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Systems Thinking and Design Innovation: Working with Leverage Points in Rural Maternal Health Systems
This video is featured in the Systems Thinking playlist and 1 more.
Summary
Are some problems too wicked, complex, and systemic for designers to solve? The United States is experiencing a maternal health crisis—with the highest maternal mortality rate among high-income nations globally and an expanding number of counties being deemed "maternity care deserts" or areas without obstetrical services. These failures are disproportionately impacting Black and Indigenous communities, especially in rural areas. In this presentation, Meghan will share research that applies systems thinking to first-hand accounts from maternal health stakeholders to identify leverage points for design innovation. Meghan will break down leverage points using Donella Meadows' framework and discuss the power of her ultimate leverage point — paradigm shifts.
Key Insights
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The US has the highest maternal mortality among high-income nations, especially impacting Black and Indigenous communities.
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Maternity care deserts disproportionately affect rural areas, with nearly half of US counties lacking obstetric care.
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A systemic paradigm shift is needed from technocratic to more holistic maternal health models.
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Financial barriers like low reimbursement and costly malpractice insurance threaten birth centers’ viability.
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Rapid labor unit closures create urgent access crises for pregnant people in rural regions.
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Managerialism and profit-driven goals conflict with maternal safety and compassionate care.
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Information flow, including transparency of hospital closures and costs, is a crucial leverage point for systemic improvement.
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Community resilience and self-organization are key structural factors for rebuilding maternal health systems.
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Pragmatic pluralism exists in maternal health paradigms; multiple belief systems coexist with tension but no clear dominant shift.
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Design opportunities include supporting grassroots initiatives, improving data communication, and redefining system boundaries beyond hospitals.
Notable Quotes
"The US has the highest maternal mortality rate among high-income nations in the world."
"Birth centers would be replicable if reimbursement structures were adequate, but they can't survive without payment."
"What does a hysterectomy cost? $2,000, $13,000, or $40,000? It depends who you ask and who pays."
"Managerialism justifies one size fits all efficiency techniques that increase burnout and diminish professional authority."
"Paradigm shifts depend on how a problem is described and who controls the narratives and beliefs."
"Where big corporations don't want to bother, little seeds can sprout in maternal health."
"Systems that can self-organize are the strongest form of resilience."
"Maternal health is embedded within a healthcare industry prioritizing cost control, risk management, and standardization, not maternal safety."
"Information flow distortion compounds dysfunction in the system over time."
"The dominant technocratic paradigm under managerialism may be incompatible with rural maternal health needs."
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