PDF(Pubmed)
Abstract：
Background: Black women in the United States experience maternal mortality three to four times more often than white women (1, 2). States vary in degree of disparity, partially due to programs and policies available to pregnant people. In Massachusetts, Black women were approximately twice as likely as white women to experience pregnancy-associated mortality, with a large percentage of these deaths reported to be preventable (3). Methods: Using Massachusetts as a state-level comparison to national policies, we searched the US Congress and Massachusetts legislative databases for maternal health policies from 2010 to 2020. We screened 1,421 national and 360 Massachusetts bills, following set inclusion/exclusion criteria. Data analysis included (1) assessment of bill characteristics, (2) thematic analysis, and a (3) quality appraisal following an adapted model of the analytical framework for evaluating public health policy proposed by the National Collaborating Centre for Healthy Public Policy. Additionally, our data analysis identified the level of racism (internalized, interpersonal or institutional) that each policy addressed. Results: From 2010 to 2020, 31 national and 16 state-level policies were proposed that address maternal health and racial disparities. The majority of policies addressed racism at the institutional level alone (National: N = 19, 61.3%, Massachusetts: N = 14, 87.5%). Two national and two Massachusetts-level policies became law, while two national policies passed only the House of Representatives. Our critical appraisal revealed that the majority of unintended effects would be neutral or positive, however, some potential negative unintended effects were identified. The appraisal also identified 54.8% (n = 17) of national policies and 68.8% (n = 11) of Massachusetts with positive impact on health equity. Conclusions: There has been an increase in policies proposed addressing racial disparities and health equity in maternal health over the last 10 years. Although half of national policies proposed showed positive impact on health equity, shedding light on the work the U.S. is doing on a federal level to confront the Black maternal health crisis, only two policies made it to law, only one of which addressed racial disparities directly and had a positive impact on health equity.
摘要：
背景：美国黑人妇女的孕产妇死亡率是白人妇女的三到四倍（1，2）。各州的差异程度各不相同，部分原因是孕妇可用的计划和政策。在马萨诸塞州,黑人女性经历妊娠相关死亡率的可能性大约是白人女性的两倍，据报道，这些死亡中有很大一部分是可以预防的(3)。方法：使用马萨诸塞州作为国家政策的州一级比较，我们在美国国会和马萨诸塞州的立法数据库中搜索了2010年至2020年的孕产妇保健政策.我们筛选了1,421项国家法案和360项马萨诸塞州法案，以下设置纳入/排除标准。数据分析包括(1)票据特征评估，(2)专题分析,和（3）质量评估遵循国家健康公共政策合作中心提出的评估公共卫生政策的分析框架的适应模型。此外,我们的数据分析确定了种族主义的水平(内在化，人际或机构)每一项政策都要解决。结果：从2010年到2020年，提出了31个国家和16个州级政策，以解决孕产妇健康和种族差异。大多数政策仅在机构层面涉及种族主义(国家:N=19，61.3%，马萨诸塞州：N=14，87.5%）。两项国家和马萨诸塞州层面的政策成为法律，而两项国家政策仅在众议院获得通过。我们的批判性评估显示，大多数意外影响是中性或积极的，然而,发现了一些潜在的非预期负面影响.评估还确定了54.8％（n=17）的国家政策和68.8％（n=11）的马萨诸塞州对健康公平有积极影响。结论：在过去10年中，针对孕产妇健康中的种族差异和健康公平提出的政策有所增加。尽管提议的国家政策中有一半对卫生公平产生了积极影响，揭示了美国在联邦一级为应对黑人孕产妇健康危机所做的工作，只有两项政策成为法律，其中只有一个直接解决了种族差异，并对卫生公平产生了积极影响。
