Strategies to reduce disparities in maternal morbidity and mortality: Patient and provider education
Introduction
The education of both patients and providers is essential if we hope to reduce disparities in maternal morbidity and mortality. Within the next few decades, over half of the population in the United States will comprise racial and ethnic minorities.1 An increasing body of evidence demonstrates that there are important differences in health outcomes and care among populations of women in this country. The maternal mortality rate among black women is nearly three times as high as among white women, and at least one study found that mortality for black women was 10 times higher than white women with the same complications.2, 3 There are disparities among racial and ethnic groups other than blacks that remain underresearched: whereas three-quarters of U.S. women establish prenatal care in the first trimester, just over half of American Indian and Alaskan native women do so.4 Finally, there are disparities in health care and outcomes among other subgroups of women, such as underuse of contraception among women with chronic medical conditions, that need to be addressed.5 As we move forward in this changing medical landscape, raising awareness of these disparities among the pool of providers and the general public needs to be an urgent priority.
Section snippets
Provider awareness: Where are we now?
The challenge of educating providers in strategies to reduce disparities in maternal morbidity and mortality first requires an understanding of the current status of provider awareness of this issue. In an effort to assess this, a survey of knowledge and attitudes about disparities was recently circulated among the approximately 2000 members of the Society for Maternal–Fetal Medicine (SMFM). The results of this survey were presented and discussed at the most recent Annual Clinical Meeting by a
Educating providers in training and in practice
The existing framework for trainees with respect to clinical education is governed by the American College of Obstetricians and Gynecologists (ACOG), the American Board of Obstetrics and Gynecology (ABOG), the Society for Maternal–Fetal Medicine (SMFM), the Accreditation Council for Graduate Medical Education (ACGME), and the Institute of Medicine (IOM), as well as other state and national organizations. For example, providers in training and in practice have access to educational material
New directions for provider education
While it is important to incorporate disparities education into conventional print publications, lectures, and panel discussions, it is critical to recognize the spectrum of different learning styles that our providers possess, particularly trainees belonging to the millennial generation. The need to incorporate innovative strategies for education was also addressed at the SMFM Annual Scientific Meeting in conjunction with the focus on disparities in health outcomes and care.6 Contemporary
A collaborative educational model
Partnerships with other agencies and groups from other disciplines are needed in order to expand the scope of provider outreach with respect to education in health disparities. Because of the significant long-term risks of morbidity and mortality that disproportionately affect minority women, collaborative educational initiatives should include not only Ob/Gyns, but internists and subspecialists. Minority women are disproportionately affected by chronic conditions such as hypertensive and
Educating our patients
One of the key ways for providers to educate women is through patient activation, empowering them to be their own health care advocates. Patient activation, which involves providing the skills and confidence that equip patients to become actively engaged in their health care, is associated with improvements in health outcomes and patient care experiences.24 It is also important to identify opportunities to engage women׳s families and utilize existing support systems to reinforce this education.
Future investigation in disparities education
Further investigation is needed to assess provider-related factors that contribute to disparity in maternal morbidity and mortality. Examples of these factors include inherent bias and stereotyping on the part of the provider, subtle changes in the interpretations of medical information based on cultural or language differences, and racial/ethnic group distrust of a provider based on historical factors. Evaluating the effects of these factors and developing educational models to enhance
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The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.