Alson Julianna G, Robinson Whitney R, Pittman LaShawnDa, Doll Kemi M
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA.
Department of Epidemiology, UNC Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Health Equity. 2021 Feb 25;5(1):49-58. doi: 10.1089/heq.2020.0081. eCollection 2021.
Black women in the United States face poor outcomes across reproductive health measures-from pregnancy outcomes to gynecologic cancers. Racial health inequities are attributable to systemic racism, but few population studies of reproductive health outcomes integrate upstream measures of systemic racism, and those who do are limited to maternal and infant health outcomes. Advances in understanding and intervening on the pathway from racism to reproductive health outcomes are limited by a paucity of methodological guidance toward this end. We aim to fill this gap by identifying quantitative measures of systemic racism that are salient across reproductive health outcomes. We conducted a review of literature from 2000 to 2019 to identify studies that use quantitative measures of exposure to systemic racism in population reproductive health studies. We analyzed the catalog of literature to identify cohesive domains and measures that integrate data across domains. For each domain, we contextualize its use within population health research, describe metrics currently in use, and present opportunities for their application to reproductive health research. We identified four domains of systemic racism that may affect reproductive health outcomes: (1) civil rights laws and legal racial discrimination, (2) residential segregation and housing discrimination, (3) police violence, and (4) mass incarceration. Multiple quantitative measures are available for each domain. In addition, a multidimensional measure exists and additional domains of systemic racism are salient for future development into distinct measures. There are quantitative measures of systemic racism available for incorporation into population studies of reproductive health that investigate hypotheses, including and beyond those related to maternal and infant health. There are also promising areas for future measure development, such as the child welfare system and intersectionality. Incorporating such measures is critical for appropriate assessment of and intervention in racial inequities in reproductive health outcomes.
美国黑人女性在各项生殖健康指标方面都面临着糟糕的结果，从妊娠结局到妇科癌症皆是如此。种族健康不平等可归因于系统性种族主义，但很少有关于生殖健康结局的人群研究纳入系统性种族主义的上游指标，即便纳入的研究也仅限于母婴健康结局。由于缺乏针对这一目标的方法学指导，在理解和干预从种族主义到生殖健康结局的路径方面进展有限。我们旨在通过确定在生殖健康结局中显著的系统性种族主义定量指标来填补这一空白。我们对2000年至2019年的文献进行了综述，以确定在人群生殖健康研究中使用系统性种族主义暴露定量指标的研究。我们分析了文献目录，以确定连贯的领域和整合跨领域数据的指标。对于每个领域，我们将其在人群健康研究中的使用情况进行背景化，描述目前使用的指标，并提出将其应用于生殖健康研究的机会。我们确定了可能影响生殖健康结局的四个系统性种族主义领域：（1）民权法律和法律上的种族歧视，（2）居住隔离和住房歧视，（3）警察暴力，以及（4）大规模监禁。每个领域都有多种定量指标。此外，还存在一种多维指标，并且系统性种族主义的其他领域对于未来发展为不同的指标也很突出。有一些系统性种族主义的定量指标可纳入生殖健康人群研究中，以调查各种假设，包括与母婴健康相关的假设及其他假设。未来指标开发也有一些有前景的领域，如儿童福利系统和交叉性研究。纳入此类指标对于适当评估和干预生殖健康结局中的种族不平等至关重要。
