Incorporating Measures of Structural Racism into Population Studies of Reproductive Health in the United States: A Narrative Review.
Incorporating Measures of Structural Racism into Population Studies of Reproductive Health in the United States: A Narrative Review.
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DOI：
10.1089/heq.2020.0081
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发表时间：
2021
期刊：
影响因子：
2.7
通讯作者：
Doll KM
中科院分区：
文献类型：
--
作者：
Alson JG;Robinson WR;Pittman L;Doll KM
目的：美国黑人妇女在生殖健康方面面临着较差的结果——从怀孕结局到妇科癌症。种族健康不平等可归因于系统性种族主义，但很少有关于生殖健康结果的人口研究纳入了系统性种族主义的上游措施，而那些纳入了系统性种族主义的研究也仅限于孕产妇和婴儿健康结果。在理解和干预从种族主义到生殖健康结果的途径方面取得的进展，由于缺乏这方面的方法学指导而受到限制。我们的目标是通过确定在生殖健康结果中突出的系统性种族主义的定量措施来填补这一空白。方法：我们对2000年至2019年的文献进行了回顾，以确定在人口生殖健康研究中使用系统性种族主义暴露定量测量的研究。我们分析了文献目录，以确定内聚域和跨域整合数据的措施。对于每个领域，我们将其在人口健康研究中的使用情况置于背景下，描述目前使用的指标，并提出将其应用于生殖健康研究的机会。结果：我们确定了可能影响生殖健康结果的系统性种族主义的四个领域：(1)民权法和合法的种族歧视，(2)居住隔离和住房歧视，(3)警察暴力，(4)大规模监禁。每个领域都有多个量化度量。此外，存在一种多层面的措施，其他系统性种族主义领域对于未来发展成不同的措施是突出的。结论：存在系统性种族主义的量化措施，可纳入调查假设的生殖健康人口研究，包括与孕产妇和婴儿健康有关的假设。未来的措施发展也有希望的领域，如儿童福利制度和交叉性。纳入这些措施对于适当评估和干预生殖健康结果方面的种族不平等至关重要。
Purpose: Black women in the United States face poor outcomes across reproductive health measures—from pregnancy outcomes to gynecologic cancers. Racial health inequities are attributable to systemic racism, but few population studies of reproductive health outcomes integrate upstream measures of systemic racism, and those who do are limited to maternal and infant health outcomes. Advances in understanding and intervening on the pathway from racism to reproductive health outcomes are limited by a paucity of methodological guidance toward this end. We aim to fill this gap by identifying quantitative measures of systemic racism that are salient across reproductive health outcomes. Methods: We conducted a review of literature from 2000 to 2019 to identify studies that use quantitative measures of exposure to systemic racism in population reproductive health studies. We analyzed the catalog of literature to identify cohesive domains and measures that integrate data across domains. For each domain, we contextualize its use within population health research, describe metrics currently in use, and present opportunities for their application to reproductive health research. Results: We identified four domains of systemic racism that may affect reproductive health outcomes: (1) civil rights laws and legal racial discrimination, (2) residential segregation and housing discrimination, (3) police violence, and (4) mass incarceration. Multiple quantitative measures are available for each domain. In addition, a multidimensional measure exists and additional domains of systemic racism are salient for future development into distinct measures. Conclusion: There are quantitative measures of systemic racism available for incorporation into population studies of reproductive health that investigate hypotheses, including and beyond those related to maternal and infant health. There are also promising areas for future measure development, such as the child welfare system and intersectionality. Incorporating such measures is critical for appropriate assessment of and intervention in racial inequities in reproductive health outcomes.