The pregnancy-related mortality ratio in the U.S. is not improving and there are considerable racial disparities.[i] Disparities in severe maternal morbidity persist even when controlling for socioeconomic status and access to prenatal care, pointing to the contribution of inequities to these disparities.[ii] Discrimination and racism occurring in the clinical and non-clinical settings can contribute to the inequities we observe in pregnancy-related mortality [iii], and are associated with worse communication, lower patient ratings of care, less adherence to treatment recommendations, and poorer overall health.[iv] Contemporary forms of racism in health care manifest in multiple ways, including stereotyping and differential treatment by providers, and lack of resources and policies that support people of color and ultimately lead to racial inequities in maternal mortality and severe maternal morbidity.[v] The elimination of inequities in pregnancy-related health outcomes is a critical piece of achieving the long-term goals of eliminating preventable maternal mortality, reducing maternal morbidity, and improving the population health of pregnant and birthing people in the U.S.
[i] Petersen, E. E., Davis, N. L., Goodman, D., Cox, S., Mayes, N., Johnston, E., Syverson, C., Seed, K., Shapiro-Mendoza, C. K., Callaghan, W. M., & Barfield, W. (2019). Vital Signs: Pregnancy-Related Deaths, United States, 2011-2015, and Strategies for Prevention, 13 States, 2013-2017. MMWR. Morbidity and mortality weekly report, 68(18), 423–429. https://doi.org/10.15585/mmwr.mm6818e1
[ii] Howell, E. A., Egorova, N. N., Janevic, T., Brodman, M., Balbierz, A., Zeitlin, J., & Hebert, P. L. (2020). Race and ethnicity, medical insurance, and within-hospital severe maternal morbidity disparities. Obstetrics & Gynecology, 135(2), 285–293. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7117864/
[iii] Howell EA. Reducing Disparities in Severe Maternal Morbidity and Mortality. Clinical Obstetrics and Gynecology. Jun 2018;61(2):387-399. doi:10.1097/GRF.0000000000000349. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7117864/
[iv] Attanasio, L., & Kozhimannil, K. B. (2015). Patient-reported Communication Quality and Perceived Discrimination in Maternity Care. Medical care, 53(10), 863–871. https://doi.org/10.1097/MLR.0000000000000411
[v] Hardeman, R. R., Kheyfets, A., Mantha, A. B., Cornell, A., Crear-Perry, J., Graves, C., Grobman, W., James-Conterelli, S., Jones, C., Lipscomb, B., Ortique, C., Stuebe, A., Welsh, K., & Howell, E. A. (2022). Developing Tools to Report Racism in Maternal Health for the CDC Maternal Mortality Review Information Application (MMRIA): Findings from the MMRIA Racism & Discrimination Working Group. Maternal and child health journal, 10.1007/s10995-021-03284-3. Advance online publication. https://doi.org/10.1007/s10995-021-03284-3