Perceived racism or racial discrimination and the risk of adverse obstetric outcomes: a systematic review

Abstract

BACKGROUND: Racial disparities are differences among distinct subgroups of the human species; biologically, there are no scientifically proven reasons for them to exist. OBJECTIVE: To assess the impact of racism or racial discrimination on obstetric outcomes. DESIGN AND SETTING: Systematic review conducted at a tertiary/academic hospital. METHODS: The Cochrane Library, SCOPUS/EMBASE, PubMed, Web of Science and ClinicalTrials.gov databases were searched from inception to June 2020. Studies presenting any type of racial discrimination, or any manifestation of racism that was perceived by women of any age in an obstetric scenario were included. Studies that only assessed racial disparities without including direct racism were excluded. The secondary outcomes evaluated included quality of antenatal care, intra and postpartum care, preterm birth and birthweight. The Risk of Bias In Non-randomized Studies -of Interventions (ROBINS-I) scale was used to assess the quality of evidence from non-randomized studies. RESULTS: A total of 508 records were retrieved and 29 were selected for qualitative synthesis. No meta-analysis could be performed due to the high heterogeneity across studies. Perceived racism was associated as a risk factor in 7/10 studies focusing on pregnancy and postpartum maternal outcomes, five studies on preterm birth, one study on small for gestational age and two studies on low birthweight. Overall, among the 29 studies, the risk of bias was classified as moderate. CONCLUSIONS: Perceived racism presented an association with poor obstetric outcomes. Anti-racist measures are needed in order to address the problems that are causing patients to perceive or experience racism.

Disparities in Postpartum Care Visits: The Dynamics of Parental Leave Duration and Postpartum Care Attendance

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Impact of sex, race, and social determinants of health on neonatal outcomes

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“…From our expanded perspective, quaternary prevention is concerned with mitigating or avoiding adverse outcomes resulting from an individual's interface with the system of health care and social services, such as from obstetric racism resulting in inequities in birth and birthing person outcomes. 44,45 Quaternary prevention activities directly address the issue of equity, viewing the role of the system of care itself as causative in reinforcing or mitigating adversities and introducing protective factors. Health equity "... is achieved when every person has the opportunity to attain [their] health potential, and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances".…”

“…From our expanded perspective, quaternary prevention is concerned with mitigating or avoiding adverse outcomes resulting from an individual’s interface with the system of health care and social services, such as from obstetric racism resulting in inequities in birth and birthing person outcomes. 44 , 45 …”