The Impacts of Racial Discrimination and Disrespectful Maternity Care on Severe Maternal Morbidity Among Black Birthing People in The United States

种族歧视和不尊重的产妇护理对美国黑人新生儿严重孕产妇发病率的影响

• 批准号: 10536376
• 负责人: Roseline Jean Louis
• 金额: $ 4.68万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10536376
• 关键词: Acute; Birth; Black race; Blood Transfusion; Caring; Case-Control Studies; Childbirth; Chronic; Clinical; Communities; Country; Data; Dehumanization; Demographic Survey; Discrimination; Disseminated Intravascular Coagulation; Eclampsia; Enrollment; Facebook; Health; Health Personnel; Health behavior; Healthcare Systems; Hospitals; Interview; Maternal and Child Health; Measures; Medical; Methods; Midwife; Minority; Minority Groups; Mothers; Myocardial Infarction; Nurse Midwives; Nurses; Outcome; Participant; Patients; Perinatal; Persons; Physicians; Population; Postpartum Period; Pregnancy; Pregnancy Outcome; Prenatal care; Provider; Public Health; Publishing; Qualitative Methods; Race; Registered nurse; Reporting; Research; Resources; Risk; Sampling; Sepsis; Sexual abuse; Surveys; Time; USAID; United States; Verbally abusive behavior; World Health Organization; adverse maternal outcomes; adverse outcome; anesthesia complication; antenatal; case control; design; dietary adherence; experience; health inequalities; high risk; improved; indexing; individual patient; intrapartum; medication compliance; minority patient; perceived discrimination; physical abuse; postpartum care; programs; racial discrimination; racial disparity; racial minority population; racism; recruit; research study; severe maternal morbidity; social stigma; standardized care

PROJECT SUMMARY Background: Severe maternal morbidity (SMM) is a significant public health problem in the United States (U.S.). Rates of SMM in the U.S. increased 200% from 1993 to 2014. Black birthing people endured 70% more risk of SMM during the antepartum period, 40% more during the intrapartum period, and 18% more risk in the postpartum period when compared to their White counterparts. In the U.S., minority patients report experiencing higher rates of both chronic racial discrimination (day-to-day occurrences of interpersonal racial discrimination occurring outside the medical setting) and acute racial discrimination in medical settings (discrimination experienced inside the medical setting, perpetuated by nurses, midwives, and obstetricians) and disrespectful care. Moreover, previous studies have primarily focused on discrimination perpetrated by physicians rather than nurses and midwives, who typically interact more frequently with hospitalized patients. While research shows a relationship between racial discrimination and adverse health outcomes, no studies have measured the relationship between experiences of discrimination (acute and chronic) and disrespectful maternity care perpetuated by all provider types and SMM outcomes. Purpose: This study aims to conduct a case-control study with a nested qualitative study collecting quantitative and qualitative data on 100 self-identified Black birthing people who gave birth in a U.S. hospital within six months of enrollment. Methods: The case-control design will compare 50 cases (birthing people who experienced an SMM outcome) and 50 controls (birthing people who didn't experience SMM outcomes). Participants will complete five surveys, including a demographic survey and scales assessing racial discrimination from providers while seeking antepartum, intrapartum, and postpartum care, respectful maternity care from all providers, and racial discrimination in their daily lives. The study is comprised of three parts: (1) measure the association between experiencing an SMM outcome and experiences of discrimination and respectful care; (2) analyze survey data and purposively recruit a sample for qualitative interviews; (3) conduct 15-20 interviews of birthing people identified by low scores on the respect scale (indicating low respect) and high scores on the discrimination scale (indicating a high level of discrimination). Implications: This study, for the first time, will provide information on both acute and chronic interpersonal racial discrimination and maternal disrespect in Black birthing people experiencing SMM outcomes, a population at high risk for health inequities. Importantly, we will measure discrimination and disrespectful care received from all provider types, including midwives and nurses, the latter of who has been omitted from previous health inequities research. The findings of this study have the potential to impact practice in many ways, including the revision of standardized care practices of providers to improve risks of adverse outcomes in minority populations.

项目概要 背景：严重孕产妇发病率（SMM）是美国的一个重大公共卫生问题。 从 1993 年到 2014 年，美国的 SMM 率增加了 200%。黑人生育者承受的风险增加了 70% 产前的SMM，产中的风险增加40%，产后的风险增加18% 与白人同龄人相比，产后时期。在美国，少数族裔患者报告经历 长期种族歧视（人际种族歧视的日常发生）的比率较高 发生在医疗环境之外）和医疗环境中的严重种族歧视（歧视） 在医疗环境中经历过，由护士、助产士和产科医生延续）和不尊重 关心。此外，之前的研究主要集中在医生而不是医生所犯下的歧视上。 护士和助产士，他们通常与住院患者互动更频繁。虽然研究表明 种族歧视与不良健康结果之间的关系，没有研究测量过 歧视经历（急性和慢性）与不尊重的产妇护理之间的关系 所有提供商类型和 SMM 结果都会延续这一趋势。 目的：本研究旨在进行病例对照研究，并通过嵌套定性研究收集定量数据 以及六个月内在美国医院分娩的 100 名自认黑人分娩者的定性数据 的入学情况。 方法：病例对照设计将比较 50 个病例（经历 SMM 结果的分娩者） 和 50 名对照（未经历 SMM 结果的分娩者）。参与者将完成五项调查， 包括人口调查和评估提供者种族歧视的量表，同时寻求 产前、产时和产后护理、所有提供者提供的尊重的产妇护理以及种族 日常生活中的歧视。该研究由三部分组成：（1）测量之间的关联 经历 SMM 结果以及歧视和尊重护理的经历； (2)分析调查数据 有目的地招募样本进行定性访谈； (3)对分娩者进行15-20次访谈 通过尊重量表上的低分（表示低尊重）和歧视量表上的高分来识别 （表明存在高度歧视）。 意义：这项研究将首次提供有关急性和慢性人际种族问题的信息。 经历 SMM 结果的黑人生育者中的歧视和母亲不尊重，这一群体 健康不平等的高风险。重要的是，我们将衡量来自以下方面的歧视和不尊重的照顾： 所有提供者类型，包括助产士和护士，后者已在之前的健康状况中被忽略 不平等研究。这项研究的结果有可能在很多方面影响实践，包括 修订提供者的标准化护理实践，以降低少数群体出现不良后果的风险。