Maternal Health and Race: Policy Recommendations for Mitigating & Preventing Disparities

July 2020

Jan Mooney and Jodie Lisenbee

UNC Charlotte Health Psychology PhD Program

Systemic maternal healthcare disparities disproportionately affect Black women and other women of color, particularly those also experiencing socioeconomic disadvantages. Provider training and inter-agency partnerships have the potential to buffer risks and support maternal health.

 

In the context of overall limited knowledge regarding maternal health[1], racial disparities in maternal healthcare persist and heighten risk for both short- and long-term negative health outcomes that accumulate across generations [2]–[5].
  • Deaths during pregnancy up to the first year postpartum are over three times as common among Black women and more than twice as common among American Indian/Alaskan Native women in comparison to white women in the United States [2].

    • ​Between 2011 and 2016; per 100,000 live births: 42.4 deaths for Black women, 30.4 for American Indian/Alaskan Native women, 13.0 for white women.

  • Black mothers and American Indian/Alaskan Native mothers continue to be more likely than white mothers to die from pregnancy, birth, and postpartum-related health complications [3],[6].

  • Black and Latinx mothers (4% and 5%, respectively) are less likely to seek care than white mothers (9%) for postpartum mental health-related reasons, and of those who do seek care, Black and Latinx mothers are less likely to follow up or continue care [4].

Research on the factors driving these disparities highlights wide gaps in our healthcare system at both interpersonal and structural levels.
  • Structural racism, or interacting and ongoing disadvantages such as neighborhood deprivation, economic inequality, educational disparities, and differential access to and quality of healthcare, is associated with health risks such as nutritional deficiency and unhealthy environmental exposure, with dangerous implications for both mothers and children [5],[7]–[9].

  • The COVID-19 pandemic exacerbates existing racial and socioeconomic disparities in access to healthcare, resources, and buffering factors such as social support. [8],[10]

  • Racial and gender-based discrimination may result in a compounded negative impact on Black women in particular [8],[11]–[13], and are further magnified by age and education level [3].

  • Current postpartum depression screening methods may fail to recognize symptoms in socially and economically disadvantaged Black mothers [14],[15].

  • Current training for healthcare providers is oriented in a reactive (rather than proactive) manner and focuses on individual behavior change, which makes it challenging to find workable solutions within the uniquely difficult life contexts of mothers experiencing social and economic stressors [16]–[20].

Targeted provider training that addresses stereotyping, interpersonal discrimination, social determinants of health, and shared decision making has the potential to facilitate greater collaboration, increased maternal empowerment, and better health outcomes for mothers [5],[22]–[26].
  • Beyond recognizing racial disparities, acknowledging and addressing systemic causes (e.g., racism) is crucial to promote maternal health, particularly for socioeconomically and racially marginalized mothers. [21]

  • Funds could be allocated to develop and maintain clinical-community partnerships to improve access to resources for broad, long-term maternal health and well-being (e.g., occupational support, housing support, health workers such as doulas, lactation consultants) [3],[4],[22],[27].

  • Leverage private industry expertise by supporting community partnerships with healthcare firms that already provide services such as telehealth, health education resources, personalized treatment, and interdisciplinary provider networks, to improve quality of and access to maternal healthcare [28].

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Misdiagnosed, and Sick. HarperOne, 2018.

[2]   CDC, “Pregnancy mortality surveillance system: Maternal and infant health,” Feb. 04, 2020.

https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm (accessed Jul. 16, 2020).

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MMWR Morb Mortal Wkly Rep, vol. 68, no. 35, pp. 762–765, Sep. 2019, doi:10.15585/mmwr.mm6835a3.

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of intersectionalities,” Curr. Dir. Psychol. Sci., vol. 27, no. 3, pp. 176–182, 2018.

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urban mothers,” Pediatrics, vol. 125, no. 3, pp. e609-17, Mar. 2010, doi: 10.1542/peds.2008-3261.

[15] S. D. Tandon, F. Cluxton-Keller, J. Leis, H. N. Le, and D. F. Perry, “A comparison of three screening tools to

identify perinatal depression among low-income African American women,” J Affect Disord, vol. 136, no. 1–2, pp. 155–162, Jan. 2012, doi: 10.1016/j.jad.2011.07.014.

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among nulliparous women: a qualitative study of the views of obstetricians and first-time pregnant women,” BMC Pregnancy Childbirth, vol. 13, no. 1, p. 231, Dec. 2013, doi: 10.1186/1471-2393-13-231.

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pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals’ barriers and facilitators using the Theoretical Domains Framework,” Obes Rev, vol. 15, no. 6, pp. 462–86, Jun. 2014, doi: 10.1111/obr.12160.

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