Does Race Impact Prenatal Care?

A recently published California-based survey on mothers found that health care providers do not usually listen to mothers about their birth preferences. Even worse, these providers seem to listen to black women the least. This suggests that black women in America do not receive the same quality of care as their white counterparts. A University of Virginia study seems to cement this case. It concluded that racial biases among white health care professionals are directly related to the standard of care provided to black patients.

I’m writing about this because this problem flows into medical malpractice cases where the victims are disporportionately black.

Results of the California Survey

Conducted by the National Partnership for Women & Families, it surveyed 2,500 women who gave birth to a single child in a California hospital in 2016. The survey found that 4 in 10 California women reported that a health professional pressured them to induce labor by using medication or other methods. It noted that of those women who were pressured to go into labor, three-quarters of them ended up having the procedure done.

The survey also found that black women experienced even more mistreatment than other California mothers. While black mothers only give birth to less than six percent of babies born in California, they experience significant disparities in treatment compared to white mothers. The survey reported that 42 percent of black mothers had C-sections, compared to 29 percent of their white ones. Black mothers also struggle with prenatal and postpartum mental health issues at a higher rate than white mothers. Thirty percent of black women reported prenatal anxiety, compared to 20 percent of white women. It also noted that a vaginal birth after C-section occurred in 16 percent of black women compared to 8 percent for white women. These statistics indicate that black women do not receive adequate care, and are induced into giving birth more often than white women.

Disparities between black and white mothers

This disparity of treatment is a nationwide problem. A 2016 study published in the American Journal of Obstetrics and Gynecology examined disparities in the quality of care between Black and white mothers. They concluded that their data suggests that these hospitals primarily serving Black mothers may provide “lower quality of care.”

They conducted the study by utilizing data from the 2010 and 2011 Nationwide Inpatient Sample of Healthcare Cost and Utilization Project. The study’s sample represented 20 percent of U.S. community hospitals. They ranked the hospitals used in their study based on their proportion of black deliveries. The top five percent of hospitals were defined as high black-serving hospitals. The next 20% were defined as medium black-serving hospitals. The remaining 75% were defined as low black-serving hospitals. 279 hospitals were labeled high black-serving, 1106 hospitals were labeled medium black-serving, while 4102 were labeled as low-black serving.

Their results showed significant disparities between black and white women. They note that three-quarters of black deliveries in the United States occur in one-quarter of U.S. hospitals. This suggests that hospitals are racially segregated. Researchers discovered that severe maternal morbidity happened more than twice as often in black deliveries than white ones. They also discovered that both black and white mothers at high black-serving hospitals experienced significant maternal morbidity rates. Their data indicates that these disparities might have been caused by differences in health care settings where both white and black women receive obstetrical delivery care.

They also concluded that their data highlights the need to improve the quality of both antenatal and delivery care for pregnant women who deliver at high black-serving hospitals.

UVA study on racial biases in the healthcare field

A 2016 University of Virginia study suggests that racial biases are directly related to the treatment disparity between black and white mothers mentioned in the previous two studies. Researchers concluded that racial preconceptions and prejudice predicted racial bias in pain perception and treatment recommendation. It also noted that black Americans are “systematically undertreated” for pain compared to white Americans.

Researchers conducted two different studies that focused on white American’s preconceived notions of black Americans. The first study’s participants were white Americans who had no medical training. The second study’s participants were White American medical students and residents. Both groups were first asked the amount of pain they would feel across eighteen different scenarios such as slamming one’s hand on a car door. They were then randomly assigned to rate the pain of a black or white person across the same scenarios. The participants were then asked to rate to the extent how fifteen supposed biological differences between black and white Americans were true or untrue on a six-point scale. Eleven of the fifteen differences listed were false. They include differences in brain sizes, pain sensitivity, and aging.

The results indicate a connection between racial bias and level of treatment towards black patients. Researchers discovered that half of the samples for the second study endorsed least one of the false beliefs. Medical students and residents who believed those false beliefs were more likely to report lower pain ratings for black patients than white patients in the same medical cases. They were also less accurate in their treatment recommendations for a black patient compared to a white one. However, individuals who do not support these beliefs do not show racial bias in treatment recommendations. This is a positive sign.

Researchers concluded that studies 1 and 2 provide a meaningful understanding of the relationship between racial bias and medical care. Both studies show that racial bias in pain assessment is related to racial bias in pain treatment recommendations. They also show that significant numbers of white people, both laypeople and medical professionals, hold false beliefs about biological differences between blacks and whites. In addition, the studies show that there is a preconceived idea that blacks and whites have differences in pain sensitivity.