Racial Disparities In Maternal Mortality Research Articles

The Future of Disparities Research in Obstetric Anesthesia

(Can J Anaesth. 2023;70(6):936–941) In recent years, the stark racial disparities in maternal mortality have captured headlines, causing deep concern, particularly within minority communities. Black patients face a significantly higher risk of peripartum death compared with their White counterparts. As a Black female obstetric anesthesiologist practicing at a prominent academic center, the author has engaged in numerous conversations with Black patients who are fearful of these troubling statistics. The study conducted by Lee and colleagues, focusing on racial and ethnic disparities in obstetric anesthesia, is a significant step toward empowering clinicians with the knowledge needed to address this issue.

The Racial Disparities in Maternal Mortality and Impact of Structural Racism and Implicit Racial Bias on Pregnant Black Women: A Review of the Literature.

The maternal mortality rate (MMR) in the United States (USA) continues to increase despite medical advances and is exacerbated by stark racial disparities. Black women are disproportionately affected and are three times more likely to experience a pregnancy-related death (PRD) compared to Non-Hispanic White (NHW) women. A literature review was conducted to examine the racial disparities in the United States' MMR, specifically among pregnant Black women. PubMed and key organizations (World Health Organization, Center for Disease Control and Prevention, American College of Obstetricians and Gynecologists, Alliance for Innovation on Maternal Health, Association of American Medical Colleges, U.S. Census Bureau, and U.S. Congress) were searched for publications after 2014. Forty-two articles were reviewed to identify the role of structural racism, implicit biases, lack of cultural competence, and disparity education on pregnant Black women. This review highlights that maternal health disparities for Black women are further impacted by both structural racism and racial implicit biases. Cultural competence and educational courses targeting racial disparities among maternal healthcare providers (MHCP) are essential for the reduction of PRDs and pregnancy-related complications (PRC) among this target population. Additionally, quality and proper continuity of care require an increased awareness surrounding the risk of cardiovascular diseases for pregnant Black women. The surging MMR for Black women is a public health crisis that requires a multi-tiered approach. Interventions should be implemented at the provider and healthcare institution level to dismantle implicit biases and structural racism. Improving patient-provider relationships through increased cultural competency and disparity education will increase patient engagement with the maternal healthcare (MHC) system.

Racial and Ethnic Disparities in Maternal Treatment and Death: Evaluating the Role of Hospital and Physician Effects

Past work has documented disparities in medical treatment and health outcomes across racial and ethnic groups.  In some instances, disparities persist beyond individual health risk factors and reveal underlying differences in the hospital facilities or the attending physicians that different patients tend to go to.  In the case of maternal mortality and cesarean delivery, not only does the U.S. perform poorly on both measures, but also there exist racial and ethnic disparities in maternal treatment that lead to disadvantaged outcomes for vulnerable populations.  By separately absorbing hospital and physician fixed effects, the contribution of both facility and practitioner variation to the present health disparities can be identified.  Hospital variation maps to a significant portion of the racial disparity in cesarean delivery and the ethnic disparity in the induction of labor.  Controlling for physician fixed effects explains some portion of the racial disparities in maternal mortality and cesarean delivery, all of the ethnic disparity in cesarean delivery, and some of both disparities in the induction of labor.  These results suggest ample opportunities for targeted intervention to minimize the variation between physicians and hospitals in their approach to maternal care toward more equitable care provision.

Community and Systems Contributors and Strategies to Reduce Racial Inequities in Maternal Health in the Deep South: Provider Perspectives.

Black pregnant individuals in Alabama are disproportionately affected by severe maternal morbidity and mortality (SMM). To understand why racial disparities in maternal health outcomes persist and identify potential strategies to reduce these inequities, we sought perspectives from obstetric health care providers, health administrators, and members of local organizations who provide pregnancy, delivery, and postpartum care services in Alabama. We conducted qualitative in-depth interviews with stakeholders (n=20), purposively recruited from community-based organizations, clinical settings, government organizations, and academic institutions. Interview guides were based on Howell's conceptual model of pathways to racial disparities in maternal mortality. Data were coded using a modified framework theory approach and analyzed thematically. Racism, unjust laws and policies, and poverty/lack of infrastructure in communities emerged as major themes contributing to racial disparities in maternal health at the community and systems levels. Inadequate health insurance coverage was described as a strong driver of the disparities. Service providers suggested strategies for Alabama should be community focused, evidence based, and culturally sensitive. These should include Medicaid expansion, expanded parental leave, and removal of laws restricting choice. Community- and systems-level interventions should include community infrastructure improvements, choice in maternity services, and provision of digital communication options. Providers shared perspectives on community and structural areas of intervention to reduce racial inequities in SMM. These results can inform discussions with health system and community partners about Alabama and other Deep South initiatives to improve maternal health outcomes in black communities.

