Society for Maternal-Fetal Medicine Consult Series #62: Best practices in equitable care delivery–Addressing systemic racism and other social determinants of health as causes of obstetrical disparities

Greenberg, Mara; Gandhi, Manisha; Davidson, Christina; Carter, Ebony B.

doi:10.1016/j.ajog.2022.04.001

Cited by 25 publications

(16 citation statements)

References 114 publications

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“…Notably absent in our review were identified barriers of systemic racism. Systemic racism has been identified as a fundamental cause of health inequities 29–31 . Although systemic racism was not specified verbatim in identified themes of these studies or explicitly in patient narratives, it is clear that systemic racism is the root cause of many stated physician/provider-associated, patient-associated, and system-associated barriers to care.…”

Section: Discussionmentioning

confidence: 99%

Barriers to Urogynecologic Care for Racial and Ethnic Minority Women: A Qualitative Systematic Review

Ackenbom

Carter-Brooks

Soyemi

et al. 2023

UROGC

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ImportanceStudies have sought to evaluate factors that have perpetuated disparities in health care, including urogynecologic care. However, there remains a lack of understanding of barriers to care specific to racial/ethnic minority populations.ObjectivesWe aimed to report identified barriers to urogynecologic care (eg, care for symptoms/diagnoses of urinary incontinence [UI], accidental bowel leakage [ABL], and pelvic organ prolapse [POP]) for underrepresented racial and ethnic minority (URM) women in the United States.Study DesignWe conducted a systematic search for studies through 5 electronic bibliographic databases. Inclusion criteria for eligible studies included the following: (1) studies reporting barriers to care for those with urogynecologic symptoms/diagnoses, (2) publication date year 2000 or later. Exclusion criteria included study cohorts with children, exclusively non-U.S. populations, cohorts without URM participants, and studies without qualitative research methodology. Study methodology, characteristics, as well as barriers and facilitators to urogynecologic care were captured using a thematic synthesis approach.ResultsThere were 360 studies identified. Twelve studies met criteria: 6 had study populations with UI, 3 with POP, 2 on UI and/or POP, and 1 on ABL. There were 7 focus group studies (total 44 groups, n = 330), 4 interview studies (total 160 interviews, n = 160), and 1 had both (10 interviews, 6 groups, n = 39). Most studies reported on patient-associated barriers (n = 10/12) and physician/provider-associated barriers (n = 10/12), whereas only half reported system-associated barriers (n = 6/12).ConclusionIdentified barriers to urogynecologic care for URM populations were examined. Findings likely do not fully reflect barriers to urogynecologic care for URM populations. Comprehensive evaluation of social determinants of health and systemic racism within studies is needed to understand the unique barriers present for racially/ethnically diverse populations.

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Section: Discussionmentioning

confidence: 99%

Barriers to Urogynecologic Care for Racial and Ethnic Minority Women: A Qualitative Systematic Review

Ackenbom

Carter-Brooks

Soyemi

et al. 2023

UROGC

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“…Significant racial, ethnic, and socioeconomic disparities in maternal and infant morbidity and mortality exist in the US, largest between non-Hispanic Black (hereafter, Black) and non-Hispanic White (hereafter White) individuals . To reverse the trend of maternal and infant health inequities, strategies are needed that are acceptable to populations most impacted by disparities with the potential to mitigate the effects of racism, improve care access and quality, address social determinants of health, expand access to resources, and, ultimately, improve health outcomes . Increasing access to home visiting (HV) has been widely recommended to improve maternal and infant health and service utilization to reduce disparities .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] To reverse the trend of maternal and infant health inequities, strategies are needed that are acceptable to populations most impacted by disparities with the potential to mitigate the effects of racism, improve care access and quality, address social determinants of health, expand access to resources, and, ultimately, improve health outcomes. [6][7][8] Increasing access to home visiting (HV) has been widely recommended to improve maternal and infant health and service utilization to reduce disparities. 9 However, reaching, engaging, and maintaining Black and Hispanic Medicaid-insured pregnant individuals in HV, who are at greater health and social risk, remains a challenge 10 and studies of well-established evidence-based HV models have shown mixed effects, if any, for birth outcomes.…”

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confidence: 99%

Community Health Worker Home Visiting, Birth Outcomes, Maternal Care, and Disparities Among Birthing Individuals With Medicaid Insurance

