Story at a glance
- Maternal morbidity and mortality are notoriously poor in the United States.
- For women of color, the risk of adverse outcomes is significantly higher than their white counterparts.
- New research suggests a diverse nurse workforce may help combat this trend.
Rates of maternal morbidity and mortality in the United States are among the highest in the world, and are exacerbated among Black mothers and people of color.
Black women in the United States are more than twice as likely to experience a maternal death than their white counterparts, while a Black college-educated mother is at a 60 percent heightened risk of this outcome when compared with white or Hispanic women who have less than a highschool education.
However, new research published in the American Journal of Obstetrics and Gynecology, Maternal-Fetal Medicine, shows that diversifying the nurse workforce tasked with caring for expectant mothers may help address racial and ethnic disparities seen in maternal health outcomes.
“Until now, evidence linking healthcare workforce diversity to improved maternal health outcomes was scant,” said lead author Jean Guglielminotti of the Columbia Vagelos College of Physicians and Surgeons in a press release.
To carry out the analysis, researchers assessed 2017 U.S. birth certificate data and state-level registered nurse workforce diversity via the American Community Survey.
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Eclampsia, blood transfusion, hysterectomy, or intensive care unit admission were classified as severe adverse maternal outcomes.
The racial makeup of working nurses was classified into three terciles, with the first representing the lowest proportion of minoritized racial and ethnic nurses. Maine had the lowest proportion of diverse nurses, at 3.3 percent, compared with Hawaii’s most diverse workforce, at 68.2 percent. On average, the state proportion of minoritized racial and ethnic nurses was around 22 percent, authors wrote.
Per 10,000 birth certificates studied, 79.5 recorded severe adverse maternal outcomes; blood transfusion and eclampsia were the most frequently reported events.
Giving birth in states with the most diverse nurse workforce was associated with a 20 percent reduced risk of severe outcomes for Black mothers, a 31 percent reduction for Hispanic mothers, and a 50 percent reduction for Asian and Pacific Islander mothers. Diverse workforces were also linked with 32 percent risk reduction for white mothers.
“Structural racism in public policies, institutional practices, cultural representations, and other norms works to perpetuate racial group inequities and what we believe contributes to these disparities in severe adverse maternal outcomes, independent of poverty and other social determinants of health,” Guglielminotti said.
Native American mothers had the highest rates of serious adverse events recorded, followed by Black mothers, and mothers of more than one race, respectively.
Previous research has pointed to the benefits of a diverse medical workforce, as better outcomes were recorded among patients when their providers spoke the same language.
“A racially diverse nurse workforce may help to reduce provider implicit bias and enhance communications and trust between patients and clinicians,” added co-author Guohua Li in the release. Authors hope the research will lead to development of intervention programs to better meet the needs of these at-risk patients.
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