Racial Disparities in Healthcare Among Pregnant Women in the United States

Tamifer Lewis

Public Health, Monroe College, King Graduate School

KG604-144: Graduate Research and Critical Analysis

Dr. Manya Bouteneff

December 4, 2022

Literature Review

Research suggests that racial disparities in healthcare among pregnant women persists in the United States (Zhang et al. 2013). Due to this continuous occurrence, it is vital to examine the factors that contribute to the adverse outcomes in maternal health. The literature review contained only research articles about factors that impacted and influenced disparities in pregnancy outcomes. Factors that were reviewed were socioeconomic status, public health insurance, race/ethnicity, and poverty status. The literature review was conducted using EBSCO Host and ProQuest databases from the Monroe College Library. The search terms used to compile pertinent articles were racial disparities maternal health, adverse pregnancy outcomes, and maternal health outcomes.

Review of Literature

Adverse Pregnancy Outcome Factors

Darling et al. (2021) conducted a study between 2001 and 2018 to examine the efficiency of qualified interventions in preterm birth, small for gestational age, low birth weight, neonatal death, cesarean deliveries, maternal care satisfaction, and coast effectiveness programs. A systematic review was used to collect data from the United States, France, Spain, and the Netherlands. The studies consisted of mostly non- Caucasian women from low-income population ranging from 12 to 46 years of age and being between 20 to 32 weeks' gestation. Interventional programs were implemented into three categories: group prenatal care, augmented prenatal care, or a combination of both group and augmented prenatal care (Darling et al. 2021). The researchers found that certain interventions, such as prenatal care and augmented care, or a combination of both, may decrease adverse outcomes in small-for-gestational-age and preterm birth, and could aid in increasing maternal care satisfaction. Interventions that worked on enhancing coordination of care were found to result in providing more effective cost savings. The researchers also found disparities in the quality of access to care in the vulnerable population. There was insufficient evidence of suitable quality to confirm that the interventions were successful at enhancing clinical outcomes in prenatal care for at risk populations (Darling et al. 2021).

Approaches to Improving Pregnancy Outcomes

In contrast to the preceding studies, Zhang et al. (2013) conducted a study between 2005 and 2007 to calculate the excessive rate of unfavorable outcomes in pregnancy within racial and ethnic groups. The study also aimed to measure the possibility of Medicaid savings that are linked to paid maternal care claims resulting from the inequalities that contribute to unfavorable maternal outcomes. A cross-sectional study using Medicaid Analytic eXtract (MAX) data was used to gather pregnancy outcome information from inpatient hospitals from 14 states (Florida, Alabama, Arkansas, North Carolina, Georgia, Louisiana, Kentucky, Mississippi, Maryland, Missouri, Tennessee, South Carolina, Virginia, and Texas). The study consisted of a little over 2 million patients who were insured with Medicaid and had a delivery code of maternal delivery stay. Zhang et al. (2013) found that, with the exception of gestational diabetes, African American women showed the worst outcomes out of all unfavorable pregnancy outcomes. These disparities are postulated as being multi-factorial, having causes stemming from complicated experiences with racism, poverty, and complex healthcare interactions. It was also found that women covered under Medicaid health insurance were more likely to have consistency in care from prenatal care through delivery compared to their counterparts. However, due to participation in Medicaid programs being influenced by reimbursement rates, some providers may choose to stop accepting Medicaid patients because of reimbursement delays and low payment rates, which could contribute to negative birth outcomes (Zhang et al. 2013).

Analysis of Literature

In the United States, the persistence of maternal mortality continues to be a problem area in public health. The contributing factors that impact pregnancy outcomes persist in burdening the U.S., leading to poor healthcare quality, and increasing health disparities. The studies used in this literature review each used a different form of research methodology to collect data, including systematic and scoping reviews and cross-sectional studies. Similarly, Darling et al. (2021), Nichols and Cohen (2020), and Zhang et al. (2013) have emphasized the correlation between race/ethnicity and financial status playing a part in influencing quality of care, access of care, and pregnancy outcomes in pregnant minority women. To mitigate the disparities in maternal health Darling et al. (2021) and Zhang et al. (2013) suggested that interventions should be inspected and geared towards determining and eradicating the racial and ethnic disparities that affect pregnancy-related outcomes. Whereas Nichols and Cohen (2020) suggested focusing on exploring the distinctive experiences of particular at-risk subgroups of women, such as women in prison, who are of childbearing age, and the pregnant women who are less likely to pursue prenatal care, such as undocumented women.

References

Centers for Disease Control and Prevention. (2019, September 6). Racial and ethnic disparities continue in pregnancy-related deaths. https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html

Darling, E. K., Cody, K., Meara Tubman-Broeren, & Marquez, O. (2021). The effect of prenatal care delivery models targeting populations with low rates of PNC attendance: A systematic review. Journal of Health Care for the Poor and Underserved, 32(1), 119-136. https://www.proquest.com/scholarly-journals/effect-prenatal-care-delivery-models-targeting/docview/2507722229/se-2

Nichols, C. R., & Cohen, A. K. (2021). Preventing maternal mortality in the United States: Lessons from California and policy recommendations. Journal of Public Health Policy, 42(1), 127-144. https://doi.org/10.1057/s41271-020-00264-9

Rabin, R. C. (2019, May 8). Huge racial disparities persist in pregnancy-related deaths, and are growing. New York Times, A20(L). https://link.gale.com/apps/doc/A584694288/ITOF?u=nysl_me_moncol&sid=bookmark-ITOF&xid=b9422ff9

Zhang, S., Cardarelli, K., Shim, R., Ye, J., Booker, K. L., & Rust, G. (2013). Racial disparities in economic and clinical outcomes of pregnancy among Medicaid recipients. Maternal and Child Health Journal, 17(8), 1518+. https://link.gale.com/apps/doc/A344827866/PPNU?u=nysl_me_moncol&sid=bookmark-PPNU&xid=51747d52

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