During my summer internship with Point-of-Care Ultrasound (POCUS) Certification Academy, I wanted to investigate the effect of varying health disparities on racial/ethnic minorities around the United States. Since, the POCUS Certification Academy (PCA) prides itself in providing quality education and opportunities to promote high quality care for patients through ultrasound standards, I wanted to combine those two interests into one. In this post I focus on the current and ongoing disparities in maternal morbidity and mortality, particularly in racial and ethnic populations.
Racial and ethnic disparities exist in US maternal mortality and morbidity rates
In Elizabeth A Howell’s “Reducing Disparities in Severe Maternal Morbidity and Mortality”, the article highlights the alarming racial and ethnic disparities in maternal mortality and severe morbidity rates within the United States. Non-Hispanic black women are at significantly higher risk, being three to four times more likely to die from pregnancy-related causes than non-Hispanic white women. These disparities have persisted for over a century, with rates widening in recent years.
The disparities extend beyond black women, affecting Native Americans/Native Alaskans, Asians/Pacific Islanders, and specific Hispanic subgroups. The causes range from a wide range of factors, encompassing social determinants, community factors, provider bias, and systemic issues within the healthcare system. The disparities are not only evident in mortality rates but also in severe maternal morbidity events, with black women experiencing higher rates for most severe morbidity indicators.
While the leading causes of maternal death in both black and white women are similar, there is a significant difference in terms of mortality rates in black women from cardiomyopathy, hypertensive disorders, hemorrhage, and respiratory complications compared to white women. Hospital quality contributes significantly to these disparities. Racial and ethnic minority women often deliver in lower quality hospitals compared to white women, and these differences in hospital quality may explain a significant portion of the disparities observed.
POCUS can play a role in addressing disparities in maternal morbidity and mortality
What exactly does the article have to do with POCUS and PCA and their initiative? In the context of addressing racial and ethnic disparities in maternal morbidity and mortality, POCUS can play a role in several ways. Particularly valuable in resource-limited settings, POCUS provides accessible and portable ultrasound imaging, potentially bridging the healthcare access gap for underserved communities, including racial and ethnic minorities.
Its integration into medical education and training programs equips healthcare providers with essential skills, ensuring better care regardless of a patient’s background. Providing additional training programs can also help future healthcare professionals develop skills in obstetric ultrasound. This equips them to serve diverse populations effectively and detect potential complications early. While not a direct solution to systemic disparities, the use of POCUS enables quicker assessments and interventions, contributing to improved outcomes for all pregnant individuals, irrespective of their demographic backgrounds.
Accessible ultrasound standards are part of the solution
Howell’s article presents racial and ethnic disparities in maternal health, showcasing the differences in mortality rates among various demographic groups. These disparities, which are rooted in various factors spanning societal, healthcare, and systemic realms, persist and require more attention. Importantly, disparities in hospital quality contribute significantly to these outcomes, illuminating a critical area for intervention.
PCA, with its emphasis on quality education and accessible ultrasound standards, holds promise as part of the solution. Its potential to enhance healthcare access, alongside equipping healthcare providers with vital skills, makes POCUS a valuable tool in reducing disparities. Integrating additional training programs and promoting its use within medical education not only fosters a more inclusive healthcare environment but also augments the capacity to detect complications early. While not a singular remedy to systemic disparities, the utilization of POCUS is a big step forward in addressing these issues.
Reference
- Howell E. A. (2018). Reducing Disparities in Severe Maternal Morbidity and Mortality. Clinical Obstetrics and Gynecology. 61(2), 387–399. doi.org/10.1097/GRF.0000000000000349
