To adequately improve outcomes, clinical leaders must understand the root causes of health disparities and take appropriate actions at the system level.
Maternal health interventions are incomplete without addressing racial health disparities. That is because the U.S. maternal health crisis is, at its core, a crisis of inequity. Although all demographics are impacted by the poor performance of the U.S. in maternal health compared with other industrialized nations, women of color are disproportionately impacted. The pregnancy-related mortality rate for Black patients in the US is 3.3x the rate for white patients. For Native American patients, it’s 2.5x the rate. These trends are similar for morbidity rates. To improve outcomes, health care organizations must examine the root causes of inequities: the intersection of structural racism and sexism.
Root causes of maternal health disparities
1 Enduring legacies of institutional racism hardwired into policy, social institutions, and culture
2 Deprioritization of women's holistic health care across the life span, particularly in favor of fetal outcomes
Without an in-depth understanding of how these root causes manifest, interventions aren’t likely to make a significant or sustained impact.
The legacies of these structural underpinnings impact women of color across four levels: systemic, institutional, interpersonal, and individual.
The four ways inequities manifest in maternal health
Restricted access to highly resourced communities
For example, Native American communities have a poverty rate of 25.4%, double the national rate. Poverty has a direct impact on health outcomes, reducing the ability to afford key social goods including healthy food, safe housing, preventive care, and medication.
Insufficient access to affordable and quality clinical care
For example, Black women are more likely to deliver in lower quality hospitals with higher morbidity rates.
Provider-held implicit biases and misinformation
For example, 40% of first- and second-year medical students wrongly believe that Black people have thicker skin than white people, leading to lower pain assessments and undertreatment of pain in Black patients.
Physical impacts of chronic stress
For example, the chromosomal markers of Black women in their 40s and 50s appear 7.5 years older on average than white women’s. This “biological weathering” is attributed to psychosocial stressors stemming from the intersectional impact of racism and sexism. Weathering leads to the shortening of telomeres and early physiological deterioration.
These multifaceted and interconnected inequities are deeply embedded within the U.S. health care system. That’s why true change is so challenging. Hospitals cannot solve structural racism and sexism on their own, but they do have a role to play in reducing maternal health inequities.