et al. 2023

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ImportanceHome visiting is recommended to address maternal and infant health disparities but is underused with mixed impacts on birth outcomes. Community health workers, working with nurses and social workers in a combined model, may be a strategy to reach high-risk individuals, improve care and outcomes, and address inequities.ObjectiveTo assess the association of participation in a home visiting program provided by community health workers working with nurses and social workers (Strong Beginnings) with adverse birth outcomes and maternal care vs usual care among birthing individuals with Medicaid.Design, Setting, and ParticipantsThis retrospective, population-based, propensity score matching cohort study used an administrative linked database, including birth records and Medicaid claims, linked to program participation. The Strong Beginnings program exposure took place in 1 county that includes the second largest metropolitan area in Michigan. Study participants included primarily non-Hispanic Black and Hispanic Strong Beginnings participants and all mother-infant dyads with a Medicaid-insured birth in the other Michigan counties (2016 through 2019) as potential matching nonparticipants. The data were analyzed between 2021 and 2023.ExposureParticipation in Strong Beginnings or usual care.Main Outcomes and MeasuresPreterm birth (less than 37 weeks’ gestation at birth), very preterm birth (less than 32 weeks’ gestation), low birth weight (less than 2500 g at birth), very low birth weight (less than 1500 g), adequate prenatal care, and postnatal care (3 weeks and 60 days).ResultsA total of 125 252 linked Medicaid-eligible mother-infant dyads (mean age [SD], 26.6 [5.6] years; 27.1% non-Hispanic Black) were included in the analytical sample (1086 in Strong Beginnings [mean age (SD), 25.5 (5.8) years]; 124 166 in usual prenatal care [mean age (SD), 26.6 (5.5) years]). Of the participants, 144 of 1086 (13.3%) in the SB group and 14 984 of 124 166 (12.1%) in the usual care group had a preterm birth. Compared with usual prenatal care, participation in the Strong Beginnings program was significantly associated with reduced risk of preterm birth (−2.2%; 95% CI, −4.1 to −0.3), very preterm birth (−1.2%; 95% CI, −2.0 to −0.4), very low birth weight (−0.8%; 95% CI, −1.3 to −0.3), and more prevalent adequate prenatal care (3.1%; 95% CI, 0.6-5.6), postpartum care in the first 3 weeks after birth (21%; 95% CI, 8.5-33.5]), and the first 60 days after birth (23.8%; 95% CI, 9.7-37.9]).Conclusions and RelevanceParticipation in a home visiting program provided by community health workers working with nurses and social workers, compared with usual care, was associated with reduced risk for adverse birth outcomes, improved prenatal and postnatal care, and reductions in disparities, among birthing individuals with Medicaid. The risk reductions in adverse birth outcomes were greater among Black individuals.

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“…Racism in health care has resulted in negative experiences during pregnancy and childbirth for women who identify as races other than White (AWHONN, 2021b; Bernstein, 2022; Craft-Blacksheare & Kahn, 2022; Janevic et al, 2020; McLemore et al, 2018; Society for Maternal-Fetal Medicine et al, 2022; Taylor, 2020). Cultural stereotypes sometimes prevent skin-to-skin care during cesarean birth being offered to some women (Finigan & Long, 2014; Koopman et al, 2016).…”

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confidence: 99%

“…Positive birth experiences occurred when Black mothers felt they had an advocate, someone who could help them navigate their care, while supporting their wants and wishes (OjiNjideka Hemphill et al, 2023). Structural racism and implicit bias have been shown to be contributing factors to higher mortality rates among Black mothers (AWHONN, 2021b; OjiNjideka Hemphill et al, 2023; Society for Maternal-Fetal Medicine et al, 2022).…”

mentioning

confidence: 99%

Skin-To-Skin Contact During Cesarean Birth in the United States over the Last Decade

Junk-Wilson,

King,

Murphy

et al. 2024

McN: The American Journal of Maternal/Child Nursing

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Purpose: To assess skin-to-skin contact during cesarean birth, including incidence and maternal characteristics. Study Design and Methods: A cross-sectional, retrospective study using survey methods was conducted. Women who had a cesarean birth within the last 10 years prior to January 2022 were recruited via social media. Descriptive statistics, chi square, and binary logistic regression analyses were calculated. Results: There were 2,327 participants, of which 29.7% experienced skin-to-skin contact during their cesarean birth. This was reported to be less often than desired. Significant associations were found among skin-to-skin contact during cesarean birth and planned cesarean birth, previous cesarean birth, maternal age, level of education, and birth region. Previous vaginal birth and race were not significantly associated with skin-to-skin contact during cesarean birth. Most (93.65%) respondents identified as White. Barriers to skin-to-skin contact during cesarean birth may be birth region, unplanned or emergency cesarean births, younger age, lacking a college degree, and lack of previous cesarean births. Clinical Implications: There are differences in incidence and access to skin-to-skin contact during cesarean birth. Our findings emphasize the continued need to address disparities in care, increase maternal health care equity, and make skin-to-skin contact during cesarean birth available for all women who desire it.

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Society for Maternal-Fetal Medicine Consult Series #62: Best practices in equitable care delivery–Addressing systemic racism and other social determinants of health as causes of obstetrical disparities

Cited by 25 publications

References 114 publications

Barriers to Urogynecologic Care for Racial and Ethnic Minority Women: A Qualitative Systematic Review

Barriers to Urogynecologic Care for Racial and Ethnic Minority Women: A Qualitative Systematic Review

Community Health Worker Home Visiting, Birth Outcomes, Maternal Care, and Disparities Among Birthing Individuals With Medicaid Insurance

Skin-To-Skin Contact During Cesarean Birth in the United States over the Last Decade

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