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Racial Disparities in Healthcare among Pregnant Women in the United States

Tamifer Lewis

Department of Public Health, Monroe College, King Graduate School

KG604-144: Graduate Research and Critical Analysis

Dr. Manya Bouteneff

December 4, 2022

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Literature Review

Introduction to the 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 the 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

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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).

Similar observations were made in a study conducted by Nichols and Cohen (2020),

between 2006 and 2018 to examine the methods used to improve the results of maternal

mortality in California. The study was conducted using a scoping review to evaluate research on

women and maternal health in the United States. The researchers used information from the US

Maternal Fetal Medicine Network to measure the percentage of studies where pregnant women,

women, and children were the main focus. The researchers also reviewed documentation on

healthcare policies and practices from California’s public health department, healthcare

foundation, and Maternal Quality Care Collaborative. Nichols and Cohen (2020) found that

although the health of fetus and children could be adversely affected by the health of the mother,

the majority of maternal programs in the United States places emphasis on the child. The

researchers also found four areas of concern in women health experiences, both in pre and

postnatal care. The problem areas entailed inadequate investment in women's health, inefficient

quality of care and avoidable caesarean delivers, expanding disparities in minority women and

women living in rural areas, and contradictory collection and distribution of data (Nichols &

Cohen, 2020).

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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 the 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

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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.

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References

Darling, E. K., Cody, K., Tubman-Broeren, M., & 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

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+.

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