The difference in maternal and child health is one of the social issues that characterize health disparities in the United States and across the world. Variations in maternal and child health outcomes across the nation can be attributed to various social factors, including differences in socioeconomic status, educational levels, and access to healthcare services. The effects of different social determinants of health on disparities in health concerning maternal health have been observed most pronouncedly in the significantly high maternal mortality rates among African American Communities compared to other communities in the U.S.
Maternal Mortality Issues among African Americans
Over the past 20 years, the United States has seen a significant decline in maternal mortality rates. However, the rate of decline in maternal mortality has been slower among African Americans compared to other communities in the U.S., resulting in the currently observed gap in maternal mortality between African Americans and other communities in the U.S (Novoa & Taylor, 2018). Maternal mortality currently stands at 43.5 out of 100,000 live births among African Americans. On the other hand, the overall prevalence of maternal death in the U.S. is 14 out of 100,000 live births, while that across developed countries globally is 11 out of 100,000 live births (Novoa & Taylor, 2018). The differences in maternal mortality prevalence rates between the African American population indicate health disparities between the community and the rest of the populations in the U.S. Exploring the differences in various social determinants of health can thus be essential in understanding these discrepancies in maternal mortality prevalence rates.
The differences in maternal mortality prevalence between the African American communities and the rest of the U.S population can be attributed to variations of social determinants of health, particularly access to health services. According to the National Academies of Sciences, Engineering, and Medicine (2017), access to health services as a social health determinant refers to the ability to access effective, culturally, and linguistically aligned, as well as affordable healthcare services that can foster preventive, chronic, and emergency healthcare service delivery. Access to healthcare also acts as a paradigm that can predict outcomes in healthcare service delivery to the sick, which promotes preventive care (Arcaya, Arcaya, & Subramanian, 2015). For the African American population, access to healthcare has been difficult over the years because of several factors, such as discriminative practices and lack of healthcare resources. According to Novoa and Taylor (2018), poor maternal health outcomes, such as high maternal mortality, indicate poor access to prenatal care or low-quality service delivery during prenatal care. Thus, the high maternal deaths among African Americans relative to other communities confirm that African Americans have relatively low access to prenatal care. The reduction in maternal mortality among other communities at a faster rate than African Americans is probably an indication of significant investment in healthcare infrastructure among those communities relative to the African American communities.
Various studies have shown that access to healthcare services among African American communities is relatively low. For instance, Novoa and Taylor (2018) posit that one of the healthcare access challenges faced by African American communities is low access to prenatal care; a higher percentage of African Americans have no access to prenatal care compared to other communities, such as the Hispanics. Additionally, those who have access to prenatal care experience low quality of prenatal care (Novoa & Taylor, 2018). As such, African American women are more likely to experience more birth-related complications compared to women from other ethnic groups. Furthermore, factors, such as stress and racist experiences during prenatal care, may also contribute to poor maternal health, resulting in the probability of maternal death (Novoa & Taylor, 2018). These factors not only indicate disparities in healthcare but also indicate poor or no social justice in the U.S.
For a government that values its people, the practice of social justice should come naturally. Inequalities, such as those observed in healthcare access between African Americans and other communities, create an impression of unfairness by the government and can result in the breakdown of social cohesion. Breakdown in social cohesion results in various outcomes, including loss of commitment and loss of communal structures (Wang, 2018). Individuals’ perceptions of inequality across populations can also result in stress, feelings of worthlessness, shame, and loss of respect. For the African American communities, inequitable access to healthcare and specifically to prenatal care can result in feelings of worthlessness and disrespect, which are contrary to the feelings that should be characteristic of a political system in which social justice is practiced.
Social justice is characterized by equitable distribution of resources, power, and obligations to all people across the nation regardless of ethnicity, race, or gender. Some of the fundamental principles that define social justice include collaboration, equal access, and inclusion (Wang, 2018). For the case of maternal deaths among African American women, the fact that the maternal deaths are attributed to lower quality of prenatal care available to African American women is an indication of the absence of social justice; the progress in healthcare across the country is not inclusive to the African American women and resources are inequitably distributed based on race and ethnicity. The only way to address the concern sustainably would be to establish policies that ensure regional balance in healthcare sector development regardless of the communities that live in specific regions.
