SMFM Special Report: Putting the “M” back in MFM: Reducing racial and ethnic disparities in maternal morbidity and mortality: A call to action

Abstract

Racial and ethnic disparities in maternal morbidity and mortality rates are an important public health problem in the United States. Because racial and ethnic minorities are expected to comprise more than one-half of the US population by 2050, this issue needs to be addressed urgently. Research suggests that the drivers of health disparities occur at 3 levels: patient, provider, and system. Although we have recognized this issue and identified elements that contribute to it, knowledge must be converted into action to address it. In addition, despite available funding and databases, research directed towards understanding and reducing these disparities is lacking. This document summarizes findings of a workshop convened at the 2016 Society for Maternal-Fetal Medicine's 36th Annual Pregnancy meeting in Atlanta, GA, to review and make recommendations about immediate actions in clinical care and research that will serve to reduce racial and ethnic disparities in maternal morbidity and mortality rates in the United States.

Does a Care Bundle Reduce Racial Disparities in Postcesarean Surgical Site Infections?

“…Increased surgical site infections in black women may be because of patient, provider, and system factors. 15 Our surgical bundle was designed to address both patient factors (by providing wound care education and 4% chlorhexidine gluconate soap) and provider factors (by standardizing clinical practice to counter unconscious bias). Since causes of racial disparities are multifold, addressing a few factors may not have been enough.…”

“…Despite previous studies showing racial disparities in surgical site infections after cesarean delivery, there has been a paucity of research directed toward reducing these disparities. 12,29 Although the National Partnership of Maternal Safety and Society of Maternal-Fetal Medicine recommended quality improvement projects that target disparities in health care access, treatment, and outcomes, 15,16 there have been few intervention or implementation studies that evaluate potential treatments, policies, or actions to reduce disparities. 30 Although our care bundle did not reduce racial disparities, it was associated with decreased rates of surgical site infections in both black and nonblack women.…”

“…Future studies should seek to determine the underlying causes of these disparities, whether due to biology, social circumstances, environmental exposures, behavioral patterns, or medical care. 15 For example, prospective observational studies that examine an association between disparities in the quality of care and disparities in surgical site infections would be helpful to understand the focus on interventions to reduce racial disparities.…”

“…disparities due to unconscious bias is to protocoled an evidence-based bundle of interventions to ensure that all patients receive an equivalent standard of care. 15 The National Partnership of Maternal Safety and Society of Maternal-Fetal Medicine recommended implementing quality improvement projects that target disparities in health care access, treatment, and outcomes. 16 Although causes of disparities are likely to be multifold, we focused on inequities in health care quality that could be modified by a quality improvement initiative.…”

Updates from the Literature, July/August 2019

“…Although there have been calls to action to address racial and ethnic disparities in SMM, the authors acknowledge that there is no ongoing, systematic data collection for population‐based maternal morbidity in the United States, and inconsistent definitions of maternal mortality and limited research on risk factors have impeded research efforts. In this study, patient‐level risk factors did not completely explain the substantial racial and ethnic disparities.…”