Monitoring System Evaluates Effect of Racial Discrimination on Women
July 1, 2022 3 minutes read
Racial discrimination and its effect on maternal and infant health will be addressed in the Pregnancy Risk Assessment Monitoring System (PRAMS), according to the authors of a recent paper.1
In a supplement on social determinants of health, PRAMS will include a special questionnaire to assess interpersonal racial discrimination, says Lee Warner, PhD, MPH, chief of Women’s Health and Fertility Branch, division of reproductive health at the National Center for Chronic Disease Prevention and Health Promotion in Atlanta. Warner answered questions via email.
“The CDC’s [PRAMS], which collects information on behaviors and experiences before, during, and shortly after pregnancy among a large population-based sample of postpartum women in the United States, has developed a special questionnaire supplement on social determinants of health,” Warner says.
The supplement is expected to be available to PRAMS grantees and other maternal and infant health surveillance systems in 2022.
The CDC’s Division of Reproductive Health is partnering with the Council of State and Territorial Epidemiologists to fund and support capacity-building of state, local, and territorial public health surveillance to use the supplement to assess social determinants of health among women who recently gave birth through PRAMS or a similar system, Warner explains.
“In addition, as part of the revision of the full PRAMS questionnaire, which typically occurs every three to five years, experts identified by the larger field of maternal and child health and PRAMS grantees have consistently highlighted health equity, social determinants of health, and interpersonal racial discrimination as critically important topics for the new questionnaire,” he says.
PRAMS will determine which questions on racial discrimination will appear on the core and standard sections of the Phase 9 questionnaire. The new version of the questionnaire should be available to PRAMS grantees in 2023.
“There are significant and persistent racial disparities in maternal, infant, and reproductive health outcomes,” Warner says. “Data from CDC’s Pregnancy Mortality Surveillance System show American Indian, Alaska Native, and Black women are two to three times more likely to die from a pregnancy-related cause than a white woman.”
These inequities exist at all education levels. Black women with a college degree are five times more likely to die due to pregnancy-related complication than white women with a college degree.2
“Racial and ethnic differences in preterm birth rates remain,” Warner says. “In 2020, the rate of preterm birth among African American women, which was 14.4%, was about 50% higher than the rate of preterm birth among white or Hispanic women, which were 9.1% and 9.8%, respectively.3 Providers can help their pregnant and postpartum patients by providing respectful, patient-centered care to manage conditions, have ongoing conversations about the warning signs of complications, and to provide timely treatment when problems arise. Hospitals and health systems can play an important coordination role, encouraging cross-communication and collaboration among healthcare providers.”
Additionally, Warner suggests providers and health systems take these actions to reduce racial and ethnic disparities in care of reproductive-age women:
- Put systems in place to improve delivery of quality care before, during, and after pregnancy;
- Standardize approaches for responding to obstetric emergencies;
- Focus on training obstetric providers and non-obstetric providers to consider recent pregnancy history when triaging patients;
- Train clinicians on diversity, shared decision-making, cultural competency, and implicit biases — all of which are important steps to address disparities in healthcare.
The CDC’s Hear Her campaign was created to raise awareness of, and prevent, pregnancy-related complications and death. It includes materials to help healthcare providers address health inequities and improve patient-provider communication.4
“Everyone has a role to play in addressing racial disparities and improving maternal, infant, and reproductive health outcomes, including communities, health facilities, systems of care, providers, and families,” Warner explains. “It is important to make sure women receive quality care before, during, and in the year after pregnancy.”
REFERENCES
- D’Angelo DV, Dieke A, Williams L, et al. Response to “The time has come for all states to measure racial discrimination: A call to action for the Pregnancy Risk Assessment Monitoring System (PRAMS).” Matern Child Health J 2021;26:12-14.
- Centers for Disease Control and Prevention. Racial/ethnic disparities in pregnancy-related deaths — United States, 2007-2016. Page last reviewed April 13, 2022.
- Centers for Disease Control and Prevention. Preterm birth. Page last reviewed Nov. 1, 2021.
- Centers for Disease Control and Prevention. Hear Her. Page last reviewed Feb. 16, 2022.
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