HLTH 2110 Week 3 Disparity Analysis Example

Black Women's Pregnancy-Related Mortality Ratio of 40.8 Against 12.7 for White Women, 2007-2016: The Number as Published and Four Explanations, None Allowed to Become the Default

Student Name

Walden University

HLTH 2110: Behavioral and Cultural Issues in Healthcare

Instructor Name

Month Day, Year

Black Women's Pregnancy-Related Mortality Ratio of 40.8 Against 12.7 for White Women, 2007-2016: The Number as Published and Four Explanations, None Allowed to Become the Default

The Measured Difference

Between 2007 and 2016, the pregnancy-related mortality ratio (PRMR) in the United States was 40.8 deaths per 100,000 live births among non-Hispanic Black women and 12.7 among non-Hispanic white women, a ratio of 3.2 to 1 (Petersen et al., 2019). The PRMR for non-Hispanic American Indian and Alaska Native women was 29.7, 2.3 times the white rate. These figures come from CDC's Pregnancy Mortality Surveillance System, which collected 6,765 pregnancy-related deaths over the decade. The overall PRMR was 16.7.

How the populations were counted matters for what the number means. A pregnancy-related death is a death during pregnancy or within one year of its end, from a cause related to the pregnancy or aggravated by it; deaths from unrelated causes, such as an accident, are excluded. States send CDC death certificates for women who died during or within a year of pregnancy, with linked birth or fetal death certificates, and medically trained epidemiologists review each case to decide whether it was pregnancy-related. Rates are expressed per live birth rather than per pregnancy, and race and Hispanic origin come from vital records. Categories are mutually exclusive: Black and white refer to non-Hispanic women, and Hispanic women of any race form a separate group. This analysis concerns the Black-white difference only.

What the Report Itself Rules In and Out

The report's own data limit some explanations before any outside evidence is considered. The disparity did not change significantly over the decade. It appeared in every age group, and among women aged 30 and older the Black rate was roughly four to five times the white rate. It appeared at every level of education. Black women who had finished college died of pregnancy-related causes at 1.6 times the rate of white women without a high school diploma, and among college-educated women the Black rate was 5.2 times the white rate. The disparity also appeared in states with low, middle and high overall rates.

Citing review committees in 13 states, the report adds that roughly three in five of these deaths could have been prevented, and that the share did not differ significantly between racial and ethnic groups (Petersen et al., 2019).

Explanation 1: Socioeconomic Position

A common explanation is that Black women have, on average, lower incomes and less education, and that these, not race, drive the difference. The report's education data weigh heavily against this explanation as a complete account. If education explained the gap, college-educated Black women would have rates close to college-educated white women. Instead, the ratio was larger among college graduates than overall. Socioeconomic position may contribute to the overall rates, but it cannot explain why the gap persists, and widens, at the top of the education scale.

Explanation 2: Differences in Chronic Conditions and Causes of Death

A second explanation is that Black women enter pregnancy with more chronic conditions, such as hypertension, and die of different causes. The report found significant differences in the share of deaths from particular causes: cardiomyopathy, thrombotic pulmonary embolism and hypertensive disorders of pregnancy accounted for significantly larger proportions of deaths among Black women than among white women (Petersen et al., 2019). This explanation has support. But it moves the question rather than answering it: if chronic conditions are more common before pregnancy, the next question is why, and the answer leads back to conditions and care across a lifetime. It also does not explain the equal share of preventable deaths, which suggests that care during and after pregnancy matters regardless of prior conditions.

Explanation 3: Where Women Receive Care

A third explanation concerns the hospitals where women deliver. Howell et al. (2016) studied severe maternal morbidity, life-threatening complications at delivery, in a national sample of hospital discharges for 2010 and 2011. They found that 74% of deliveries to Black women occurred in a relatively small group of hospitals where Black patients made up a large share of deliveries, and that these hospitals had higher rates of severe maternal morbidity for both Black and white women after adjusting for patient characteristics. This points to quality differences between hospitals as part of the explanation. The study concerned morbidity rather than death, so it supports this explanation for deaths only indirectly.

Explanation 4: Racism in Care and in Conditions

A fourth explanation holds that racism, both in the conditions women live in and in how they are treated by health care systems, contributes to the gap. Jones (2000) describes racism operating at institutional, interpersonal and internalized levels; institutional racism could shape where hospitals are and how they are funded, while interpersonal bias could shape whether symptoms are taken seriously. A systematic review found that most studies measuring implicit bias among health care professionals found evidence of pro-white or anti-Black bias, and some linked it to differences in care and communication (Hall et al., 2015). This explanation is consistent with the education finding and with the hospital finding. It is also harder to measure directly than the others, and the report does not test it.

Weighing the Explanations

The evidence rules out socioeconomic position as a complete explanation and supports partial roles for chronic conditions and site of care. The racism explanation fits the pattern of the evidence but rests on studies other than the one that produced the number. None of the four should become the default, because each points to different action: the first to income support, the second to care before pregnancy, the third to hospital quality and the fourth to how institutions and clinicians treat Black women.

Table 1

Four Explanations Against the Report's Evidence

No single row accounts for the whole difference, and the strongest evidence rules out only the first explanation as complete.

Conclusion

The published figure, a pregnancy-related mortality ratio of 40.8 for Black women against 12.7 for white women, is a measured difference with a clear definition and a known counting method. The report's own data show that the gap survives education, age and state. What produced it is not settled by the number, and an analysis that settles it by assumption would mistake the strongest explanation for the proven one.

References

Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E., Day, S. H., & Coyne-Beasley, T. (2015). Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review. American Journal of Public Health, 105(12), e60-e76. https://doi.org/10.2105/AJPH.2015.302903

Howell, E. A., Egorova, N., Balbierz, A., Zeitlin, J., & Hebert, P. L. (2016). Black-white differences in severe maternal morbidity and site of care. American Journal of Obstetrics and Gynecology, 214(1), 122.e1-122.e7. https://doi.org/10.1016/j.ajog.2015.08.019

Jones, C. P. (2000). Levels of racism: A theoretic framework and a gardener's tale. American Journal of Public Health, 90(8), 1212-1215. https://doi.org/10.2105/AJPH.90.8.1212

Petersen, E. E., Davis, N. L., Goodman, D., Cox, S., Syverson, C., Seed, K., Shapiro-Mendoza, C., Callaghan, W. M., & Barfield, W. (2019). Racial/ethnic disparities in pregnancy-related deaths: United States, 2007-2016. Morbidity and Mortality Weekly Report, 68(35), 762-765. https://doi.org/10.15585/mmwr.mm6835a3