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Arnold School of Public Health

Structural racism worsens maternal health disparities for some minority women during pandemic

October 20, 2022 | Erin Bluvas,

Arnold School researchers and a collaborator from the School of Medicine Columbia have completed a study examining the effects of residential segregation on maternal outcomes for minority women before and during the pandemic. They published their findings in JAMA Network Open.

“Structural racism, such as residential segregation, places women of color in disadvantaged situations where they have unequal access to maternal health care,” says Peiyin Hung, assistant professor of health services policy and management and deputy director for the Rural and Minority Health Research Center. “This has been particularly true during the COVID-19 pandemic, where inequities have been exacerbated for marginalized groups.”

With this study, the researchers compared information collected in South Carolina before (January 2018-February 2020) and during the COVID-19 pandemic (March 2020-June 2021) to assess patterns in severe maternal morbidity (i.e., unexpected labor/delivery outcomes that impact women’s health). Data included childbirth records, emergency department visits, outpatient surgery/services, birth certificates, maternal demographics, prenatal care utilization and chronic disease risk factors.

The team’s analyses of more than 166K births revealed that minority women living in highly segregated communities were more likely to experience severe maternal morbidity. While the disparities between Black and white women did not widen during the pandemic period of the study, the inequities between Hispanic and white women worsened. Disparities between the latter two groups had been steadily decreasing prior to the pandemic, but this trend reversed and became particularly elevated after its onset in 2020.

After accounting for individual-level variables such as nutrition, insurance, obesity, insurance and hospital-level maternity care level, the authors looked toward structural racism to explain these discrepancies. They point to a range of factors, including discrimination of housing, education, employment, health care, economic opportunities and criminal justice, as the likely causes of disproportionately adverse outcomes for women of color.

“Improving maternal outcomes for minority populations requires engagement with these families who might have distinct barriers to receiving optimal health care before, during and following childbirth,” Hung says. “Policymakers, health care providers, and community stakeholders should work together to remedy residential segregation or combat corresponding structural racism to reduce maternal health disparities.” 


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