomes faced by women of different racial/ethnic groups. In particular, maternal mortality – or death of a mother during or within a year after pregnancy – is quite different for African American women and American Indian women compared to White women and Asian American women. The reasons for these differences can often be connected to other factors – such as income, lack of education, and lack of prenatal care. However, for African American women, these differences persist even for women with higher incomes and higher education levels raising concerns structural concerns about how bias may impact their care given the historic bias that African American women have faced for centuries in the United States. A desire to address this bias and a pregnancy experience that include signs of bias led a journalist, Kimberly Seals Allers, now author, app creator and much more – to develop the iRTH App and offer a path to addressing the bias that some women face interacting with health care during their pregnancy.
Goal of iRTH App
With so many apps targeting pregnant women, a key question to ask is how is this one different from the others? The goal of the iRTH app is to provide a mobile app to Black and brown women and birthing people that helps them have a safer pregnancy and birth and provides team with tools to assist with early parenting. This vision seeks to make maternal health care more equitable and provide guidance for helping women and birthing people thrive after giving birth which can aid in more equitable outcomes for their children. The app does this in a somewhat simple, yet elegant manner. The app takes a page out of the playbook of Yelp, Google, and so many other rating services by allowing users to assess their maternal health care experiences.
Unique Approach Used by iRTH
At first glance, this appears to be duplicative of the typical rating app. However, this is where iRTH app makes a more ingenious move. The app uses the experience of mothers and birthing people to design questions and collect data on maternal health experiences that reflect the unique needs of these mothers. In that manner, it is asking questions that are not typically asked in general questionnaires. It is getting to one of the root causes of poor maternal health outcomes – identifying who, what, and where is offering a good experience of health care. By creating ratings for unique populations and offering those to individual clinics – such as obstetric//gynecology or midwife clinics – and to larger entities like health systems, iRTH app staff can help these entities better understand what they are doing well and what they are not doing well. Any poor experience of care is essentially a quality of care problem. So, iRTH app is helping individual health care clinicians and health systems improve their quality of care if they dare to use this rich source of information. When individual health care clinicians and health systems use this data, they can improve the health and wellbeing of their patients who are the people they serve and their key source of revenue and profit. So, this app is quite unique in that it empowers pregnant women and birthing people of color, seeks to reduce bias, improves quality of care when the data arising from it is utilized appropriately, and can impact the bottom line of health care businesses for the better. The app indeed turns the lemon that one woman experience into lemonade for a health care system plagued with numerous structural problems – bias and discrimination being one of the toughest to counter among these problems.
The App is Only as Good as its Users
Like many apps, iRTH depends on users to provide honest assessments of their experiences. The users can use the app for free and gain benefits from their use along with helping others at the same time. In this way, the community of black and brown pregnant woman and birthing people are helping themselves and future individuals who seek to have a positive birthing experience. An unintended benefit from this app is that it can also help women who do not identify as African American or Latino because clinicians and health systems who are providing a great experience to these women are likely to do the same for all patients.