Office of Research on Women's Health, National Institutes of Health (NIH), 6707 Democracy Boulevard, Suite 400, Bethesda, MD, 20817, USA.
Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, USA.
J Racial Ethn Health Disparities. 2021 Jun;8(3):661-669. doi: 10.1007/s40615-020-00825-4. Epub 2020 Jul 27.
Maternal morbidity and mortality (MMM) is a significant problem in the USA, with about 700 maternal deaths every year and an estimated 50,000 "near misses." Disparities in MMM by race are marked; black women are disproportionately affected. We use Urie Bronfenbrenner's ecological systems theory to examine the root causes of racial disparities in MMM at the individual (microsystem), interpersonal (mesosystem), community (exosystem), and societal (macrosystem) levels of influence. This review discusses the interaction of these levels of influence on racial disparities related to MMM-covering preconception health, access to prenatal care, implicit bias among health care providers and its possible influence on obstetric care, "maternity care deserts," and the need for quality improvement among black-serving hospitals. Relevant policies-parental leave, Medicaid coverage during pregnancy, and Medicaid expansion-are considered. We also apply the ecological systems theory to identify interventions that would most likely reduce disparities in MMM by race, such as revising the educational curricula of health care professionals, enhancing utilization of alternate prenatal care providers, and reforming Medicaid policies.
产妇发病率和死亡率（MMM）是美国的一个重大问题，每年约有 700 名产妇死亡，估计有 5 万名“险些丧命”。产妇发病率和死亡率的种族差异显著；黑人妇女受到的影响不成比例。我们使用 Urie Bronfenbrenner 的生态系统理论来研究个人（微系统）、人际（中系统）、社区（外系统）和社会（宏系统）层面上影响 MMM 的种族差异的根本原因。这篇综述讨论了这些影响层面相互作用对与 MMM 相关的种族差异的影响，包括孕前健康、获得产前保健、医疗保健提供者中的隐性偏见及其对产科护理的可能影响、“产妇护理荒漠”，以及为黑人服务的医院提高质量的必要性。相关政策——陪产假、怀孕期间的医疗补助覆盖范围以及医疗补助扩大——都在考虑之中。我们还应用生态系统理论来确定最有可能减少种族差异的干预措施，例如修改医疗保健专业人员的教育课程，加强利用替代产前保健提供者，以及改革医疗补助政策。
