Abstract
T
Every year in the United States, 50,000 people have unexpected outcomes involving labor and delivery and 700 people die during pregnancy or within 1 year after delivery with African American women being three times more likely to die than white women. 2 Of these deaths, two in three of them are preventable. 2 Without standardized high-quality care, improved cultural competency among health care providers, and improved access to community services, these significant problems are not likely to improve.
As discussed in the Crear-Perry et al's article, access to paid family leave, accessibility of health care, culturally appropriate care, and community investment with services outside of acute care settings are ways to address structural and social determinates of maternal health. 1 Although these interventions can decrease disparities, Howell revealed that it may be beneficial to look for novel approaches for the delivery of care, such as funding for maternity care homes, to reduce maternal mortality. 3 Masten et al found that maternity care homes reduce preterm birth rates and NICU use and should be considered when socioeconomic health inequities and the impacts of racism are evident. 4 Evaluating newer models of care may be beneficial to reduce maternal mortality in the African American population.
Individuals who are important in leading the expansion of these novel models are community based. Julian et al examine the differences between physician-led and community-informed perinatal and reproductive health care models. 5 The authors argued that physician-centered models do not adequately address clinical, structural, and social determinants of health simultaneously, which further points away from increasing the number of conventional providers and clinics to decrease poor maternal health outcomes of African American women. In an effort to support and integrate a community-informed model to advocate for racial equality, the obstetrics and gynecology workforce must build capacity through racial diversification, education to correct professional racism, and innovation in the interprofessional and community collaboration. 5
Causes of the vast racial disparities in maternal health care are multifaceted. Social determinants of health, limited access to care, and providers' racial bias all contribute to a disproportionate number of preventable deaths in African American women. There is currently a great need for innovative community-based approaches to maternal care delivery. Providers can and should support this goal by acknowledging and continuously working to reduce their own implicit bias and by advocating for community-driven models that improve access to high-quality maternal care.
The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, and knowledge or beliefs) in the subject matter or materials discussed in this article.