Obstetric and perinatal racial and ethnic disparities

Abstract

Purpose of reviewHealthcare disparities are health differences that adversely affect disadvantaged populations. In the United States, research shows that women of color, in particular Black and Hispanic women and their offspring, experience disproportionately higher mortality, severe maternal morbidity, and neonatal morbidity and mortality. This review highlights recent population health sciences and comparative effectiveness research that discuss racial and ethnic disparities in maternal and perinatal outcomes. Recent findingsEpidemiological research confirms the presence of maternal and neonatal disparities in national and multistate database analysis. These disparities are associated with geographical variations, hospital characteristics and practice patterns, and patient demographics and comorbidities. Proposed solutions include expanded perinatal insurance coverage, increased maternal healthcare public funding, and quality improvement initiatives/efforts that promote healthcare protocols and practice standardization. SummaryObstetrical healthcare disparities are persistent, prevalent, and complex and are associated with systemic racism and social determinants of health. Some of the excess disparity gap can be explained through community-, hospital-, provider-, and patient-level factors. Providers and healthcare organizations should be mindful of these disparities and strive to promote healthcare justice and patient equity. Several solutions provide promise in closing this gap, but much effort remains.

Emergency Contraception: Access and Challenges at Times of Uncertainty

“…144,145 These factors make it more difficult for them to get access to reproductive health resources. Even after controlling for socioeconomic factors such as education, income, or access to health care, racial and ethnic disparities have been reported for unintended pregnancies, 146,147 cervical cancer, sexually transmitted infection screening, 148,149 mental health care, 150 and obstetric and perinatal care, 151,152 and for women's ability to obtain accurate information related to general health and reproductive health on the internet. 153 A Veteran Affairs Health System's study of veteran women found that racial and ethnic disparities also extend to knowledge about contraceptives.…”

Antiemetic Administration and Its Association with Race: A Retrospective Cohort Study

“…4–8 Intraoperative anesthesia healthcare disparities have not been thoroughly investigated, and the precise contribution of anesthesiologists to these disparities is questionable; disparities identified in anesthesia procedure times, blood transfusion use, and neuraxial or regional anesthesia use cannot be conclusively attributed to the anesthesiologist’s practice patterns because patient, surgeon, and institutional preferences confound medical decision-making. 5,8–18 For instance, while previous research has found racial differences in anesthesia procedure times, these findings were attributed to interhospital and surgical duration differences. 9,10…”

“…[4][5][6][7][8] Intraoperative anesthesia healthcare disparities have not been thoroughly investigated, and the precise contribution of anesthesiologists to these disparities is questionable; disparities identified in anesthesia procedure times, blood transfusion use, and neuraxial or regional anesthesia use cannot be conclusively attributed to the anesthesiologist's practice patterns because patient, surgeon, and institutional preferences confound medical decision-making. 5,[8][9][10][11][12][13][14][15][16][17][18] For instance, while previous research has found racial differences in anesthesia procedure times, these findings were attributed to interhospital and surgical duration differences. 9,10 We previously demonstrated antiemetic administration disparities for postoperative nausea and vomiting by socioeconomic status with differences in administration by insurance status (Medicaid vs. commercially insured patients receiving less antiemetic) and by median income in patient ZIP code (lower vs. higher median income patients receiving less antiemetics).…”