A conceptual understanding of the impact of interconnected forms of racism on maternal hypertension through Black Women’s lived experiences

RationaleSignificant racial disparities in maternal mortality and morbidity rates in the U.S. have persisted over time, with Black women disproportionately bearing the burden. Studies have documented how experiences of structural racism contributes the disparities we see. However, most of these studies have focused on how domains of racism operate simultaneously, yet little is known about how these domains are interconnected and adversely impact health during pregnancy for Black women. To address this gap in the literature, this study explored how various domains of racism interconnect to shape Black women's lived experience during pregnancy, with a particular focus on factors maternal hypertension. MethodsUsing a Charmaz grounded theory approach, this study presents qualitative findings from focus groups with Black women living in Greater New Haven, Connecticut and conducted between August 2020 and October 2020. ResultsWe identified five domains of racism and four ways these domains interconnect. These findings highlight the multidimensional nature of structural racism and the ways interconnected marginalization across domains creates novel pathways that adversely impact health. ConclusionsOur results show how institutions interact at various levels to create distinct health barriers for Black women that need to be addressed through holistic policies and interventions. To truly dismantle structural racism, we must attend to the underlying ideologies that allow these inequities in resources and opportunities to continue, especially capitalism and white supremacy. As we continue to challenge these larger ideologies, policy is a key tool to mitigate the health harms caused by structural racism.

Black Women’s Maternal Health: Insights From Community Based Participatory Research in Newark, New Jersey

This study on Black women’s maternal health engaged a group of six community members in a community based participatory research project in a state with one of the largest racial disparities in maternal mortality and severe maternal morbidity in the United States. The community members conducted 31 semi-structured interviews with other Black women who had given birth within the past 3 years to examine their experiences throughout the perinatal and post-partum period. Four main themes emerged: (1) challenges related to the structure of healthcare, including insurance gaps, long wait times, lack of co-location of services, and financial challenges for both insured and uninsured people; (2) negative experiences with healthcare providers, including dismissal of concerns, lack of listening, and missed opportunities for relationship building; (3) preference for racial concordance with providers and experiences with discrimination across multiple dimensions; and (4) mental health concerns and lack of social support. CBPR is a research methodology that could be more widely deployed to illuminate the experiences of community members in order to develop solutions to complex problems. The results indicate that Black women’s maternal health will benefit from multi-level interventions with changes driven by insights from Black women.

Stakeholder Perspectives on Racial Disparities in Maternal Mortality and Morbidity in Alabama

Through interviews with providers and other professionals in maternity health care, our team sought to identify multi-level determinants of maternal health disparities and factors that contribute to sub-optimal maternal outcomes for Black women in Alabama. Black women are three times more likely to die from pregnancy-related causes than White women. AL has the third worst maternal mortality ratio in the US.

Examining the Role of Psychosocial Influences on Black Maternal Health During the COVID-19 Pandemic.

IntroductionDue to the disproportionate impact of COVID-19 on communities of color, racial disparities in maternal mortality and morbidity are likely to increase. However, neighborhood and social support factors have yet to be discussed as potential mechanisms by which COVID-19 can exacerbate racial disparities.MethodsWe examined literature on the role of neighborhood factors and social support on maternal health outcomes and provided analytical perspective on the potential impacts of COVID-19 on Black birthing people.ResultsEven prior to the pandemic, Black individuals were disproportionately impacted by psychosocial stress. However, the compounding effect of pre-existing and current pandemic psychosocial stressors may be a mechanism by which racial disparities are exacerbated and result in higher rates of maternal mortality and morbidity in Black women.ConclusionWe recommend continued monitoring of data related to racial disparities in maternal mortality and morbidity throughout the pandemic. Given that Black women may be disproportionately impacted by psychosocial stress, it is necessary for leadership structures and communities to recognize the potential for worsening disparities and intervene.

The disproportionate burdens of the mifepristone REMS

Of the people who need abortion care in the United States every year, 75% are poor or living on low-incomes and approximately 60% are Black, Indigenous, and other people of color [1]. Black, Indigenous, and other people of color face profound inequities in accessing essential health care as a result of a long history of systemic racism and discrimination [2]. Accessing abortion is no different. Further, due to the stark racial disparities in maternal mortality and morbidity in the United States, Black and Indigenous people who cannot access the abortion care they need confront unconscionably elevated risks in carrying a pregnancy to term [3–5].

Dissenting Statement and Rebuttal of Commissioner Gail L. Heriot in U.S. Commission on Civil Right Report: Racial Disparities on Maternal Health

On September 15, 2021, the U.S. Commission on Civil Rights published a report entitled Racial Disparities in Maternal Health (the “Report”). This Dissenting Statement and Rebuttal (the “Statement”) is a part of that report. Among other things, the Statement points out several errors in Report. For example, the Report incorrectly states that maternal mortality has increased 50% over the last generation. What has actually happened is that changes in death certificates have caused more deaths to be classified as maternal in nature. The Report also emphasizes the theory that racism plays a prominent role in causing racial disparities in maternal mortality. The Statement points out in response that maternal mortality rates for Hispanic and Asian American mothers are lower than the rate for white mothers. This tends to detract from the theory that racism is what’s causing the disparities.

Let COVID-19 Serve as a Catalyst to Fix National Crisis of Poor Maternal Mortality Data.

Let COVID-19 Serve as a Catalyst to Fix National Crisis of Poor Maternal Mortality Data.

