I’m co-writing this edition of The Preprint with my colleague, Dr. Dawn Godbolt, who joined Maven last year as our Director of Health Equity. Dawn leads our strategy to measure, understand and address inequity.
The data is now overwhelming that among the many forms of inequity in the United States, anti-Black racism is particularly severe. Just last week, the New York Times highlighted the stark finding that the richest Black mother faces greater risk in childbirth than the poorest white mother. Similarly wide disparities in health outcomes persist across a vast number of health conditions, even impacting overall longevity.
But as much as Black History Month requires somber reflection on the ways racism diminishes people’s opportunities to thrive, it also provides an opportunity to celebrate Black innovation and scholarship. Writing in a special edition of the journal Maternal and Child Health in April of last year, an editorial team of Black women scientists wrote:
“With recognition of the added health risk for Black people because of racism, Black investigators likely bring an understanding of critically-valuable protective elements within Black communities... Their lived experiences must be acknowledged and included as imperative for inquiry and the interpretation and implementation of research findings.”
In celebration of and solidarity with the Black research community, here are five papers published in the past year that furthered our understanding of women’s and family health.
Advancing Birth Equity (Maternal and Child Health Journal - April 2022)
Edited by Allison S. Bryant, Kimberly D. Gregory, Rachel R. Hardeman, Elizabeth A. Howell and Fleda Mask Jackson, the April 2022 issue of MCH is a transdisciplinary and intergenerational survey of the field, with contributions that included a spotlight on the role of Black midwives in fostering #blackboyjoy to the establishment of a working definition of racism to support the ongoing efforts of states’ Maternal Mortality Review Committees.
Towards an Ideal Health System (Commonwealth Fund - July 2022)
In the aftermath of the ruling in Dobbs v. Jackson Women’s Health Organization, Dr. Laurie Zephyrin explained the multitude of ways in which women and birthing people would be made more vulnerable. In addition, her team’s interviews with 88 Black and Latinx adults receiving Medicare benefits spotlighted several patient-centered practices for systems, startups, and other industry participants to consider in developing their health equity strategies. The study participants told Dr. Zephyrin’s team they value having the opportunity to meet with a provider who shares their background and speaks their language; they wanted insurers and providers to work hand-in-hand with community groups to make sure health information would be trustworthy and accessible; and they wanted healthcare to be held accountable in reducing bias and discrimination, including through investing in a patient-advocate workforce.
High and Low-performing Hospitals for Childbirth (American Journal of Obstetrics and Gynecology - June 2022)
Through interviews with 50 team members at 6 New York-based facilities, including frontline nurses, department chairs, and quality and safety professionals, a team led by Dr. Elizabeth Howell identified six attributes of hospitals most successful in reducing rates of severe maternal mortality morbidity. Notably, the findings emphasize the importance of not only staffing appropriate to patient levels (capacity strain having been found to correlate with higher rates of racial disparities) but also to problems to be solved: Two of the key attributes of the best performers included that senior hospital officials were themselves dedicated to quality improvement (with pay alignment an emerging tool) and continuing education of hospital staff.
“We cannot fix what we cannot see, and we cannot see what we do not measure.”
“Explicit awareness that racial and ethnic disparities exist and that racism and bias in the hospital can lead to differential treatment,” the authors found, was a hallmark of a high-performing system. Under the leadership of Chiquita Brooks-LaSure, CMS will later this year introduce a ‘birthing-friendly’ hospital designation, the first hospital quality metric specifically dedicated to maternal health.
Patient Preferences for Menopause Therapy (Menopause - December 2022)
The lack of care for women going through menopause remains astonishing. Women repeatedly describe having their symptoms dismissed by their providers — either because of callousness (“it’s normal”) or ignorance (menopause is not even listed among the 300+ topics in the NIH Research Portfolio Online Reporting Tools system).
Growing attention on menopause in mainstream media is a positive sign that perhaps this long-overlooked space will receive the attention it deserves. Our hope is that patient-centeredness is at the core of the care model, which is why we were encouraged by a study conducted by researchers at the University of Chicago on patient preferences with regards to treatment. Leveraging data from the Study of Women’s Health Across the Nation (SWAN), the authors found noteworthy differences in self-reported quality of life improvements from Black and white women depending on their course of treatment.
IVF and Infant Health Disparities (Pediatrics - October 2022)
A team led by Canadian researchers sought to understand how assisted-reproductive technology (ART) impacted infant health outcomes by race. Their study found that rates of neonatal mortality for Black infants conceived using ART were four-times those of white infants, double the disparity seen among babies conceived without intervention.
Given the relative inaccessibility of ART to all but the most economically privileged patients, these data are noteworthy to consider in light of the recent NBER study, which found that higher-income parents had higher incidence of poor birth outcomes (as measured by rates of prematurity and low birth weight) but lower rates of infant mortality — again, except for Black infants. Taken together, both papers show that wealth does not protect Black women and their babies from harm during and after birth. As Dr. Howell found when examining hospital quality, mere awareness that racism can lead to differential treatment is helpful in improving the performance of the health system.
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We believe that we cannot fix what we cannot see, and we cannot see what we do not measure. We are grateful for the guidance this scholarship provides as we strive to improve care for all, and hopeful for more representation of Black scientists.