Prioritize implementation research to effectively address the maternal health crisis

TO THE EDITORS: We read with great interest Chinn et al’s¹ report on the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s (NICHD) workshops to identify priorities for maternal health research. We strongly agree with their recommendation for investments in research to identify policies and practices that address unacceptably high rates of maternal morbidity and mortality in the United States and racial disparities in these outcomes. However, we note a major omission in the stated research priorities: implementation research—the scientific study of strategies to promote the effective, equitable uptake of evidence-based practices into routine care.² Implementation research seeks to shorten the large lag—estimated at 17 years—between a clinical advance and its incorporation into routine care.² Given this lag, research investments that identify effective practices will not yield population-level improvements without complementary investments in implementation research.

The need for implementation research in maternal healthcare is demonstrated by strikingly unwarranted variation. For example, a recent study reported large differences in cesarean delivery rates after induction of labor between hospitals and physicians.³ State perinatal quality improvement collaboratives are working to minimize such outcome variation by standardizing the use of evidence-based practices, but the success of such collaboratives is inconsistent. In California’s collaborative to reduce severe maternal morbidity from hemorrhage, one-third of participating hospitals did not succeed in reducing morbidity.⁴ Variability in both clinical outcomes and quality improvement success suggests that maternal health initiatives could be greatly enhanced by research identifying barriers, facilitators, and effective strategies for implementing evidence-based practices in routine care delivery in maternity settings.

The conditions are right for rapid advances in implementation research for maternal health. In such diverse fields as mental health, oncology, and surgery, research incorporating rigorous implementation frameworks and outcome measures has demonstrated success in accelerating the use of evidence-based practices in routine care. Among maternal health researchers, there is growing interest and expertise in implementation science. At the 2020 Annual Conference on the Science of Dissemination and Implementation in Health, more than 100 individuals registered to participate in a special adjunct session on maternal health. The NICHD is prepared to fund implementation research studies and capacity building through 2 implementation research program announcements and training grant mechanisms. Adding implementation research to the list of maternal health research priorities is urgently needed to ensure that evidence generated by research investments is more efficiently and effectively translated into real-world improvements for patients and communities. ■