Racial and ethnic disparities in reproductive medicine in the United States: a narrative review of contemporary high-quality evidence - 22/08/24
, Divya K. Shah, MD, MME b, Regina Leonis, MD c, John Rees, MD d, Katharine F.B. Correia, PhD eAbstract |
There has been increasing debate around how or if race and ethnicity should be used in medical research—including the conceptualization of race as a biological entity, a social construct, or a proxy for racism. The objectives of this narrative review are to identify and synthesize reported racial and ethnic inequalities in obstetrics and gynecology (ob/gyn) and develop informed recommendations for racial and ethnic inequity research in ob/gyn. A reproducible search of the 8 highest impact ob/gyn journals was conducted. Articles published between January 1, 2010 and June 30, 2023 containing keywords related to racial and ethnic disparities, bias, prejudice, inequalities, and inequities were included (n=318). Data were abstracted and summarized into 4 themes: 1) access to care, 2) adherence to national guidelines, 3) clinical outcomes, and 4) clinical trial diversity. Research related to each theme was organized topically under the headings i) obstetrics, ii) reproductive medicine, iii) gynecologic cancer, and iv) other. Additionally, interactive tables were developed. These include data on study timeline, population, location, and results for every article. The tables enable readers to filter by journal, publication year, race and ethnicity, and topic. Numerous studies identified adverse reproductive outcomes among racial and ethnic minorities as compared to white patients, which persist despite adjusting for differential access to care, socioeconomic or lifestyle factors, and clinical characteristics. These include higher maternal morbidity and mortality among Black and Hispanic/Latinx patients; reduced success during fertility treatments for Black, Hispanic/Latinx, and Asian patients; and lower survival rates and lower likelihood of receiving guideline concordant care for gynecological cancers for non-White patients. We conclude that many racial and ethnic inequities in ob/gyn cannot be fully attributed to patient characteristics or access to care. Research focused on explaining these disparities based on biological differences incorrectly reinforces the notion of race as a biological trait. More research that deconstructs race and assesses efficacy of interventions to reduce these disparities is needed.
Le texte complet de cet article est disponible en PDF.Key words : race, racism, inequities, bias, prejudice, inequalities
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| The authors report no conflict of interest. This research was funded in part by Amherst College’s Summer Undergraduate Research Fellowship program. |
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| Previous Presentation: Parts of this research were presented by KC at the Women in Statistics and Data Science Conference on October 8, 2021, in an oral presentation titled “The Creation of a Data Art Collection to Raise Awareness of Racial Disparities in Obstetrics & Gynecology Health Care” (location: virtual). |
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