Using the Ecological Systems Theory to Understand Black/White Disparities in Maternal Morbidity and Mortality in the United States

Maternal morbidity and mortality (MMM) is a significant problem in the USA, with about 700 maternal deaths every year and an estimated 50,000 near misses. Disparities in MMM by race are marked; black women are disproportionately affected. We use Urie Bronfenbrenner's ecological systems theory to examine the root causes of racial disparities in MMM at the individual (microsystem), interpersonal (mesosystem), community (exosystem), and societal (macrosystem) levels of influence. This review discusses the interaction of these levels of influence on racial disparities related to MMM-covering preconception health, access to prenatal care, implicit bias among health care providers and its possible influence on obstetric care, maternity care deserts, and the need for quality improvement among black-serving hospitals. Relevant policies-parental leave, Medicaid coverage during pregnancy, and Medicaid expansion-are considered. We also apply the ecological systems theory to identify interventions that would most likely reduce disparities in MMM by race, such as revising the educational curricula of health care professionals, enhancing utilization of alternate prenatal care providers, and reforming Medicaid policies.

Automated summary

Racial disparities in maternal morbidity and mortality in the USA are significant, with black women disproportionately affected. Understanding and addressing these disparities requires a multi-level approach, considering individual, interpersonal, community, and societal factors. Policy interventions, educational reforms, and healthcare improvements are crucial in reducing these disparities.