Pharmacology Nov 8

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Racial Disparities in Healthcare Among Pregnant Women in the United States

Tamifer Lewis

Department of Public Health, Monroe College, King Graduate School

KG604-144: Graduate Research and Critical Analysis

Dr. Manya Bouteneff

December 4, 2022

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Racial Disparities in Healthcare Among Pregnant Women in the United States

Literature Review

Introduction to the Literature Review

Research suggests that racial disparities in healthcare among pregnant women persists in

the United States (Zhang et al., 2013). Due to this continuous occurrence, it is vital to examine

the factors that contribute to the adverse outcomes in maternal health. The literature review

contained only research articles about factors that impacted and influenced disparities in

pregnancy outcomes. Factors that were reviewed were socioeconomic status, public health

insurance, race/ethnicity, and poverty status. The literature review was conducted using EBSCO

Host and ProQuest databases from the Monroe College Library, as well as through Google

Scholar. To ensure only high-quality, secondary research, the present researcher applied the

following search parameters: research needed to have been published between 2012-2022, the

full article had to have been accessible, and each research article had to have been published in

an academic journal. The search terms used to compile pertinent articles were ‘racial disparities’,

‘maternal health’, ‘adverse pregnancy outcomes’, and ‘maternal health outcomes’.

Review of the Literature

Adverse Pregnancy Outcome Factors

Darling et al. (2021) conducted a study between 2001 and 2018 to examine the efficiency

of qualified interventions in preterm birth, small for gestational age, low birth weight, neonatal

death, cesarean deliveries, maternal care satisfaction, and coast effectiveness programs. A

systematic review was used to collect data from the United States, France, Spain, and the

Netherlands. The studies consisted of mostly non- Caucasian women from low-income

population ranging from 12 to 46 years of age and being between 20 to 32 weeks' gestation.

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Interventional programs were implemented into three categories: group prenatal care, augmented

prenatal care, or a combination of both group and augmented prenatal care (Darling et al., 2021).

The researchers found that certain interventions, such as prenatal care and augmented care, or a

combination of both, may decrease adverse outcomes in small-for-gestational-age and preterm

birth, and could aid in increasing maternal care satisfaction. Interventions that worked on

enhancing coordination of care were found to result in providing more effective cost savings.

The researchers also found disparities in the quality of access to care in the vulnerable

population. There was insufficient evidence of suitable quality to confirm that the interventions

were successful at enhancing clinical outcomes in prenatal care for at risk populations (Darling et

al., 2021).

Similar observations were made in a study conducted by Nichols and Cohen (2020),

between 2006 and 2018 to examine the methods used to improve the results of maternal

mortality in California. The study was conducted using a scoping review to evaluate research on

women and maternal health in the United States. The researchers used information from the US

Maternal Fetal Medicine Network to measure the percentage of studies where pregnant women,

women, and children were the main focus. The researchers also reviewed documentation on

healthcare policies and practices from California’s public health department, healthcare

foundation, and Maternal Quality Care Collaborative. Nichols and Cohen (2020) found that

although the health of fetus and children could be adversely affected by the health of the mother,

the majority of maternal programs in the United States places emphasis on the child. The

researchers also found four areas of concern in women health experiences, both in pre and

postnatal care. The problem areas entailed inadequate investment in women's health, inefficient

quality of care and avoidable caesarean delivers, expanding disparities in minority women and

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women living in rural areas, and contradictory collection and distribution of data (Nichols &

Cohen, 2020).

