Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, California, USA.
BMC Pregnancy Childbirth. 2021 Jul 2;21(1):477. doi: 10.1186/s12884-021-03942-y.
During public health emergencies, including the COVID-19 pandemic, access to adequate healthcare is crucial for providing for the health and wellbeing of families. Pregnant and postpartum people are a particularly vulnerable subgroup to consider when studying healthcare access. Not only are perinatal people likely at higher risk for illness, mortality, and morbidity from COVID-19 infection, they are also at higher risk for negative outcomes due to delayed or inadequate access to routine care.
We surveyed 820 pregnant people in California over two waves of the COVID-19 pandemic: (1) a 'non-surge' wave (June 2020, n = 433), and (2) during a 'surge' in cases (December 2020, n = 387) to describe current access to perinatal healthcare, as well as concerns and decision-making regarding childbirth, over time. We also examined whether existing structural vulnerabilities - including acute financial insecurity and racial/ethnic minoritization - are associated with access, concerns, and decision-making over these two waves.
Pregnant Californians generally enjoyed more access to, and fewer concerns about, perinatal healthcare during the winter of 2020-2021, despite surging COVID-19 cases and hospitalizations, as compared to those surveyed during the COVID-19 'lull' in the summer of 2020. However, across 'surge' and 'non-surge' pandemic circumstances, marginalized pregnant people continued to fare worse - especially those facing acute financial difficulty, and racially minoritized individuals identifying as Black or Indigenous.
It is important for clinicians, researchers, and policymakers to understand whether and how shifting community transmission and infection rates may impact access to perinatal healthcare. Targeting minoritized and financially insecure communities for increased upstream perinatal healthcare supports are promising avenues to blunt the negative impacts of the COVID-19 pandemic on pregnant people in California.
在公共卫生紧急事件期间，包括 COVID-19 大流行期间，获得足够的医疗保健对于保障家庭的健康和福祉至关重要。孕妇和产后人群是研究医疗保健可及性时需要特别考虑的一个脆弱亚组。不仅围产期人群因 COVID-19 感染而患病、死亡和发病的风险较高，而且由于常规护理的延迟或不足，他们也面临着更多的不良后果风险。
我们在 COVID-19 大流行的两个阶段对加利福尼亚州的 820 名孕妇进行了调查：（1）“非高峰期”波（2020 年 6 月，n=433），（2）“高峰期”波（2020 年 12 月，n=387），以描述当前围产期医疗保健的可及性，以及随着时间的推移对分娩的关注和决策。我们还研究了现有的结构性脆弱性——包括急性财务不安全和种族/族裔少数化——是否与这两个阶段的可及性、关注和决策相关。
与 2020 年夏季 COVID-19“平静”期间相比，尽管 COVID-19 病例和住院人数激增，但 2020-2021 年冬季，加利福尼亚州的孕妇普遍享有更多的围产期医疗保健可及性，对围产期医疗保健的担忧也较少。然而，在“高峰期”和“非高峰期”大流行情况下，边缘化的孕妇状况仍然更糟——尤其是那些面临急性经济困难的孕妇，以及自我认同为黑人或土著的少数族裔孕妇。
临床医生、研究人员和政策制定者了解社区传播和感染率的变化是否以及如何影响围产期医疗保健的可及性非常重要。针对少数族裔和经济困难社区增加上游围产期医疗保健支持是缓解 COVID-19 大流行对加利福尼亚州孕妇负面影响的有希望的途径。
