Racial and Ethnic Disparities in Reproductive Health Services and Outcomes, 2020

Abstract

Racial and ethnic disparities in women's health have existed for decades, despite efforts to strengthen women's reproductive health access and utilization. Recent guidance by the American College of Obstetricians and Gynecologists (ACOG) underscores the often unacknowledged and unmeasured role of racial bias and systemic racial injustice in reproductive health disparities and highlights a renewed commitment to eliminating them. Reaching health equity requires an understanding of current racial–ethnic gaps in reproductive health and a concerted effort to develop and implement strategies to close gaps. We summarized national data for several reproductive health measures, such as contraceptive use, Pap tests, mammograms, maternal mortality, and unintended pregnancies, by race–ethnicity to inform health-equity strategies. Studies were retrieved by systematically searching the PubMed (2010–2020) electronic database to identify most recently published national estimates by race–ethnicity (non-Hispanic Black or African American, Hispanic or Latinx, and non-Hispanic White women). Disparities were found in each reproductive health category. We describe relevant components of the Affordable Care Act (ACA) and the Preventing Maternal Deaths Act, which can help to further strengthen reproductive health care, close gaps in services and outcomes, and decrease racial–ethnic reproductive health disparities. Owing to continued diminishment of certain components of the ACA, to optimally reach reproductive health equity, comprehensive health insurance coverage is vital. Strengthening policy-level strategies, along with ACOG's heightened commitment to eliminating racial disparities in women's health by confronting bias and racism, can strengthen actions toward reproductive health equity.

Racism and the Reproductive Health Experiences of U.S.-Born Black Women

“…[18][19][20][21][22] Demands persist for increased research examining the effects of racism on reproductive health. 16,[23][24][25][26] Our aim was to explore U.S. Black women's lived experiences of racism and the associated effects on reproductive health decisions and the reproductive health care experience.…”

Contraceptive use among cisgender women with bacterial sexually transmitted infections: A cross-sectional study

“…24 The American College of Obstetricians and Gynecologists recommends several policy and programmatic strategies to help address racial disparities around contraception including removing cost barriers, increasing access via pharmacist training, expanding Medicaid to strengthen health insurance access, and improving patient-centered shared decision making for contraceptive counseling. 25 Since this study did not ascertain the reasons behind contraceptive method choice of these women, we cannot conclude which factors may have influenced participants’ specific choices. Given these observed differences, additional efforts are urgently needed to ensure that all women who would like to use contraception are informed and empowered to do so.…”

More than grit: growing and sustaining physician-scientists in obstetrics and gynecology

“…32e37 This is particularly important in the field of obstetrics and gynecology, where persistent inequities in representation, compensation, academic advancement, and health outcomes exist. 12,38,39 In this section, we focus on a few salient DEI issues that impact the development and retention of early stage investigators in obstetrics and gynecology. We use "underrepresented in medicine" to refer broadly to the groups and people with intersectional identities who are impacted by systemic racism, bias, and discrimination, including underrepresented racial/ ethnic groups, people who identify as women or transgender, members of the LGBTQþ community, people with disabilities, and others.…”