Global InformationRace and maternal health in the United States information
Maternal health outcomes differ significantly between racial groups within the United States. The American College of Obstetricians and Gynecologists describes these disparities in obstetric outcomes as "prevalent and persistent."[1] Black, indigenous, and people of color are disproportionately affected by many of the maternal health outcomes listed as national objectives in the U.S. Department of Health and Human Services's national health objectives program, Healthy People 2030.[2][3] The American Public Health Association considers maternal mortality to be a human rights issue, also noting the disparate rates of Black maternal death.[4] Race affects maternal health throughout the pregnancy continuum, beginning prior to conception and continuing through pregnancy (antepartum), during labor and childbirth (intrapartum), and after birth (postpartum).
There are multiple explanations for racial disparities in maternal health. Biological factors, such as higher rates of preexisting chronic disease prior to pregnancy, fail to fully account for differences in outcomes.[5] There is a lack of evidence to support a genetic difference between racial groups as a cause of maternal health disparities such as preterm birth.[6] Social factors, such as structural racism, have been suggested as a contributory cause of the wide racial disparities in maternal health in the United States.[7][8] Disparities in adverse pregnancy outcomes for Black women have been hypothesized to be related to higher loads of allostatic stress before and during pregnancy, epigenetic changes, and/or telomere shortening.[9] Studies of potential biomarkers of allostatic stress have failed to date to demonstrate the racial group differences seen with self-report measures.[9][10] Inequities in access and the provision of health care may also effect maternal outcomes.[5] The effects of implicit and explicit provider bias in obstetrical care has been poorly studied and may contribute to disparate outcomes.[11] The information health care providers share and how that information is presented affects the autonomy and decision-making of birthing women.[12]
Proposed interventions to reduce racial disparities in maternal health outcomes target changes at individual, health care system, and health care policy levels.[1] Some states are utilizing federal block grant money for initiatives targeting reductions in maternal morbidity and mortality for Black and Hispanic women.[13] Measurement, methodological, and ethical issues arise when using race in health outcomes research.[14][15] Recommendations for appropriate use of race as a research variable may limit use of white normative standards in the future, which can imply non-white people as being atypical.[16] Proposed alternative variables for race may be genetic ancestry, socioeconomic factors, or differential opportunities.[16]
- ^ a b "Racial and Ethnic Disparities in Obstetrics and Gynecology". www.acog.org. Retrieved 2021-05-04.
- ^ "Pregnancy and Childbirth - Healthy People 2030 | health.gov". health.gov. Retrieved 2021-04-13.
- ^ Pham, Olivia; Ranji, Usha (2020-11-10). "Racial Disparities in Maternal and Infant Health: An Overview - Issue Brief". KFF. Retrieved 2021-05-07.
- ^ "Reducing US Maternal Mortality as a Human Right". www.apha.org. Retrieved 2021-05-04.
- ^ a b Bryant, Allison S.; Worjoloh, Ayaba; Caughey, Aaron B.; Washington, A. Eugene (2010-04-01). "Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants". American Journal of Obstetrics and Gynecology. 202 (4): 335–343. doi:10.1016/j.ajog.2009.10.864. ISSN 0002-9378. PMC 2847630. PMID 20060513.
- ^ Burris, Heather H.; Wright, Clyde J.; Kirpalani, Haresh; Collins Jr, James W.; Lorch, Scott A.; Elovitz, Michal A.; Hwang, Sunah S. (January 2020). "The promise and pitfalls of precision medicine to resolve black–white racial disparities in preterm birth". Pediatric Research. 87 (2): 221–226. doi:10.1038/s41390-019-0528-z. ISSN 1530-0447. PMID 31382269. S2CID 199452590.
- ^ Liese, Kylea L.; Mogos, Mulubrhan; Abboud, Sarah; Decocker, Karen; Koch, Abigail R.; Geller, Stacie E. (2019-08-01). "Racial and Ethnic Disparities in Severe Maternal Morbidity in the United States". Journal of Racial and Ethnic Health Disparities. 6 (4): 790–798. doi:10.1007/s40615-019-00577-w. ISSN 2196-8837. PMID 30877505. S2CID 80617408.
- ^ HOWELL, ELIZABETH A.; AHMED, ZAINAB N. (January 2019). "Eight steps for narrowing the maternal health disparity gap". Contemporary Ob/Gyn. 64 (1): 30–36. ISSN 0090-3159. PMC 6822100. PMID 31673195.
- ^ a b Leimert, Kelycia B.; Olson, David M. (2020-02-01). "Racial disparities in pregnancy outcomes: genetics, epigenetics, and allostatic load". Current Opinion in Physiology. 13: 155–165. doi:10.1016/j.cophys.2019.12.003. ISSN 2468-8673.
- ^ Wallace, Maeve E.; Harville, Emily W. (2013-08-01). "Allostatic Load and Birth Outcomes Among White and Black Women in New Orleans". Maternal and Child Health Journal. 17 (6): 1025–1029. doi:10.1007/s10995-012-1083-y. ISSN 1573-6628. PMC 3504172. PMID 22833335.
- ^ Arvizo, Cynthia; Garrison, Etoi (October 2019). "Diversity and inclusion: the role of unconscious bias on patient care, health outcomes and the workforce in obstetrics and gynaecology". Current Opinion in Obstetrics and Gynecology. 31 (5): 356–362. doi:10.1097/GCO.0000000000000566. ISSN 1040-872X. PMID 31415246. S2CID 201018788.
- ^ Altman, Molly R.; Oseguera, Talita; McLemore, Monica R.; Kantrowitz-Gordon, Ira; Franck, Linda S.; Lyndon, Audrey (2019-10-01). "Information and power: Women of color's experiences interacting with health care providers in pregnancy and birth". Social Science & Medicine. 238: 112491. doi:10.1016/j.socscimed.2019.112491. ISSN 0277-9536. PMID 31434029. S2CID 201276858.
- ^ Ahn, Roy; Gonzalez, Grace P.; Anderson, Britta; Vladutiu, Catherine J.; Fowler, Erin R.; Manning, Leticia (2020-12-01). "Initiatives to Reduce Maternal Mortality and Severe Maternal Morbidity in the United States". Annals of Internal Medicine. 173 (11_Supplement): S3–S10. doi:10.7326/M19-3258. ISSN 0003-4819. PMID 33253021. S2CID 227240645.
- ^ Sue, Stanley; Dhindsa, Meenu K. (2006-08-01). "Ethnic and Racial Health Disparities Research: Issues and Problems". Health Education & Behavior. 33 (4): 459–469. doi:10.1177/1090198106287922. ISSN 1090-1981. PMID 16769755. S2CID 9216446.
- ^ Cooper, Richard S.; Nadkarni, Girish N.; Ogedegbe, Gbenga (2018-10-16). "Race, Ancestry, and Reporting in Medical Journals". JAMA. 320 (15): 1531–1532. doi:10.1001/jama.2018.10960. ISSN 0098-7484. PMID 30264132. S2CID 52878269.
- ^ a b Ioannidis, John P. A.; Powe, Neil R.; Yancy, Clyde (2021-02-16). "Recalibrating the Use of Race in Medical Research". JAMA. 325 (7): 623–624. doi:10.1001/jama.2021.0003. ISSN 0098-7484. PMID 33492329.