May 6, 2021

Maternal Health Literacy: Educating Mothers to Keep Them Safe

By Sophia Kenward, SWHR Policy and Communications Intern 

Navigating the American health care system can feel like learning a foreign language. Fluency can vary depending on the person, and some might not know the language at all. The ability to understand and successfully navigate the health care system is called health literacy. Poor health literacy is a contributing factor to health disparities and may influence maternal and infant health.  

In the United States, an estimated 700 deaths occur each year from pregnancy-related causes (which includes women who die within one year after birth from a pregnancy-related complication). American Indian/Alaska Native and Black women are 2 to 3 times more likely to die from a pregnancy-related complication than white women.  

However, three out of five maternal deaths in the U.S. are preventable, in part due to weaknesses in the health care system such as lack of access to appropriate and high-quality care, missed or delayed diagnoses, and/or lack of knowledge about warning signs among both patients and providers. More research is needed to better understand the role of health literacy in maternal mortality and morbidity and potential interventions to improve outcomes. 

Health literacy is a relatively new concept, but one of increasing interest for public health professionals. According to the Department of Health and Human Servicesthere are two kinds of health literacy. 

Individuals with low health literacy are more likely to report poorer health status, more likely to be hospitalized, and less likely to use preventative care. A number of factors can influence personal health literacy, including an individual’s socioeconomic status, educationrace and ethnicity, age, and disability. It is important to note that high levels of traditional education do not necessarily mean that an individual has adequate health literacy.  

Inadequate health literacy is more common in socially disadvantaged groups, including older adults, immigrant populations, minority populations, and low-income populations. Researchers found that nearly 72% of low-income mothers with infants were rated as having low maternal health literacy, even among mothers with high levels of traditional education. Having adequate health literacy was found to be associated with small but potentially clinically meaningful differences” in maternal outcomes, and babies born to women with low health literacy had greater odds of preterm birth before 34 weeks, small for gestational age status, and low birth weight. 

Research has shown that mothers with adequate health literacy are more likely to engage in positive behaviors that impact health outcomes. One study showed health literacy education led to increased involvement in physical and mental self-care during pregnancy. After being provided with health literacy educational sessions, mothers displayed positive changes in nutritional behavior, physical activity, prenatal care, and intake of dietary supplements. Evidence suggests that women who engage in prenatal self-care are more likely to have better health outcomes, so improving the health literacy of pregnant women could serve as a positive step toward improving maternal health 

But health literacy is not just about an individual’s abilities — organizations like doctor’s offices and hospitals have a responsibility to advance health literacy as well. The ability of health care organizations and providers to communicate clearly with their patients plays a critical role in promoting health literacy. In the health care system, patients are often presented with complex information and asked to make major decisions about their treatment or treatment of a family member. For example, new mothers are typically provided with educational materials after birth to help them know what to expect and identify potential health problems. These materials must be easily understandable and culturally appropriate to provide women with critical information about when they should seek postpartum care. 

Community-based organizations led by women of color are working to help ensure the health literacy of pregnant and postpartum women of color, given the stark racial disparities in maternal health outcomes in the U.SIncreased grant funding for health literacy and education programs at these organizations could help assist mothers in making informed choices about their health careFor example, the Kira Johnson Act — part of the Momnibus legislation endorsed by SWHR — would provide funding for community-based organizations that “promote evidence-based health literacy and pregnancy, childbirth, and parenting education for pregnant and postpartum individuals.” 

Health literacy is a crucial factor in a woman’s self-care and self-efficacy, and the relationship between maternal health outcomes and health literacy deserves more attention and research. Improving maternal health literacy may empower women to communicate better with their providers and take agency in decisions for the safety of themselves and their children.  

SWHR’s blog series on maternal and infant health disparities is supported by a grant from AMAG Pharmaceuticals. SWHR maintains editorial control and independence over blog content.