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Racial Disparities in Birth Outcomes

Racial disparities, also known as ethnic disparities, have existed in health care for many decades. These disparities include women’s reproductive health and perinatal care.

Pregnancy-related mortality rates, or the maternal rate of death due to complications of pregnancy, are higher for mothers who are Black, American Indian and Alaska Natives, and Pacific Islanders than for white women. About 41 out of every 100,000 Black mothers and about 30 out of 100,000 AIAN mothers die during pregnancy, according to a Kaiser Family Foundation study, in contrast to only 13 of every 100,000 white mothers.

The disparity in maternal mortality rates grows more significant as the women age. For example, the mortality rate for Black women between the ages of 30 and 34 is more than four times higher than the rate for white women, according to a Centers for Disease Control and Prevention study.

Black infants also face birth injuries more often than white infants, according to the CDC.

What are racial disparities?

An American College of Physicians paper defines racial disparities as “racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.”

The Center for Medicare Advocacy defines it as “a difference in which disadvantaged social groups such as the poor, racial/ethnic minorities, women and other groups who have persistently experienced social disadvantage or discrimination systematically experience worse health or greater health risks than more advantaged social groups.”

Although racial discrimination may be a factor in these disparities, racial discrimination and racial disparities are different. Racial discrimination refers to treating someone unfairly based on their race.

Why do racial disparities in birth outcomes exist?

Birth outcomes are poorer for people of color for several reasons.

Access to Prenatal Care

Minority mothers are less likely than white mothers to have less access to good prenatal care. A study published in the American Journal of Public Health showed that more than half of white mothers had adequate prenatal care, as compared with only 44 percent of African American women. The lack of good prenatal care puts women of color at an increased risk for birth and delivery complications, including low birth weight and preterm birth.

Access to Health Care

In general, minority women have less access to high-quality health care than white women do. The lack of access contributes to adverse birth outcomes. Some of this access disparity occurs because of lack of good health insurance, geographic location, cultural barriers, stereotyping, and the reluctance of some cultures to see a doctor.

Women of color are more likely to be uninsured. While Medicaid will fill coverage gaps during the pregnancy and for the children, it will not insure women before they know they are pregnant. Many women also lose Medicaid coverage 60 days after delivery.

Health-care access disparity is vast when managing chronic conditions, such as heart disease. Yet cardiovascular conditions are the leading cause of pregnancy-related death among women overall, according to KFF.

Further, a study of pregnancy-related deaths from 2007 to 2016 showed that the percentage of cardiomyopathy, pulmonary embolism, and high blood pressure associated with pregnancy-related deaths was higher among Black women than among white women.

The study also showed that more pregnancy-related deaths among AIAN women were associated with hemorrhage and high blood pressure than among Black women. Many of these deaths could be prevented with better access to quality health care.

Research shows that even when minority women have access to quality health care, their providers tend to ignore them or scold or criticize them. One study showed that health care quality improved when Black physicians cared for Black patients.

Risk Factors

Black, AIAN, Native Hawaiians, and other Pacific Islanders (NHOPI) are also more likely to have risk factors that contribute to infant mortality, according to KFF. For example, preterm birth, which is birth before 37 weeks, and low birth weight, which refers to a baby weighing less than 5.5 pounds, are among the leading causes of infant mortality.

Lack of prenatal care or delayed prenatal care also increases the risk of birth complications. The percentage of preterm births, low birthweight babies, and late or no prenatal care is higher for Black, AIAN, and NHOPI women than for white women. Hispanic women are twice as likely as white women to deliver while having no prenatal care or late prenatal care.

Teen birth rates are also higher among Black, Hispanic, NHOPI, and AIAN teens when compared with white teens, although birth rates are lower for Asian teens than for white teens. Teen pregnancy is linked to an increased risk of complications during pregnancy and delivery. Teens also are less likely to receive early and regular prenatal care.

Economic and Social Factors

Economic and social factors also adversely affect women’s health and birth outcomes. These social and economic factors include less education, income, and economic stability, as well as inadequate food security, access to nutritional food, community and social context and neighborhood safety.

Systemic racism and racial discrimination can negatively affect the socioeconomic status of minority women compared with their white counterparts.

Implicit Racial Bias

Implicit racial bias is also present in the health care system, according to the CDC. This bias affects everything from patient-provider interactions to treatment decisions and, ultimately, health outcomes.

One way to improve perinatal outcomes is to make systemic and societal changes. These changes should provide a genuinely equal economic and social opportunity to women of all races. Another way to improve outcomes is to improve access to quality health care. Improving access to health care means ensuring minority women have health insurance and have quality doctors nearby. It also means improving doctors’ abilities to communicate with women from different cultures.

It may also mean having more physicians of color, especially in obstetrics, gynecology, and pediatrics. At the very least, physicians and other providers need the training to treat patients of color as well as they treat their white counterparts. The provision of women’s health education, particularly prenatal and infant health education, can also reduce racial disparities in birth outcomes.

Finally, communities need to fight against implicit racial bias by recognizing where it exists and striving to end it.