Intertwined disparities: Applying the maternal-infant dyad lens to advance perinatal health equity

Abstract

Differences in the quality of delivery hospital care contribute to persistent, intertwined racial and ethnic disparities in both maternal and infant health. Despite the shared causal pathways and overlapping burden of maternal and infant health disparities, little research on perinatal quality of care has addressed obstetric and neonatal care jointly to improve outcomes and reduce health inequities for the maternal-infant dyad. In this paper, we review the role of hospital quality in shaping perinatal health outcomes, and investigate how a framework that considers the mother-infant dyad can enhance our understanding of the full burden of obstetric and neonatal disparities on health and society. We conclude with a discussion of how integrating a maternal-infant dyad lens into research and clinical intervention to improve quality of care can move the needle on disparity reduction for both women and infants around the time of birth and throughout the life course.

Figure 1.. Pathways linking hospital organization and quality to maternal and infant health disparities.

Adapted from Howell, EA & Zeitlin, J. Improving Hospital Quality to Reduce Disparities in Severe Maternal Morbidity and Mortality. Semin Perinatol. 2017 August ; 41(5): 266–272.