The Selection Theory of Health Disparity
The selection theory of health disparity can explain the differences in access to maternal healthcare across different ethnic groups. The theory emphasizes people’s tendency to sort themselves into clusters depending on certain shared characteristics, such as race and ethnicity (Arcaya et al., 2015). This tendency is what probably drives African Americans to live in areas in which they are clustered by ethnicity, making it easy to perpetrate social injustice against them. The decision to cluster by ethnicity increases vulnerability to exclusion since excluding the areas inhabited by African Americans from healthcare sector developments is sufficient towards limiting access to prenatal care among a large population of African Americans.
Resolving Issues in Maternal Health
The suboptimal access to care among African Americans has been caused by systemic factors, which can only be addressed through systemic solutions. Some of the approaches that have been identified for improving access to care among African Americans and subsequently reducing maternal deaths include the implementation of social development programs, investment in education to increase awareness of the need for optimum access to care, the involvement of African Americans in healthcare policy development and decision making, and expanding access to care among African American communities through greater investment in healthcare infrastructure and resources (Noonan, Velasco-Mondragon, & Wagner, 2016). These approaches are yet to be extensively pursued, and their outcomes have not been presented in the literature.
Addressing the maternal health issues faced by African Americans will require a systemic approach to problem-solving because the issues are systemic. In this project, the proposed intervention was drawn from the recommendations of the WHO (2020) on improving the quality of maternal care through education and support to midwifery. Specific steps would involve guiding midwives and doctors working within the African American communities on best practices for managing complications in pregnancy, increasing the participation of African Americans in advocacy for the improvement of healthcare infrastructure and universal health coverage for the low-income members of the community, and strengthening the quality of education for healthcare providers. Part of the advocacy practice will be to eliminate the systemic racism that has been a hindrance to accessing prenatal services by African American mothers. Educating healthcare professionals on cultural practice in healthcare service delivery can help promote equitable service delivery to African American mothers. The principle of clustering will be applied in this project by encouraging societal collaboration in advocacy for better healthcare services and fostering inclusion through support for cultural care practice.
This project will be aimed at creating awareness of the discrepancies in access to prenatal care and the roles of different stakeholders in the delivery of quality prenatal care to African American mothers. Midwives, nurses, and other healthcare professionals will be targeted in the efforts towards transformation.
Contributions to Research
One of the areas that have been under-researched in healthcare disparity relates to the systemic factors contributing to high maternal deaths among the African American communities. Most of the previous research has focused on the causes of the high maternal deaths in the African American community without providing possible solutions to those deaths or causative systemic issues. Additionally, research on improving healthcare access has been mostly focused on healthcare reforms targeting the entire country. This DNP project addresses issues pertaining specifically to disparities in prenatal care access affecting African American communities and practices that can be implemented to address those issues. As such, it fills a gap that exists in the current literature.
The high prevalence of maternal deaths among African American mothers has been attributed to differences in healthcare access. For African American mothers, access to prenatal care is often limited, and where available, the quality of such care is constrained either due to resource limitations or the practice of racism. African Americans experience challenges in healthcare access due to the propensity for selection. Therefore, reducing maternal deaths requires a systemic approach to handling the underlying challenges in healthcare access among the community, such as racism and inequitable healthcare resource distribution. These issues can only be resolved using methods that focus on the systemic roots of the problem, such as advocacy for better healthcare infrastructure and cultural care practices. These methods have not been applied extensively before, and the project will potentially cover the gaps in the literature by addressing these issues.
Arcaya, M. C., Arcaya, A. L., & Subramanian, S. V. (2015). Inequalities in health: Definitions, concepts, and theories. Global Health Action, 8(27106). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4481045/
National Academies of Sciences, Engineering, and Medicine (2017). Communities in Action: Pathways to health equity. Washington, DC: The National Academies Press. https://www.nap.edu/read/24624/chapter/5
Noonan, A. S., Velasco-Mondragon, H. E., & Wagner, F. A. (2016). Improving the health of African Americans in the USA: An overdue opportunity for social justice. Public Health Reviews, 37(12). https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-016-0025-4
Novoa, C., & Taylor, J. (2018, Feb 1). Exploring African Americans’ high maternal and infant death rates. Center for American Progress. https://www.americanprogress.org/issues/early-childhood/reports/2018/02/01/445576/exploring-african-americans-high-maternal-infant-death-rates/
Wang, F. (2018). Social justice leadership – Theory and practice: A case of Ontario. Educational Administration Quarterly, 54(3), 470-498. https://journals.sagepub.com/doi/abs/10.1177/0013161X18761341?journalCode=eaqa
WHO (2020). Maternal health. World Health Organization. https://www.who.int/health-topics/maternal-health#tab=tab_1