GRCA 3 Paragraph Discussion section

Tamifer Lewis

Public Health, Monroe College, King Graduate School

KG604-144: Graduate Research and Critical Analysis

Dr. Manya Bouteneff

December 4, 2022

Discussion

There is current evidence that racial disparities in healthcare among pregnant women continues to be a problem in the United States. In an article published by The New York Times, there has been a persistence and growth in racial disparity throughout the years despite calls to take action to improve medical care access for women of color (Rabin, 2019). Similarly, in a study conducted by Nichols and Cohen (2019) mounting disparities continue amid women health outcomes in the United States, primarily among race and ethnicity and within residents living in urban and rural areas (Nichols and Cohen, 2019). These disparities directly affect African American, Alaska Native and Native American Women (Rabin, 2019). When compared to other high-income countries, the United States has substandard records in maternal health outcomes, and while the rate of maternal mortality dropped across the world, America's maternal health outcomes have worsened (Rabin, 2019).

To reduce the disparities among minority women policy changes have been made. Federal law enacted the Preventing Maternal Death Act providing states with grants to explore, examine and investigate pregnancy related deaths for up to one year after the birth of a child (Rabin, 2019). Also, The American College of Obstetrics and Gynecologists created new guidelines in treating cardiovascular disease in pregnant women (Rabin, 2019). In 2014 Alliance for Innovation on Maternal Health (AIM) was developed by the American College of Obstetrics and Gynecology to collaborate with partners of the states and hospitals to gather information on safety measures being taken to improve maternal health outcomes, allowing partners to assess and track program progress (Nichols and Cohen, 2019). In the study conducted by Nichols and Cohen (2019), two out of the various programs that California implemented were the Black Infant Health Program (BIH) and increasing the states income eligibility for pregnant women to 200% of the federal poverty level. With the implementation of these programs, mortality rates decreased from 22.1% to 8.3% in the best practices toolkit, a program developed for hemorrhage and high blood pressure during pregnancy. Altogether, California's maternal mortality rate decreased by above 50% between 2006 and 2018 (Nichols and Cohen, 2019). To prevent negative pregnancy outcomes in women of color, California used federal funds to develop programs that focused on African American mothers and the health determinants that are influenced by social and structural factors. The Black Infant Health Program provided support to African American women through group trainings, entailing of stress reduction, life skills development, and building social support (Nichols and Cohen, 2019). Nearly half of the babies born in the United States are insured under Medicaid which covers the child through the first year of life. However, in most states, Medicaid provides coverage for the mother until 60 days postpartum, after which the mother must meet the federal poverty level to be eligible for coverage (Nichols and Cohen, 2019). This exposes the mother to various risks that can adversely affect her health. Expanding Medicaid access would mitigate the maternal healthcare barriers that affect low socioeconomic minority women.

Racial disparities in maternal healthcare are a persistent problem in the United States. African American mothers experience higher adverse pregnancy outcomes and are less likely to obtain sufficient prenatal care when compared to Caucasian women (Zhang et al., 2013). Similarly, racial disparities among women of color are made worse by partialities in the healthcare that they receive (Nichols and Cohen, 2019). To mitigate racial disparities in maternal health among minority women it is important to understand the determinants that contribute to their health outcomes. With increased federal funding, programs can be geared towards providing quality care to women of color. This can be established by utilizing specific methods of care that are relatable to those being serviced in the community, providing them with medical professionals that are culturally competent and adequately trained in servicing underserved communities, fostering a trusting provider-patient relationship. Nichols and Cohen (2019) suggest that funding should be used to address the social factors that influence maternal health to reduce the psychosocial risks in women who may be more vulnerable to adverse pregnancy outcomes. The pregnancy-related risks of a mother do not end after her child's birth. The expansion of Medicaid access and coverage would provide a mother with the means of receiving adequate care during all stages of pregnancy and during the postpartum period, in which she can still be adversely affected from her pregnancy. It is vital for the federal government to enact policies requiring states to provide medical coverage to women for one year after the birth of their child. Providing coverage to various specialties would ensure the mother has efficient access to care should adverse symptoms develop. Nichols and Cohen (2019) postulated that state programs should expand Medicaid coverage for women focusing on their healthcare needs before, during and after pregnancy, paying close attention to women’s health and chronic disease management, especially to those who have or had high risk pregnancies. Implementing these programs would develop a foundation in the quality of racial maternal care across all states and provide cohesion and uniformity in the delivery of care.

References

Centers for Disease Control and Prevention. (2019, September 6). Racial and ethnic disparities continue in pregnancy-related deaths. https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html

Darling, E. K., Cody, K., Meara Tubman-Broeren, & Marquez, O. (2021). The effect of prenatal care delivery models targeting populations with low rates of PNC attendance: A systematic review. Journal of Health Care for the Poor and Underserved, 32(1), 119-136. https://www.proquest.com/scholarly-journals/effect-prenatal-care-delivery-models-targeting/docview/2507722229/se-2

Nichols, C. R., & Cohen, A. K. (2021). Preventing maternal mortality in the United States: Lessons from California and policy recommendations. Journal of Public Health Policy, 42(1), 127-144. https://doi.org/10.1057/s41271-020-00264-9

Rabin, R. C. (2019, May 8). Huge racial disparities persist in pregnancy-related deaths, and are growing. New York Times, A20(L). https://link.gale.com/apps/doc/A584694288/ITOF?u=nysl_me_moncol&sid=bookmark-ITOF&xid=b9422ff9

Zhang, S., Cardarelli, K., Shim, R., Ye, J., Booker, K. L., & Rust, G. (2013). Racial disparities in economic and clinical outcomes of pregnancy among Medicaid recipients. Maternal and Child Health Journal, 17(8), 1518+. https://link.gale.com/apps/doc/A344827866/PPNU?u=nysl_me_moncol&sid=bookmark-PPNU&xid=51747d52