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

项目总结 背景：在美国，严重的孕产妇发病率(SMM)是一个重要的公共卫生问题。 从1993年到2014年，美国SMM的比率增长了200%。黑人分娩的人患癌症的风险要高出70% 在产前阶段，SMM的风险增加了40%，在产期，风险增加了18% 与白人同龄人相比，她们处于产后期。在美国，少数族裔患者报告经历了 更高的长期种族歧视比率(日常发生的人际种族歧视 发生在医疗环境之外)和医疗环境中的严重种族歧视(歧视 在医疗环境中经历，由护士、助产士和产科医生永久保留)和不尊重 关心。此外，以前的研究主要集中在医生的歧视上，而不是 护士和助产士，他们通常更频繁地与住院患者互动。虽然研究表明 种族歧视和不良健康后果之间的关系，还没有研究衡量 歧视经历(急性和慢性)与不尊重产妇护理的关系 由所有提供商类型和SMM结果永久保留。 目的：本研究旨在进行病例对照研究，采用巢式定性研究，收集定量的 以及美国一家医院在6个月内分娩的100名自我确认的黑人分娩者的定性数据 招生人数。 方法：病例对照设计将比较50例(经历SMM结局的分娩者)。 和50名对照组(分娩的人没有经历SMM结局)。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，同时寻求 产前、产中和产后护理，来自所有提供者的尊重的产妇护理，以及种族 他们在日常生活中受到歧视。本研究由三部分组成：(1)测量两者之间的关联 体验SMM结果以及受到歧视和尊重关怀的经历；(2)分析调查数据 有目的地抽取样本进行定性访谈；(3)对分娩人员进行15-20次访谈 由尊重量表上的低分(表示低尊重)和歧视量表上的高分来识别 (表明歧视程度很高)。 含义：这项研究将首次提供关于急性和慢性人际间种族的信息。 在经历SMM结局的黑人分娩者中，歧视和母亲不尊重，一个人口在 健康不平等的高风险。重要的是，我们将衡量从 所有提供者类型，包括助产士和护士，后者在以前的健康状况中被省略 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，以改善少数族裔人口的不良后果风险。

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.