The Impacts of Racial Discrimination and Disrespectful Maternity Care on Severe Maternal Morbidity Among Black Birthing People in The United States

项目摘要 背景：严重孕产妇死亡率（SMM）是美国一个重要的公共卫生问题。 从1993年到2014年，美国的SMM率增加了200%。黑人生育的人承受了70%以上的风险， SMM在产前期间，40%以上，在分娩期间，18%以上的风险， 产后时期相比，他们的白色同行。在美国，少数患者报告 慢性种族歧视（人际种族歧视的日常发生率）较高 医疗环境之外发生的种族歧视）和医疗环境中的严重种族歧视（歧视 在医疗环境中有经验的人，由护士、助产士和产科医生延续）和不尊重 在乎此外，以前的研究主要集中在医生的歧视，而不是 护士和助产士，他们通常更频繁地与住院病人互动。虽然研究显示， 种族歧视与不良健康结果之间的关系，没有研究衡量 歧视经历（急性和慢性）与不尊重产妇护理之间的关系 由所有提供者类型和SMM结果延续。 目的：本研究旨在进行一项病例对照研究，采用巢式定性研究，收集定量 100名自称在美国医院分娩的黑人的定性数据 注册。 方法：病例对照设计将比较50例（经历SMM结局的分娩者） 和50个对照组（没有经历SMM结果的分娩者）。参与者将完成五项调查， 包括人口统计调查和评估提供者种族歧视的量表， 产前，产时和产后护理，所有提供者的尊重产妇护理，以及种族 日常生活中的歧视。本研究包括三个部分：（1）测量 经历SMM结果以及歧视和尊重护理的经历;（2）分析调查数据 并有目的地招募一个样本进行定性访谈;（3）对分娩人群进行15-20次访谈 通过尊重量表上的低分（表明低尊重）和歧视量表上的高分来识别 （这是一种严重的歧视）。 启示：本研究将首次提供急性和慢性人际种族歧视的信息， 在经历SMM结果的黑人分娩人群中， 健康不公平的高风险。重要的是，我们将衡量来自以下方面的歧视和不尊重的护理： 所有提供者类型，包括助产士和护士，后者已从以前的健康中删除 不平等研究。这项研究的结果有可能在许多方面影响实践，包括 修订提供者的标准化护理做法，以减少少数群体出现不良后果的风险。

PROJECT SUMMARY Background: Severe maternal morbidity (SMM) is a significant public health problem in the United States (U.S.). Rates of SMM in the U.S. increased 200% from 1993 to 2014. Black birthing people endured 70% more risk of SMM during the antepartum period, 40% more during the intrapartum period, and 18% more risk in the postpartum period when compared to their White counterparts. In the U.S., minority patients report experiencing higher rates of both chronic racial discrimination (day-to-day occurrences of interpersonal racial discrimination occurring outside the medical setting) and acute racial discrimination in medical settings (discrimination experienced inside the medical setting, perpetuated by nurses, midwives, and obstetricians) and disrespectful care. Moreover, previous studies have primarily focused on discrimination perpetrated by physicians rather than nurses and midwives, who typically interact more frequently with hospitalized patients. While research shows a relationship between racial discrimination and adverse health outcomes, no studies have measured the relationship between experiences of discrimination (acute and chronic) and disrespectful maternity care perpetuated by all provider types and SMM outcomes. Purpose: This study aims to conduct a case-control study with a nested qualitative study collecting quantitative and qualitative data on 100 self-identified Black birthing people who gave birth in a U.S. hospital within six months of enrollment. Methods: The case-control design will compare 50 cases (birthing people who experienced an SMM outcome) and 50 controls (birthing people who didn't experience SMM outcomes). Participants will complete five surveys, including a demographic survey and scales assessing racial discrimination from providers while seeking antepartum, intrapartum, and postpartum care, respectful maternity care from all providers, and racial discrimination in their daily lives. The study is comprised of three parts: (1) measure the association between experiencing an SMM outcome and experiences of discrimination and respectful care; (2) analyze survey data and purposively recruit a sample for qualitative interviews; (3) conduct 15-20 interviews of birthing people identified by low scores on the respect scale (indicating low respect) and high scores on the discrimination scale (indicating a high level of discrimination). Implications: This study, for the first time, will provide information on both acute and chronic interpersonal racial discrimination and maternal disrespect in Black birthing people experiencing SMM outcomes, a population at high risk for health inequities. Importantly, we will measure discrimination and disrespectful care received from all provider types, including midwives and nurses, the latter of who has been omitted from previous health inequities research. The findings of this study have the potential to impact practice in many ways, including the revision of standardized care practices of providers to improve risks of adverse outcomes in minority populations.