Beyond access, proximity to care, and healthcare use: sustained racial disparities in perinatal outcomes due to marginalization-related diminished returns and racism

Abstract

In the most recent issue of the Journal of Pediatric Nursing: Nursing Care of Children and Families, Thurston, Fields, and White attempted to answer a pressing question: “Does increasing access to prenatal care reduce racial disparities in birth outcomes?” ( Thurston, Fields and White, 2021 Thurston H. Fields B.E. White J. Does increasing access to prenatal care reduce racial disparities in birth outcomes?. Journal of Pediatric Nursing: Nursing Care of Children and Families. 2021; 59: 96-102https://doi.org/10.1016/j.pedn.2021.01.012 Google Scholar ). This research question is of high interest because large racial disparities in perinatal outcomes ( MacDorman and Kirmeyer, 2009 MacDorman M.F. Kirmeyer S. Fetal and perinatal mortality: United States, 2005. 2009 Google Scholar ) have sustained over time ( Roberts, Reither and Lim, 2019 Roberts M.T. Reither E.N. Lim S. Contributors to Wisconsin’s persistent black-white gap in life expectancy. BMC Public Health. 2019; 19: 891https://doi.org/10.1186/s12889-019-7145-y Google Scholar ) despite previous attempts to reduce them ( Brown Speights et al., 2017 Brown Speights J.S. Goldfarb S.S. Wells B.A. Beitsch L. Levine R.S. Rust G. State-level progress in reducing the black–White infant mortality gap, United States, 1999–2013. American Journal of Public Health. 2017; 107: 775-782 Google Scholar ). The paper's paradoxical result invites us to think more deeply about the role that racism-related diminished returns ( Assari and Caldwell, 2021 Assari S. Caldwell C.H. Racism, diminished returns of socioeconomic resources, and black middle-income Children’s health paradox. JAMA Pediatrics. 2021; https://doi.org/10.1001/jamapediatrics.2021.3277 Google Scholar ) may play as a contributing factor to such a pervasive Black-White gap in perinatal outcomes ( Dominguez, 2008 Dominguez T.P. Race, racism, and racial disparities in adverse birth outcomes. Clinical Obstetrics and Gynecology. 2008; 51: 360-370 Google Scholar ).