In the United States, research continues to show that the dangers of childbirth are very real. According to the U.S. Centers for Disease Control and Prevention (CDC), roughly 700 women die from pregnancy-related complications every year. Perhaps more troublesome, however, is the fact that it's long been known that childbirth can be far more dangerous for black women than white. While researchers have struggled to find a concrete answer for the racial and ethnic disparities present in pregnancy-related mortality rates, new research suggests the issue isn't simply a matter of differences in insurance or finances.
"To our surprise, our data do not suggest that any differences in treatment patterns were reflected in worse outcomes for Medicaid-covered and commercially insured mothers within the same hospital," researchers at the Blavatnik Family Women's Health Research Institute at the Icahn School of Medicine at Mount Sinai in New York wrote in their recently published study. "These results indicate that pathways other than insurance are responsible for the higher risks of severe maternal morbidity among black and Latina compared with white women that were observed in our study."
Researchers examined four years worth of delivery and discharge data from hospitals in New York City in an attempt to uncover two things: whether black and Latina women experienced worse outcomes than white women who delivered at the same hospital and if a woman's insurance type impacted her health outcome.
Ultimately, researchers found that black women had the highest rate of severe maternal morbidity, or unexpected health outcomes stemming from labor that can have significant short or long term health consequences for the mother. Some 4.2% of black women experienced severe maternal morbidity, compared to 2.9% of Latina woman and just 1.5% of white women.
"Our data demonstrate that black and Latina women are more likely than white women to experience a severe maternal morbidity within the same hospital after accounting for patient sociodemographic and clinical characteristics," researchers wrote in their study. "These disparities were not explained by type of medical insurance. In fact, women insured by Medicaid and those with commercial insurance had similar risks for severe maternal morbidity within the same hospital."
Of course, researchers have long known that racial and ethnic disparities exist in pregnancy-related mortality rates. In 2019, for example, data from the CDC found that black women were two to three times more likely to die from pregnancy-related causes than white women. Even more troubling, however, was the CDC's conclusion that although "most pregnancy-related deaths are preventable," racial and ethnic disparities in such deaths have continued to persist over time.
Researchers behind this latest study have urged more research into whether things like structural racism and implicit bias may be contributing factors behind such racial disparities.
"More detailed research examining causes of variations in care for pregnant black and Latina women compared with white women within the same hospitals, such as patient–doctor communication, structural racism, bias, language issues, shared decision making, and differential use of obstetric-quality tools, is needed because these could be important levers to reduce disparities within hospitals," researchers wrote in their report. "Racial and ethnic disparities in severe maternal morbidities within the same hospital are disconcerting and demand immediate attention."
In the meantime, researchers recommended moving to address racial and ethnic disparities within and between hospitals by "optimizing the quality of care through things like standardizing care, improving communication skills, translation services and community partnerships, and implementing bias trainings, disparities dashboards and quality improvements specifically targeted at narrowing gaps identified in care.
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. doi: 10.1097/AOG.0000000000003667