Maternal Health Disparities ___________________________________________________________________
For example, historical economic stresses and restrictions on housing, jobs, and education have resulted in health inequali- ties for racial and ethnic minority groups. Healthy People 2030 groups social determinants of health into five categories [38]: • Economic stability
Preconception counseling and care is critical to optimizing maternal health. This includes management of chronic dis- eases, maternal and fetal screenings, and lifestyle changes. Racial and/or ethnic minority women tend to have less acces- sibility to preconception and antenatal care [37]. Closing these access and engagement gaps could help address some of the disparities in birth complications. Postnatal care is less emphasized but is a significantly important aspect of maternal care. During the eight weeks following deliv- ery, the physical and emotional needs of the mothers should be assessed, including chronic health issues or complications that developed during the gestational period (e.g., gestational diabetes, hypertension, anemia, peripartum anxiety, peripar- tum depression). Unfortunately, it is reported that 16% to 36% of women do not attend a six-week follow-up visit following birth [36]. Furthermore, those who do attend the six-week visit report insufficient care and postnatal guidance, indicat- ing a need to improve both adherence and provision of care during this period. Healthcare professionals have a responsibility to repair biased systems that perpetuate racial health disparities. The American College of Obstetricians and Gynecologists has released a statement on racism in obstetrics and gynecology that reads, in part, [41]: Racial and ethnic inequities in obstetrics and gynecology cannot be reversed with- out addressing all aspects of racism and racial bias, including sociopolitical forces that perpetuate racism. The actualization of an equitable health care system which serves all people can only occur through acknowledgment of the historical context from which modern health inequities grew, including reproductive injustices.
• Education access and quality • Health care access and quality • Social and community context • Neighborhood and built environment
These factors have a major impact on people’s health, well- being, and quality of life. Social determinants contribute to maternal outcomes; however, they do not fully explain the large number of women of racial and ethnic backgrounds having higher than average maternal morbidity and mortality rates [37]. Implicit biases have been directly linked with lesser quality of care for certain patients, particularly those of minority groups. In some cases, this lower quality of care is triggered by stress- ful circumstances [35]. One explanation is that implicit biases are a heuristic, or a cognitive or mental shortcut. Heuristics offer individuals general rules to apply to situations in which there is limited, conflicting, or unclear information. Use of a heuristic results in a quick judgment based on fragments of memory and knowledge, and therefore, the decisions made may be erroneous. If the thinking patterns are flawed, negative attitudes can reinforce stereotypes [39]. Negative stereotyping can be a contributing factor to maternal health disparities. For example, healthcare providers may neglect to recognize the pain of non-Hispanic Black women or feel that this group’s expressions of pain are more dispropor- tionate than their actual experiences. One study found that a Black woman in New York City with a college education is nearly three times more likely to endure severe maternal mor- bidities compared with a White woman of similar age with less than a high school education [37]. In one study of patients following cesarean delivery, Black and Hispanic women were evaluated for pain less frequently, had higher pain scores, and received less pain medication than White women, even after controlling for other clinical factors, suggesting that these inequities are the result of different approaches to care delivery [40]. These implicit racial beliefs also have the potential to affect the way a patient is counseled about treatment options [35]. Serious maternal complications, including hemorrhage, embo- lism, eclampsia, and stroke, occur in all racial and age groups; however, there is a clearly documented increased risk for racial or ethnic minority women. Failure to recognize these compli- cations could be related to the high-stress environments in which they occur, but they may also be related to stereotypical unconscious thoughts related to minority groups [38].
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MDNJ1525
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