Health literacy is relevant to maternal care in the postpartum unit where I work. A lack of knowledge in regards to newborns can result in “newborn adaption issues, neonatal feeding concerns, and neonatal health outcomes.” (Gaupšienė et al., 2023)” As nurses we must evaluate the level of knowledge the patient has about their current circumstances and educate them as needed. In addition to newborn literacy, we must also evaluate the mother’s knowledge about personal postpartum care and needs. “Maternal health literacy (MHL) is the ability of mothers to access, understand, appraise and apply information on mother and child health that contributes to reducing maternal and child mortality.” (Phommachanh et al., 2021) Having a lack of awareness about postpartum care can lead to unhealthy practices that endanger the mother and newborn.
    Evidence-based strategies that can be used to promote health literacy include creating a welcoming environment and using basic language. Creating a welcoming environment makes patients feel more comfortable. “ If patients feel welcomed and that they are being listened to, they will be more likely to ask questions and divulge more helpful information.” (How to Improve, 2024). The use of basic language makes it easier for the patient to understand what going on and feel that they are a part of their care. “Using basic language is an effective strategy for avoiding miscommunication that should be applied on a case-by-case basis, as using overly simplistic language to certain patients may cause offense.” (How to Improve, 2024) By creating a welcoming environment and using basic language, we are using strategies to promote learning and better outcomes for the mother and newborn. 
 Working in an Emergency Department has been an enlightening experience in both seeing how poorly educated the majority of the population is in addition to the misunderstanding of how the medical system works (i.e., what should be a primary care issue versus an Emergency Room visit).  Health literacy has a multi-pronged influence on this –not from just the aspect of not understanding what does or does not constitute a medical emergency– but additionally in being able to address medical concerns and issues before they require a legitimate Emergency Room visit.  One study conducted surveyed patients’ understanding of basic medical terms and unsurprisingly found that over one-third of those patients surveyed had poor health literacy in understanding basic medical terms and conditions; these patients were also three times more likely to go to the Emergency Department unnecessarily and for otherwise preventable conditions (Balakrishnan et al., 2017).  
The solution, however, is equally as complex, integrating both a mix of educational programs and penalties to prevent misuse of Emergency Departments for non-emergent conditions.  One company mandated their employees take a health literacy programs as part of their health insurance enrollment options and later found that this literacy program decreased Emergency Department visits and hospital admissions by over one-third compared to previous years when the program was not integrated (Greene et al., 2019).  This would be great for those who use any type of public or private insurance, as it would inevitably tackle the bulk of the population. However, penalizing misuse or overuse of Emergency Departments was additionally found to be impactful, with one study done showing that those who were not forced to make co-payments were more likely to abuse Emergency Departments, though even even a small co-pay upfront reduced unnecessary visits by nearly 50% (Yaremchuk, Schwartz, & Nelson, 2010). 
The empathetic part of me understandings that health literacy also correlates to generally low-income populations; however, the empathy ends when we recognized we’re faced with overcrowded hospitals and burned-out staff who might miss the real emergencies while dealing with patients who present with none.  In tandem with mandatory health literacy programs and mandatory co-pays, I’d also support Emergency Departments following the official definition, as per EMTALA, of what constitutes a medical emergency and handling possible patients appropriately with regards to this.