The Time has Come for All States to Measure Racial Discrimination: A Call to Action for the Pregnancy Risk Assessment Monitoring System (PRAMS)

Abstract

Introduction Racial/ethnic inequities in preterm birth (PTB) are well documented. Most of this research has focused on maternal behavioral and socio-demographic characteristics. However, the full magnitude of the racial/ethnic gap remains inadequately understood. Studies now point to the role of racial discrimination in producing PTB inequities, but limitations exist, namely the use of a single, dichotomous item to measures discrimination and the limited generalizability of most studies which have been conducted in single cities or states. Methods In this commentary we briefly review extant research on explanations for racial/ethnic inequities in PTB, and the role of racial discrimination in producing the racial/ethnic gap in adverse birth outcomes such as PTB. Results The Pregnancy Risk Assessment Monitoring System (PRAMS), a state-level, population-based survey, annually collects data from 51 states and cities (“states”) on maternal behaviors and experiences in the perinatal period. The questionnaire consists of mandatory “Core” questions, and optional “Standard” questions. Currently 22 states include a “Standard” question on discrimination; 29 do not. PRAMS offers a unique opportunity to systematically assess discrimination among a diverse, population-based sample across the US. Discussion We urge PRAMS to at least include the current measure of discrimination as a mandatory "Core" question. Ideally, PRAMS should include a validated discrimination scale as a "Core" question. The time has come to name and assess the impact of discrimination on adverse birth outcomes. PRAMS can play a vital role in helping to close the racial/ethnic gap in PTB.

Experiences of racism and perinatal depression: Findings from the pregnancy risk assessment monitoring system, 2018

“…Additionally, most of the 48 participating PRAMS states do not include the survey item about experiences of racism, which limits the ability of researchers and practitioners to understand the prevalence and impacts of experiences of interpersonal racism in the perinatal period. We support the call for PRAMS to revise their measure of racism to be more comprehensive, use a validated measure and include the measure as a core mandatory measure in all participating state surveys (Almeida et al, 2021). The measure of depression used by PRAMS is also a limitation because it is a single item that is not diagnostically valid.…”

Socially Assigned Race and the Health of Racialized Women and Their Infants

“… 27 More states should consider incorporating the question on socially assigned race into their PRAMS surveys. 28 In addition, due to the cross-sectional nature of the PRAMS data, we were not able to conduct a formal mediation analysis to understand the potential mediating role of thinking about race, treatment by race, or nativity status on the impact of social racial ascription on women's and infant's health outcomes.…”

Racial, ethnic and nativity inequalities in gestational diabetes mellitus: The role of racial discrimination

“…According to a review of self-reported racism and health, studies with time-frame exposures that are unspecified or a year or less have significantly higher health outcomes compared to lifetime and 1 to 5-year time-frame exposures, possibly because they are the same exposures and/or because it reduces recall bias ( Paradies, 2006 ). An important focus for future research on the etiology of GDM is to improve the measure of discrimination in a way that captures the various types, as well as when and in what context it occurs ( Almeida et al, 2022 ).…”