Racial Disparities in Healthcare among Pregnant Women in the United States
(colorectal cancer), but you need to choose a minority population to examine in relation to colon cancer.
3 OBJECTIVE SUMMARIES
Complete Literature review
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Racial Disparities in Healthcare among Pregnant Women in the United States
Tamifer Lewis
Department of Public Health, Monroe College, King Graduate School
KG604-144: Graduate Research and Critical Analysis
Dr. Manya Bouteneff
December 4, 2022
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Literature Review
Introduction to the Literature Review
Research suggests that racial disparities in healthcare among pregnant women persists in
the United States (Zhang et al., 2013). Due to this continuous occurrence, it is vital to examine
the factors that contribute to the adverse outcomes in maternal health. The literature review
contained only research articles about factors that impacted and influenced disparities in
pregnancy outcomes. Factors that were reviewed were socioeconomic status, public health
insurance, race/ethnicity, and poverty status. The literature review was conducted using EBSCO
Host and ProQuest databases from the Monroe College Library. The search terms used to
compile pertinent articles were racial disparities maternal health, adverse pregnancy outcomes,
and maternal health outcomes.
Review of the Literature
Adverse Pregnancy Outcome Factors
Darling et al. (2021) conducted a study between 2001 and 2018 to examine the efficiency
of qualified interventions in preterm birth, small for gestational age, low birth weight, neonatal
death, cesarean deliveries, maternal care satisfaction, and coast effectiveness programs. A
systematic review was used to collect data from the United States, France, Spain, and the
Netherlands. The studies consisted of mostly non- Caucasian women from low-income
population ranging from 12 to 46 years of age and being between 20 to 32 weeks' gestation.
Interventional programs were implemented into three categories: group prenatal care, augmented
prenatal care, or a combination of both group and augmented prenatal care (Darling et al., 2021).
The researchers found that certain interventions, such as prenatal care and augmented care, or a
combination of both, may decrease adverse outcomes in small-for-gestational-age and preterm
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birth, and could aid in increasing maternal care satisfaction. Interventions that worked on
enhancing coordination of care were found to result in providing more effective cost savings.
The researchers also found disparities in the quality of access to care in the vulnerable
population. There was insufficient evidence of suitable quality to confirm that the interventions
were successful at enhancing clinical outcomes in prenatal care for at risk populations (Darling et
al., 2021).
Similar observations were made in a study conducted by Nichols and Cohen (2020),
between 2006 and 2018 to examine the methods used to improve the results of maternal
mortality in California. The study was conducted using a scoping review to evaluate research on
women and maternal health in the United States. The researchers used information from the US
Maternal Fetal Medicine Network to measure the percentage of studies where pregnant women,
women, and children were the main focus. The researchers also reviewed documentation on
healthcare policies and practices from California’s public health department, healthcare
foundation, and Maternal Quality Care Collaborative. Nichols and Cohen (2020) found that
although the health of fetus and children could be adversely affected by the health of the mother,
the majority of maternal programs in the United States places emphasis on the child. The
researchers also found four areas of concern in women health experiences, both in pre and
postnatal care. The problem areas entailed inadequate investment in women's health, inefficient
quality of care and avoidable caesarean delivers, expanding disparities in minority women and
women living in rural areas, and contradictory collection and distribution of data (Nichols &
Cohen, 2020).
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Approaches to Improving Pregnancy Outcomes
In contrast to the preceding studies, Zhang et al. (2013) conducted a study between 2005
and 2007 to calculate the excessive rate of unfavorable outcomes in pregnancy within racial and
ethnic groups. The study also aimed to measure the possibility of Medicaid savings that are
linked to paid maternal care claims resulting from the inequalities that contribute to unfavorable
maternal outcomes. A cross-sectional study using Medicaid Analytic eXtract (MAX) data was
used to gather pregnancy outcome information from inpatient hospitals from 14 states (Florida,
Alabama, Arkansas, North Carolina, Georgia, Louisiana, Kentucky, Mississippi, Maryland,
Missouri, Tennessee, South Carolina, Virginia, and Texas). The study consisted of a little over 2
million patients who were insured with Medicaid and had a delivery code of maternal delivery
stay. Zhang et al. (2013) found that, with the exception of gestational diabetes, African American
women showed the worst outcomes out of all unfavorable pregnancy outcomes. These disparities
are postulated as being multi-factorial, having causes stemming from complicated experiences
with racism, poverty, and complex healthcare interactions. It was also found that women covered
under Medicaid health insurance were more likely to have consistency in care from prenatal care
through delivery compared to their counterparts. However, due to participation in Medicaid
programs being influenced by reimbursement rates, some providers may choose to stop
accepting Medicaid patients because of reimbursement delays and low payment rates, which
could contribute to negative birth outcomes (Zhang et al., 2013).
Analysis of the Literature
In the United States, the persistence of maternal mortality continues to be a problem area
in public health. The contributing factors that impact pregnancy outcomes persist in burdening
the U.S., leading to poor healthcare quality, and increasing health disparities. The studies used in
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this literature review each used a different form of research methodology to collect data,
including systematic and scoping reviews and cross-sectional studies. Similarly, Darling et al.
(2021), Nichols and Cohen (2020), and Zhang et al. (2013) have emphasized the correlation
between race/ethnicity and financial status playing a part in influencing quality of care, access of
care, and pregnancy outcomes in pregnant minority women. To mitigate the disparities in
maternal health Darling et al. (2021) and Zhang et al. (2013) suggested that interventions should
be inspected and geared towards determining and eradicating the racial and ethnic disparities that
affect pregnancy-related outcomes. Whereas Nichols and Cohen (2020) suggested focusing on
exploring the distinctive experiences of particular at-risk subgroups of women, such as women in
prison, who are of childbearing age, and the pregnant women who are less likely to pursue
prenatal care, such as undocumented women.
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References
Darling, E. K., Cody, K., Tubman-Broeren, M., & Marquez, O. (2021). The effect of prenatal
care delivery models targeting populations with low rates of PNC attendance: A
systematic review. Journal of Health Care for the Poor and Underserved, 32(1), 119-
136. https://www.proquest.com/scholarly-journals/effect-prenatal-care-delivery-models-
targeting/docview/2507722229/se-2
Nichols, C. R., & Cohen, A. K. (2021). Preventing maternal mortality in the United States:
Lessons from California and policy recommendations. Journal of Public Health Policy,
42(1), 127-144. https://doi.org/10.1057/s41271-020-00264-9
Zhang, S., Cardarelli, K., Shim, R., Ye, J., Booker, K. L., & Rust, G. (2013). Racial disparities in
economic and clinical outcomes of pregnancy among Medicaid recipients. Maternal and
Child Health Journal, 17(8), 1518+.
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