Three Essays Exploring Black-White Racial/Ethnic Disparities in Postpartum Care in the United States

Objective: To quantify disparities in postpartum care consistency and quality between Black and White birthing people, to explore how Black birthing people experience navigating their healthcare and social needs across the postpartum year, and to connect Black birthing people’s experiences and needs in the postpartum period with recommendations for appropriate social support and resources.

Methods: Aims 1 and 2 used generalized linear models to estimate disparities in the receipt of a postpartum checkup visit, delivery of recommended postpartum care content, medical utilization and expenditures in the postpartum year between Non-Hispanic Black and White birthing people. We applied IOM-concordant methods for quantifying racial disparities in both aims. Aim 3 employed sequential interviews with 11 Black postpartum people to explore their experiences navigating their health needs and social environment over the postpartum year in NC, in conjunction with 11 provider/birth worker interviews. Building from these data, 16 state-level stakeholders participated in concept mapping to identify services and policy solutions to meet Black postpartum people’s most salient needs over time. 

Results: We found significant national Black-White disparities in postpartum care utilization between 2014 and 2018, with Black birthing parents reporting more postpartum medical events, as well as higher office-based and outpatient expenditures in the postpartum year. We found significant national Black-White disparities in total medical and inpatient expenditures in the postpartum year, with Black birthing parents reporting lower expenditures. In NC, we did not find significant Black-White disparities in the receipt of a postpartum checkup from 2016 through 2018, but we did find Black birthing people received significantly more postpartum care screening and counseling than their White counterparts. Using IOM-concordant methods of measuring disparities over typical methods resulted in changes to the magnitude of estimated disparities. In Aim 3, we identified five key themes, including how Black postpartum participants experienced racism and discrimination, took on emotional labor to find stability and reinforce their autonomy, secured external support, and sought safety from institutionalized and structural racism.

Contributions and significance: This study generates a robust assessment of Black-White disparities in postpartum care and contributes a better understanding of Black birthing people’s postpartum needs across time.