Maternal health innovations in the United States: A scoping review of implementation approaches, equity integration, and scaling factors.

BACKGROUND

The United States maternal health crisis persists as a public health emergency characterized by high mortality rates and stark racial disparities. These disparities reflect structural racism and intersecting social inequities operating simultaneously across multiple systems.

PURPOSE: This scoping review maps maternal health innovations implemented in the United States from 2017 to 2025, examining equity integration, implementation approaches, and scalability through structural racism, intersectionality, and RE-AIM frameworks.

METHODS

A scoping review was conducted following PRISMA-ScR guidelines and JBI methodology. Systematic searches of PubMed/MEDLINE, CINAHL Plus, PsycINFO, and grey literature were performed from April through August 2025. Two independent reviewers screened records; a third reviewer resolved disagreements. Quality assessment used the Mixed Methods Appraisal Tool.

DISCUSSION: Fourteen studies across six categories were identified: Digital Health and Telehealth (n = 4, 29%), Clinical Quality Improvement (n = 2, 14%), Community Workforce Development (n = 2, 14%), Social Determinants of Health (n = 2, 14%), Policy and Payment Reform (n = 2, 14%), and Communication and Mental Health Access (n = 2, 14%). All retrieved innovations incorporated explicit equity considerations targeting Medicaid populations, racial and ethnic minorities, and safety-net communities. Nine innovations (64%) achieved scaled implementation; sustainability was strongest among policy-institutionalized and cost-effective interventions. The equity integration finding reflects characteristics of the equity-focused literature retrieved rather than a field-wide empirical claim. Critical scaling factors include infrastructure capacity, policy alignment, sustainable funding, and demonstrated cost-effectiveness.

CONCLUSION

Nurses are positioned to lead equity-centered maternal health innovation and advance the dismantling of structural determinants driving persistent racial disparities in maternal outcomes across the United States.