Maternal Healthcare Disparities and Their Long-Term Impact
Introduction
Maternal health is a critical component of overall public health, yet significant disparities in maternal healthcare access and quality persist globally. Despite advances in medical science and improved healthcare infrastructure, maternal mortality and morbidity rates remain disproportionately high among marginalised communities. These disparities stem from socioeconomic, racial, ethnic, geographic, and systemic healthcare deficit factors. This article explores the root causes of maternal healthcare disparities, their impact on maternal and child health, and the strategies needed to bridge these gaps.
Understanding Maternal Healthcare Disparities
Between 2016 and 2019, maternal morbidity rose across nearly all population categories, despite continued efforts to enhance care quality. The Centres for Disease Control and Prevention (CDC) defines severe maternal morbidity (SMM) as “unexpected outcomes of labour and delivery that result in significant short- or long-term consequences to a woman’s health.” Each year, over 25,000 deliveries in the United States involve SMM, including life-threatening complications such as:
- Intravascular coagulation
- Hysterectomy (surgical removal of uterus)
- Renal failure
- Sepsis
- Adult respiratory distress syndrome
Additional types of maternal morbidity include preeclampsia, eclampsia, postpartum haemorrhage, and obstetric trauma — all of which are rising in prevalence.
1. Racial and Ethnic Disparities
- Maternal morbidity and mortality rates are disproportionately high among non-Hispanic Black individuals.
- Black women are three to four times more likely to die from pregnancy-related complications as compared to white women.
- The incidence of caesarean deliveries in first-time, low-risk pregnancies is greater for Black women compared to White women, with the disparity amplifying with advancing maternal age.
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- Severe postpartum haemorrhage rates are significantly worse for non-Hispanic Asian or Pacific Islander (API) individuals compared to White individuals, with the gap widening over time.
2. Socioeconomic Disparities
- Women hailing from low-income households encounter impediments to timely and adequate prenatal and postpartum care, including lack of insurance, high out-of-pocket expenditures, and transportation issues.
- Rural communities face higher rates of maternal mortality and morbidity due to hospital closures, extensive travel distances, and restricted healthcare provider availability.
3. Age and Maternal Health Outcomes
- The risks of pregnancy-related complications such as preeclampsia, eclampsia, and postpartum haemorrhage are higher for older mothers (over 40) and adolescent moms (under 18).
- The physiological and social challenges associated with teen pregnancy further exacerbate these risks.
4. Mental Health and Maternal Care
- Maternal mental health issues are prevalent, with 10% to 25% of postpartum women developing depressive disorders.
- Up to 20% of postpartum deaths are linked to suicide, yet screening for postpartum depression remains inconsistent, with only 51% to 96% of providers asking about depression during postpartum visits.
5. Violence Against Pregnant and Postpartum Women
- In the United States, homicide is the primary cause homicide is the leading cause of death during pregnancy and within 42 days postpartum in the United States.
- Intimate partner violence during pregnancy increases the risk of adverse pregnancy outcomes, including preterm birth and low birth weight.
Barriers to Effective Maternal Healthcare
Barriers to maternal healthcare exist at five interrelated levels:
1. Community-Level Barriers
- Inadequate access to clinical care, particularly in rural and underserved areas.
- Lack of social support networks and culturally competent care.
2. Health Facility Barriers
- Insufficient staff training to handle obstetric emergencies.
- Lack of specialized maternal care services, including high-risk pregnancy management.
3. Patient and Family Barriers
- Limited knowledge about warning signs and when to seek medical attention.
- Financial strain and fear of healthcare costs preventing timely care-seeking.
4. Provider-Level Barriers
- Implicit bias and discriminatory practices in healthcare delivery.
- Missed or delayed diagnoses of pregnancy-related complications.
5. System-Level Barriers
- Lack of affordable health insurance.
- Long travel distances and lack of public transportation.
- Closure of rural hospitals and obstetric units.
Long-Term Impact of Maternal Healthcare Disparities
The consequences of maternal healthcare disparities extend well beyond pregnancy and childbirth, affecting maternal and child health outcomes for years.
1. Increased Maternal and Infant Mortality
- Delayed or inadequate care during pregnancy and childbirth increases the risk of maternal death.
- Poor access to prenatal care leads to higher rates of preterm birth and low birth weight, which are linked to infant mortality.
2. Chronic Health Issues
Women who experience severe maternal morbidity face increased long-term risks of:
- Cardiovascular disease
- Hypertension
- Diabetes
- Renal dysfunction
- Mental health disorders
3. Adverse Child Health Outcomes
Children born to mothers who experience poor maternal health outcomes face higher risks of:
- Developmental delays
- Learning disabilities
- Behavioral issues
- Respiratory problems
4. Economic and Social Burden
- The total cost of maternal morbidity in the United States from conception through the child’s fifth birthday was estimated at $32.3 billion in 2019 — approximately $9,000 per parent-child pair.
- Poor maternal health limits workforce participation and increases dependency on social support systems.
Strategies to Improve Maternal Healthcare Equity
Addressing maternal healthcare disparities requires a comprehensive, multi-level approach:
- Strengthening Access to Care
- Expand Medicaid coverage for pregnancy and postpartum care.
- Increase funding for community-based clinics and rural maternity services.
- Enhancing Quality of Care
- Improve training for obstetric emergencies and complex maternal care.
- Increase provider accountability for racial and socioeconomic disparities in care delivery.
- Culturally Competent and Respectful Care
- Train healthcare professionals in cultural sensitivity and implicit bias reduction.
- Encourage diversity in the maternal healthcare workforce.
- Promoting Mental Health Support
- Integrate mental health screening into routine prenatal and postpartum visits.
- Increase access to maternal mental health counselling and support groups.
- Reducing Financial and Geographic Barriers
- Strengthen transportation options for pregnant women in rural areas.
- Provide financial assistance for uninsured or underinsured women
Conclusion
Maternal healthcare disparities remain a significant public health challenge, with long-term consequences for mothers, children, and society. Despite ongoing efforts, racial, ethnic, and socioeconomic gaps in maternal care persist, contributing to preventable maternal mortality and morbidity. By addressing systemic barriers, improving healthcare access, and fostering culturally competent care, healthcare systems can reduce these disparities and ensure that every mother receives the care she needs for a healthy pregnancy and beyond. Ensuring equitable maternal healthcare is not only a moral obligation but also a critical step toward improving overall public health outcomes.
