Health Care Disparities in the COVID-19 Pandemic in the United States: A Focus on Obstetrics

Abstract

The influence of social determinants of health on disease dynamics and outcomes has become increasingly clear, making them a prime target of investigation and mitigation efforts. The obstetric population is uniquely positioned to provide insight into the health inequities exacerbated by the coronavirus disease 2019 pandemic given their susceptibility to infectious disease morbidity and frequent interactions with the health care system, which provide opportunities for ascertainment of disease incidence and severity. This review summarizes the data on disparities identified in the US obstetric population during the coronavirus disease 2019 pandemic as they relate to race and ethnicity, built environment, insurance status, language, and immigration status.

Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Women

“…Importantly, women of color were twice as likely as White women to report that a healthcare provider had ignored, refused, or delayed treatment [ 7 ], which is particularly problematic because the delayed clinical response is associated with maternal mortality [ 4 , 7 ]. Moreover, although racial disparities in birth outcomes, such as fetal deaths, stillbirths, or maternal deaths during hospitalizations, remained consistent with pre-COVID-19 levels [ 8 , 9 ], women of color reported increased challenges in access to obstetric and mental healthcare compared to White women [ 10 , 11 ]. Visitor restriction policies were more strictly enforced for women of color compared to White women, which isolated them from the social support systems that provided a source of advocacy and protection against discriminatory treatment by healthcare workers [ 12 ].…”

“…Differences in health disparities observed between minority race populations can be attributed to a myriad of historical, political, and societal factors that individuated the experiences of racism across racial and ethnic groups. For example, language barriers in patient-provider interactions contribute to reductions in healthcare delivery for patients who do not speak the majority language, conferring a unique challenge for racial groups with large immigrant populations (e.g., Latina and Asian women in the USA) [ 10 , 25 ], while policies leading to higher rates of incarceration are more specific to low-SES, Black birth outcomes [ 26 ]. In general, there is limited qualitative research on the experiences of racism for AAPI and Middle Eastern women, specifically during pregnancy and delivery.…”

The association of race and ethnicity on obstetric patients’ COVID‐19 outcomes: A summary of current literature

“…Several studies assess the impact of COVID‐19 infection on systemic complications and have found that although minority racial groups are at increased risk of COVID‐19 infection, there is no correlation with multisystem severity 53–56 . Ko et al.…”

“…Several studies assess the impact of COVID-19 infection on systemic complications and have found that although minority racial groups are at increased risk of COVID-19 infection, there is no correlation with multisystem severity. [53][54][55][56] primarily degrades Ang II to produce Ang (1-7), which when combined with MAS, antagonizes the classical ACE-Ang-II-AT 1 R pathway.…”

Social determinants of health, prenatal maternal stress, and earlier birth during the COVID‐19 pandemic

“…These disparities persisted during the COVID‐19 pandemic and may have been exacerbated among communities most disadvantaged by SDoH. For example, reports indicate that pregnant persons of color were disproportionately affected during the pandemic (Gur et al., 2020), including evidence of higher rates of infection during the pandemic's early period (Delahoy et al., 2020; Prasannan et al., 2021) and an increase in longstanding racial inequities in access to prenatal care (Emeruwa et al., 2022; Onwuzurike et al., 2020).…”