Expected Surge in Maternal Mortality and Severe Morbidity among African-Americans in the Era of COVID-19 Pandemic.

Prior to the COVID-19 pandemic, African-American mothers were three times as likely to die from pregnancy-related causes compared to white mothers. The impact of the pandemic among African-Americans could further worsen the racial disparities in maternal mortality (MM) and severe maternal morbidity (SMM). This study aimed to create a theoretical framework delineating the contributors to an expected rise in maternal mortality (MM) and severe maternal morbidity (SMM) among African-Americans in the era of the COVID-19 pandemic due to preliminary studies suggesting heightened vulnerability of African-Americans to the virus as well as its adverse health effects. Rapid searches were conducted in PubMed and Google to identify published articles on the health determinants of MM and SMM that have been or likely to be disproportionately affected by the pandemic in African-Americans. We identified socioeconomic and health trends determinants that may contribute to future adverse maternal health outcomes. There is a need to intensify advocacy, implement culturally acceptable programs, and formulate policies to address social determinants of health.

Racial and Ethnic Disparities in Pregnancy-Related Mortality in Illinois, 2002-2015.

Background: Little is known about racial or ethnic differences in the potential preventability of pregnancy-related deaths, or the provider, systems, or patient factors associated with those deaths. Materials and Methods: This is a retrospective cohort study of pregnancy-related deaths among black, Hispanic, and white women between 2002 and 2015 in Illinois using Illinois Department of Public Health maternal mortality data. We compared the distribution of women's characteristics and calculated race- and ethnicity-specific pregnancy-related mortality ratios (PRMRs) per 100,000 live births. We describe the proportion of deaths that were determined to be potentially preventable by race and ethnicity and critical factors associated with pregnancy-related deaths by cause. Results: There were 130, 33, and 109 pregnancy-related deaths of black, Hispanic, and white women, respectively, in Illinois during the study period. Overall, black women's PRMR was nearly four times that of white women (32.6 vs. 8.9 per 100,000 live births). The PRMR for Hispanic women under 30 years was lower than for white women, but that advantage disappeared after age 30. Emboli and vascular accidents were the most common underlying cause of death overall. Over a third of deaths were potentially preventable. Provider factors, particularly delays in diagnosis and treatment and inappropriate treatment, were cited in 56.1%, 71.4%, and 50.0% of black, Hispanic, and white women's preventable deaths, respectively. Conclusion: Surprisingly, racial disparities in maternal mortality were not associated with statistically significant differences in the cause of death or class of contributing critical factors in this small, single-state analysis; further study in aggregate or pooled data with deeper qualitative assessment of individual cases is, therefore, required to understand how to narrow racial disparities in maternal outcome. If aggregate or pooled analysis showed systematic racial or ethnic differences in committee findings, it would be important to assess whether those differences were due to committee bias or other factors.

TUCKER ET AL. RESPOND

We appreciate Holtzman’s interest in our efforts to gain insight into the reasons for racial disparities in maternal mortality. The persistent 3- to 4-times greater risk of pregnancy-related mortality for Black women is the largest gap among the traditional indicators of maternal and infant health in the United States. We, too, are concerned that racial disparities also exist for infant outcomes and that they, like those for pregnancy-related mortality, remain largely unexplained. The role of stress, neuroendocrine pathways, and immune system functions are all areas of biomedical research that we hope will help us to better understand why some groups have increased risks for adverse health outcomes. In addition, as implied by Holtzman, we must make efforts to understand how biology is affected by the larger context of women’s lives. Further, while we work to identify and change factors that convey susceptibility to pregnancy complications, preterm birth, and infant mortality, it is critical to improve access and quality of care for all women and infants.

What have we learned about racial disparities in maternal mortality in Michigan

What have we learned about racial disparities in maternal mortality in Michigan

Racial disparity in infant and maternal mortality: confluence of infection, and microvascular dysfunction.

Racial disparities in infant and maternal mortality have been attributed to the unique stresses faced by Black women in the United States, but the underlying pathophysiological pathways are poorly understood. This paper reviews the literature related to potential causes of racial disparities in infant and maternal mortality. A review of the literature from 1966 to 2003 was conducted using a series of searches of Medline, obstetrical journals, and bibliographies. The review focused on potential contributing pathophysiological factors to infant and maternal mortality. Racial disparities in neonatal mortality largely result from excess rates of preterm birth, fetal growth restriction, and neonatal sepsis while racial disparities in maternal mortality reflect greater prevalence and/or severity of cardiovascular/preeclamptic complications, hemorrhage, and infection among African American women. A large body of epidemiological, placental, and pathophysiological evidence suggests that racial disparities in these disparate outcomes result from two distinct, but potentially converging, pathways: infection and vascular. Racial disparities in intrauterine infection and microvascular dysfunction during pregnancy may result from a constellation of environmental and intergenerational risk factors including psychosocial stress, douching, bottle-feeding, lead exposure, diet, intrauterine growth, and genes. Disparities in infant and maternal mortality appear to reflect a confluence of infections and microvascular dysfunction during pregnancy among African American women. Interventions that target these conditions offer promise for reducing racial disparities in these critical outcomes.