Suchergebnisse

Background: Black and Latina women in New York City are twice as likely to experi­ence a potentially life-threatening morbid­ity during childbirth than White women. Health care quality is thought to play a role in this stark disparity, and patient-provider communication is one aspect of health care quality targeted for improvement. Perceived health care discrimination may influence patient-provider communication but has not been adequately explored during the birth hospitalization.Purpose: Our objective was to investi­gate the impact of perceived racial-ethnic discrimination on patient-provider com­munication among Black and Latina women giving birth in a hospital setting.Methods: We conducted four focus groups of Black and Latina women (n=27) who gave birth in the past year at a large hospital in New York City. Moderators of concordant race/ethnicity asked a series of questions on the women's experiences and interactions with health care providers during their birth hospitalizations. One group was conducted in Spanish. We used an integrative analytic approach. We used the behavioral model for vulnerable populations adapted for critical race theory as a starting conceptual model. Two analysts deductively coded transcripts for emergent themes, using con­stant comparison method to reconcile and refine code structure. Codes were catego­rized into themes and assigned to concep­tual model categories.Results: Predisposing patient factors in our conceptual model were intersectional identities (eg, immigrant/Latina or Black/ Medicaid recipient), race consciousness ("… as a woman of color, if I am not assertive, if I am not willing to ask, then they will not make an effort to answer"), and socially assigned race (eg, "what you look like, how you talk"). We classified themes of differential treatment as impeding factors, which included factors overlooked in previ­ous research, such as perceived differential treatment due to the relationship with the infant's father and room assignment. Themes for differential treatment co-oc­curred with negative provider communica­tion attributes (eg, impersonal, judgmental) or experience (eg, not listened to, given low priority, preferences not respected).Conclusions: Perceived racial-ethnic discrimination during childbirth influences patient-provider communication and is an important and potentially modifiable aspect of the patient experience. Interventions to reduce obstetric health care disparities should address perceived discrimination, both from the provider and patient per­spectives.Ethn Dis. 2020;30(4):533-542;doi:10.18865/ed.30.4.533

Noncitizen immigrants are often excluded from accessing critical safety-net programs, such as Medicaid. Access to health care plays a central role in current policy debates on maternal health. Yet, immigrant exclusions are rarely considered in maternal health policy research. Through open-ended interviews with 31 policymakers, researchers, and program administrators, we examined state variations in approaches to providing care for pregnant, post, and intrapartum immigrant women. We found four themes: (a) a patchwork safety-net exists that provides some access to immigrants ineligible for Medicaid; (b) patchwork coverage leads to patchwork care, which can contribute to maternal health inequities; (c) immigrant Medicaid policy is assembled along a hierarchy of deservingness based on documentation status; (d) Trump-era public charge rules and political climate may have a substantial chilling effect on benefit uptake regardless of eligibility. We discuss implications for efforts to expand Medicaid postpartum and address the maternal health crisis.

OBJECTIVE: To synthesize the literature on associations between social determinants of health and pregnancy-related mortality and morbidity in the US and to highlight opportunities for intervention and future research. DATA SOURCES: We performed a systematic search using Medline Ovid, CINAHL, Popline, Scopus and ClinicalTrials.gov (1990–2018) using MeSH terms related to maternal mortality, morbidity, and social determinants of health, and limited to the United States. METHODS OF STUDY SELECTION: Selection criteria included studies examining associations between social determinants and adverse maternal outcomes including pregnancy-related death, severe maternal morbidity, and emergency hospitalizations or readmissions. Using Covidence, three authors screened abstracts and two screened full articles for inclusion. TABULATION, INTEGRATION, AND RESULTS: Two authors extracted data from each article and the data were analyzed using a descriptive approach. A total of 83 studies met inclusion criteria and were analyzed. Seventy eight out of 83 studies examined socioeconomic position or individual factors as predictors, demonstrating evidence of associations between minority race and ethnicity (58/67 studies with positive findings), public or no insurance coverage (21/30), and lower education levels (8/12) and increased incidence of maternal death and severe maternal morbidity. Only 2/83 studies investigated associations between these outcomes and socioeconomic, political and cultural context (e.g. public policy); and 20/83 studies investigated material and physical circumstances (e.g. neighborhood environment, segregation), limiting the diversity of social determinants of health studied as well as evaluation of such evidence. CONCLUSION: Empirical studies provide evidence for the role of race and ethnicity, insurance, and education in pregnancy-related mortality and severe maternal morbidity risk, although many other important social determinants, including mechanisms of effect, remain to be studied in greater depth.