You Don't Have to Be Infected to Suffer: COVID-19 and Racial Disparities in Severe Maternal Morbidity and Mortality
06. Juni 2020
08. Juni 2020
25. Juni 2020 (online)
Both coronavirus disease 2019 (COVID-19) and maternal mortality disproportionately affect minorities. However, direct viral infection is not the only way that the former can affect the latter. Most adverse maternal events that end in hospitals have their genesis upstream in communities. Hospitals often represent a last opportunity to reverse a process that begins at a remove in space and time. The COVID-19 pandemic did not create these upstream injuries, but it has brought them to national attention, exacerbated them, and highlighted the need for health care providers to move out of the footprint of their institutions. The breach between community events that seed morbidity and hospitals that attempt rescues has grown in recent years, as the gap between rich and poor has grown and as maternity services in minority communities have closed. COVID-19 has become yet another barrier. For example, professional organizations have recommended a reduced number of prenatal visits, and the platforms hospitals use to substitute for some of these visits are not helpful to people who either lack the technology or the safe space in which to have confidential conversations with providers. Despite these challenges, there are opportunities for departments of obstetrics and gynecology. Community-based organizations including legal professionals, health-home coordinators, and advocacy groups, surround almost every hospital, and can be willing partners with interested departments. COVID-19 has made it clearer than ever that it is time to step out of the footprint of our institutions, and to recognize that the need to find upstream opportunities to prevent downstream tragedies.
COVID-19 will exacerbate disparities in perinatal outcomes.
The virus, per se, is not the pandemic's biggest threat to the health of minority women.
The solution to maternal mortality cannot be found within the walls of hospitals.
- 1 Glass K. When maternity wards in black neighborhoods disappear. New York Times. Available at: https://www.nytimes.com/2020/05/05/parenting/coronavirus-black-maternal-mortality.html . Accessed May 5, 2020
- 2 Boelig RC, Saccone G, Bellussi F, Berghella V. MFM guidance for COVID-19. American Journal of Obstetrics & Gynecology MFM 2020; DOI: 10.1016/j.ajogmf.2020.100106.
- 3 Redlining Mitchell B, Franco J. HOLC “redlining” maps: The persistent structure of segregation and economic inequality. National Community Reinvestment Coalition. Available at: https://ncrc.org/holc/ . Accessed May 25, 2020
- 4 Choi A, Herbert H, Winslow O, Browne A. Long island divided. Newsday November 2019. Available at: https://projects.newsday.com/long-island/real-estate-agents-investigation/#open-paywall-message . Accessed May 25, 2020
- 5 Smith RB, Fecht D, Gulliver J, Beevers SD, Dajnak D. Blangiardo Met al. Impact of London's road traffic air and noise pollution on birth weight: Retrospective population based cohort study. BMJ 2017; 359 Doi: 10.1136/bmj.j5299
- 6 Villarreal A. New York mother dies after raising alarm on hospital neglect. The Guardian May 2, 2020. Available at: https://www.theguardian.com/us-news/2020/may/02/amber-rose-isaac-new-york-childbirth-death . Accessed May 25, 2020
- 7 Maani N, Galea S. The role of physicians in addressing social determinants of health. JAMA 2020; 323 (16) 1551-1552