PICOT Question
Maternal mortality rates are a public health issue that significantly impacts the population. The rate of maternal deaths is a critical measure of the development of a country, and the public health system it has implemented. In the United States, research has identified a significant gap with regards to this indicator. This gap is the difference between maternal mortality based on ethnicity and race. According to statistical research, African-American mothers are dying at a much higher rate than that of Caucasian mothers, up to three or four times more often. This gap in maternal mortality rates articulates the effects of institutionalized racism. There is a need to protect the health of both infants and mothers by improving the quality of American healthcare programs and improving public health outcomes. The question that this paper seeks to answer is: What issues do African-American mothers face – compared to non-Hispanic white mothers – that can be attributed to racial disparities and contribute to the increase in their mortality rate during pregnancy?
Background Information
The goal for quality care in healthcare systems worldwide is to decrease the maternal mortality frequency by75 % (Willcox et al., 2020). On the global scale, the U.S. maternal mortality rate is relatively low, at 17.4 deaths per 100,000 live births (CDC, 2019). However, if this rate is separated by race, it is found that Alaska Native, African-American, and American-Indian ladies die at three times the rate of Caucasian women during pregnancy (Gingrey, 2020). Furthermore, it is worrying that while international maternal mortality rates decrease, the opposite trend is occurring in the United States, as the statistics increase with every year (MacDorman et al., 2016). In contrast to other OECD and developed nations, the United States is lagging behind both in tracking maternal mortality rates, and in preventing those (MacDorman et al., 2016). The maternal mortality rates must be decreased, and this will require an in-depth understanding of the causes underlying this mortality. Focusing on the populations that are most at-risk for this issue will go a long way in ensuring that effective maternal health policy is formulated and implemented.
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Foreground Information
Research indicates that the increased mortality rate for women from minority populations is linked to poverty and the health issues that are associated with this diminished socioeconomic status (Gingrey, 2020). One of the significant causes of maternal mortality is cardiovascular disease, as it is associated with increased adverse outcomes for pregnant mothers (Neggers, 2016). The depressed access to education, economic opportunity, and employment offered to minority communities means that a large proportion of these communities live in low-income households, which contributes to adverse health outcomes, including the heightened incidence of cardiovascular disease (Chetty et al., 2019). In keeping with this narrative, African-Americans have the highest incidence of hypertension in the U.S., in comparison to other racial groups (Bartolome et al., 2016). Likewise, the American Hispanic population is at higher risk of developing cardiovascular disease (Graham, 2015). Cardiovascular diseases are associated with poor diet and lifestyle, which is a common feature among low-income communities in the US.
Supporting evidence
Cardiovascular Disease
Thus, the institutionalized racial disparity in access to economic opportunity, healthcare, education, and other factors that contribute to positive health outcomes, has played a role in increasing the risk of maternal death for mothers coming from minority communities. One research paper by Graham (2015) reviews the increase in adverse health outcomes, particularly cardiovascular disease, in ethnic and racial minorities, and demonstrates that comorbidities exacerbate it with diabetes, as well as environmental factors. As diabetes and poor environmental factors are further linked to lowered economic opportunity, this data furthers the evidence that institutionalized racial disparity contributes heavily to the pre-existing conditions that heighten maternal mortality rates for minority women.
Obesity
Another primary reason for high maternal mortality proportions in the U.S. is obesity. The high obesity incidence rate in the U.S. thus contributes to the rise in deaths even though other developed countries have been able to cut their maternal mortality frequency (Neggers, 2016). Again, obesity is more common among members of ethnic and racial minority groups in the United States (Broady & Meeks, 2015). This increased incidence of obesity is linked to social inequality, as the lower economic opportunity is linked to unhealthy diet and lifestyle (Broady & Meeks, 2015). As a result, women from minority collections have greater maternal mortality proportions than women from majority groups.
Conclusion
In conclusion, several racial disparities exist within the US in terms of public health. These disparities are the product of institutionalized discrimination. Concerning maternal mortality, they include increased risk for cardiovascular disease, as well as increased risk for obesity. Their impacts on overall health outcomes are negative for members of racial or ethnic minority communities. For childbearing women, in particular, these racial disparities increase the risk for mortality for pregnant women who come from ethnic minorities such as African-American communities, in comparison to non-Hispanic white women. As a result, institutionalised racism contributes to the increased death rates for African-American women and infants.
Recommendations
Policymakers can assist in lowering African-American maternal mortality rates by accounting for the population-specific risks outlined above. Furthermore, they can alleviate the restrictions placed on African-American workers so that they have better opportunities and access to economic opportunity, which will better their health outcomes. Health care professionals and communities can lower this mortality rate by sensitizing patients - and the population at large - of the background-specific risks of pregnancy for African American mothers. This will foster early detection, screening, and a healthy-lifestyle movement at the grassroots level fur pregnant mothers. Recommending light exercise for such patients will also benefit them.
References
Bartolome, R. E., Chen, A., Handler, J., Platt, S. T., & Gould, B. (2016). Population care management and team-based approach to reduce racial disparities among African Americans/blacks with hypertension. The Permanente Journal , 20 (1), 53.
CDC. (2019). Maternal Mortality. Center for Disease Control . Retrieved from https://www.cdc.gov/nchs/maternal-mortality/index.htm
Chetty, R., Hendren, N., Jones, M. R., & Porter, S. R. (2020). Race and economic opportunity in the United States: An intergenerational perspective. The Quarterly Journal of Economics , 135 (2), 711-783.
Gingrey, J. P. (2020). Maternal Mortality: A US Public Health Crisis. American Public Health Association 110 (4), 421
Graham, G. (2015). Disparities in cardiovascular disease risk in the United States. Current cardiology reviews , 11 (3), 238-245.
MacDorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Is the United States maternal mortality rate increasing? Disentangling trends from measurement issues short title: US maternal mortality trends. Obstetrics and Gynaecology , 128 (3), 447.
Willcox, M. L., Price, J., Scott, S., Nicholson, B. D., Stuart, B., Roberts, N. W., ... & Harnden, A. (2020). Death audits and reviews for reducing maternal, perinatal and child mortality. Cochrane Database of Systematic Reviews , (3).
