"Disparities: defined as "differences that result in a particular type of health difference that is closely linked with economic, social, or environmental disadvantage, are complex and are the result of numerous factors including social, environmental, biologic, genetic, behavioural, as well as healthcare factors." [1]
There have been various reports and studies in both the United Kingdom and the United States that have shown significant ethnic and racial disparities in maternal morbidity and mortality, as a result of conditions triggered or amplified by pregnancy [1, 2].
This article will look at a few reviews, one from the UK and one from the US, discussing why this could be the case and how both healthcare systems are planning to reconstruct their respective maternal care systems so that mothers and their babies can be better off.
The first paper, "Impact of maternal risk factors on ethnic disparities in maternal mortality: a national population-based cohort study", conducted a study in which a cohort of women who died during or up to six weeks after pregnancy in the UK between 2009 and 2019 via national surveillance. These came from MBBRACE-UK records, an organisation responsible for enhanced maternal death surveillance in the UK, including a database of every maternal death in the UK since 2009 [2].
In total 801 women died in the UK between 2009 and 2019 during, or within 6 weeks after the end of, pregnancy of which:
559 (70%) were in the White aggregated (high-level) group
100 (12%) were in the Black aggregated group
105 (13%) were in the Asian aggregated group
23 (3%) were in the Mixed aggregated group
However, in the analysis of this data, mixed aggregated group were excluded due to uncertainty due to the routine population dataset providing only the ethnic group of the baby [2].
After analysing data from the routine population data of all women giving birth in the UK from 2015 to 2019, women of Black and Asian ethnic groups were at a 3.2 fold increased risk of maternal mortality compared with women of white ethnicity. After adjusting for increasing maternal age, social deprivation and known multiple pregnancy (all factors associated with increased risk of maternal death) women of Black ethnic origin remained at a significantly increased risk (2.4 times higher) of maternal death compared with White ethnic women [2].
The next paper, "Reducing Disparities in Severe Maternal Morbidity and Mortality", obtained data from the US and saw that such disparity in maternal death had been present for over a century, with Non-Hispanic black women having the highest rates for 22 of 25 severe morbidity indicators. In the US, Black women are 3-4 times more likely to die a pregnancy-related death compared with White women, with quality of healthcare ranging from preconception to postpartum being particularly critical in improving these outcomes for racial and ethnic minority women [1].
The paper then went on to research and understand how quality of hospital care, specifically in delivery, can contribute to racial an ethnic disparities in severe maternal morbidity and mortality rates. Several investigations have found that racial and ethnic minority women deliver in different and lower quality hospitals than White women. Through national data, the researchers found that 75% of Black deliveries in the US occurred in a quarter of hospitals, whereas only 18% of Whites delivered in the same hospitals, with hospitals that disproportionately cared for Black deliveries had higher risk-adjusted severe maternal morbidity rates for both Black and White women in those hospitals [1].
A simulation method was utilised by the researchers to quantify the impact of delivery location on disparity and they estimated that if Black women delivered at the same hospitals as White women, nearly 1000 black women could potentially avoid severe morbid events during delivery which would reduce the black severe maternal morbidity rate from 4.2% to 2.9% [1].
References
Reducing Disparities in Severe Maternal Morbidity and Mortality - Elizabeth A Howell, MD, MPP
Impact of maternal risk factors on ethnic disparities in maternal mortality: a national population-based cohort study - Nicola Vousden et al Assessed and Endorsed by the MedReport Medical Review Board