Social and structural determinants of health inequities in maternal health

Maternal health disparities

In comparison to other high-income countries, the U.S. has the highest maternal mortality rate, and most of these deaths are preventable. Between 2007 and 2016, approximately 700 women died each year from a pregnancy-related death.1 Not surprisingly, the rates for Black and American Indian/Alaska Native women were higher than their White counterparts, approximately 41 per 100,000 live births, 30 per 100,000 live births, and 13 per 100,000 live births respectively. This number increased during

The importance of structural and social determinants of health

The World Health Organization (WHO) commissioned the social determinants of health (SDOH) more than a decade ago, to address health inequities. SDOH are the conditions in which people are born, grow, live, work, and age and are grouped into five (5) domains: economic stability, quality education, quality health care, neighborhood, and built environment, and social and community context. The distribution of money and power shapes these conditions and resources at the global, national, and local

Mother blame and the problematic framing around infant mortality

For years, experts in infant health have postulated that solutions to address infant mortality should intervene on maternal behaviors within enhanced risk periods for infant mortality. Developed by Citymatch and health department affiliates, the Perinatal Periods of Risk (PPOR) tool was formulated to help communities with high infant mortality rates use local data to reduce infant mortality rates. According to CityMatch, the PPOR “provides an analytic framework and steps for investigating and

Utilizing reproductive justice to derive solutions

A strong body of research thus demonstrates the integral relationship between the health of mothers and birthing people and the health and development of their infants. We have also demonstrated the ways that culture, policies, and other social determinants of health in the United States lead to negative maternal and infant health outcomes. This section is concerned with both clinical and non-clinical solutions that can be implemented for the benefit of infant-parent dyads. Prior to discussing

Medicaid expansion

Data shows that the postpartum period brings about vulnerability causing women and birthing people to be more likely to die of pregnancy-related conditions during this time. These deaths are preventable. This burden of risk is keenly experienced by mothers and populations of birthing people that already experience a level of social precarity. In 2020, Medicaid provided health care coverage for 42% of births in the United States.319 Despite the vulnerability that people face, in some states,

Paid family leave

Paid parental leave allows people to take time away from their work to acclimate to their new responsibilities as parents, heal from childbirth, and rest. It is associated with increased breastfeeding and improved maternal mental health. Unfortunately because of the racist, capitalist, sexist conditions under which people must find employment, there are disparities in who has access to this benefit.21 We previously discussed the precarity that is faced in the postpartum period. This is often

Telehealth

In the wake of the COVID-19 crisis, researchers from the National Birth Equity Collaborative participated in the Maternal Telehealth Access Project (MTAP) study that sought to understand barriers to quality perinatal and postpartum care for Black, Indigenous, and People of Color during the COVID-19 pandemic.24 Researchers found that telehealth could be a sustainable and effective option for the provision of care in some cases. Participants also cited several technological and skill-based

Ensuring optimal perinatal mental health

We have discussed a myriad of reasons that might lead mothers, families, and birthing people to experience concerns related to mental health in the perinatal period. Our current construction of the perinatal mental health field has occurred inside of a culture that does not often believe, validate, or care for Black mothers and birthing people. Thus it is important that when discussing perinatal mental health, we attune to the systemic reasons that might render someone more vulnerable to

Conclusion

This paper has detailed many opportunities for growth in areas that directly relate to maternal and infant health equity. The health and well-being of birthing people and their infants in the U.S. are inextricably linked . The inequities experienced by racialized and marginalized communities will persist until there are sustained efforts to address the social and structural determinants of health as well as the root causes (e.g., racism and White supremacy) that contribute to these disparate

Disclosures

We certify that, to the best of our knowledge, no aspect of our current personal or professional circumstance places us in the position of having a conflict of interest with this chapter.

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