Approaches to Improving Pregnancy Outcomes

In contrast to the preceding studies, Zhang et al. (2013) conducted a study between 2005

and 2007 to calculate the excessive rate of unfavorable outcomes in pregnancy within racial and

ethnic groups. The study also aimed to measure the possibility of Medicaid savings that are

linked to paid maternal care claims resulting from the inequalities that contribute to unfavorable

maternal outcomes. A cross-sectional study using Medicaid Analytic eXtract (MAX) data was

used to gather pregnancy outcome information from inpatient hospitals from 14 states (Florida,

Alabama, Arkansas, North Carolina, Georgia, Louisiana, Kentucky, Mississippi, Maryland,

Missouri, Tennessee, South Carolina, Virginia, and Texas). The study consisted of a little over 2

million patients who were insured with Medicaid and had a delivery code of maternal delivery

stay. Zhang et al. (2013) found that, with the exception of gestational diabetes, African American

women showed the worst outcomes out of all unfavorable pregnancy outcomes. These disparities

are postulated as being multi-factorial, having causes stemming from complicated experiences

with racism, poverty, and complex healthcare interactions. It was also found that women covered

under Medicaid health insurance were more likely to have consistency in care from prenatal care

through delivery compared to their counterparts. However, due to participation in Medicaid

programs being influenced by reimbursement rates, some providers may choose to stop

accepting Medicaid patients because of reimbursement delays and low payment rates, which

could contribute to negative birth outcomes (Zhang et al., 2013).

Analysis of the Literature

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In the United States, the persistence of maternal mortality continues to be a problem area

in public health. The contributing factors that impact pregnancy outcomes persist in burdening

the U.S., leading to poor healthcare quality, and increasing health disparities. The studies used in

the literature review each used a different form of research methodology to collect data,

including systematic and scoping reviews and cross-sectional studies. Similarly, Darling et al.

(2021), Nichols and Cohen (2020), and Zhang et al. (2013) have emphasized the correlation

between race/ethnicity and financial status playing a part in influencing quality of care, access of

care, and pregnancy outcomes in pregnant minority women. To mitigate the disparities in

maternal health, Darling et al. (2021) and Zhang et al. (2013) suggested that interventions should

be inspected and geared towards determining and eradicating the racial and ethnic disparities that

affect pregnancy-related outcomes. Whereas Nichols and Cohen (2020) suggested focusing on

exploring the distinctive experiences of particular at-risk subgroups of women, such as women in

prison, who are of childbearing age, and the pregnant women who are less likely to pursue

prenatal care, such as undocumented women.

Discussion

Introduction to Discussion

There is current evidence that racial disparities in healthcare among pregnant women

continues to be a 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). According to an article published by The New York

Times (Rabin, 2019), 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. Similarly,

in a study conducted by Nichols and Cohen (2020) mounting disparities continue amid women’s

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health outcomes in the United States, primarily along lines of race and ethnicity in residents

living in urban and rural areas. These disparities directly affect African American, Alaska

Native, and Native American Women (Rabin, 2019). While the rate of maternal mortality has

dropped across the world, America's maternal health outcomes have worsened (Rabin, 2019).

Evidence-Based Recommendations

Recommendations from the Literature

To reduce the disparities among minority women different interventions have been tried.

Federal law enacted the Preventing Maternal Death Act (as cited in Rabin, 2019) providing states

with grants to explore, examine and investigate pregnancy related deaths for up to one year after

the birth of a child. Also, The American College of Obstetrics and Gynecologists created new

guidelines in treating cardiovascular disease in pregnant women (as cited in Rabin, 2019). In

2014, the Alliance for Innovation on Maternal Health (AIM) was developed by the American

College of Obstetrics and Gynecology to collaborate with partners of states and hospitals to

gather information on safety measures being taken to improve maternal health outcomes,

allowing partners to assess and track program progress (as cited in Nichols & Cohen, 2020). In

the study conducted by Nichols and Cohen (2020), two out of the various initiatives 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%. Altogether,

California's maternal mortality rate decreased by over 50% between 2006 and 2018 (Nichols &

Cohen, 2020). 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

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Program has provided support to African American women through group trainings, entailing

stress reduction, life skills development, and building social support (Nichols & Cohen, 2020).

Recommendations for Future Mitigation

Write your recommendation here using the W. 11 PPT to help you.

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References

Darling, E. K., Cody, K., Tubman-Broeren, M., & 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. (2020). 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