从死亡率评论中吸取的教训:对孕产妇死亡的非生物贡献者
Howard Minkoff1, Cynthia Chazotte2, Lisa M Nathan3
1Departments of Obstetrics and Gynecology, Maimonides Medical Center and SUNY Downstate, SUNY Downstate School of Public Health, Brooklyn, New York.
American journal of perinatology
|June 6, 2023
概括
高产妇死亡率源于结构性种族主义和医疗保健协调不良等系统性问题,而不仅仅是医疗紧急情况. 解决这些上游因素对于改善结果至关重要,特别是对于黑人妇女来说.
科学领域:
- 公共卫生 公共卫生
- 健康差异 在健康上的差异
- 医疗系统分析 医学系统分析
背景情况:
- 在美国,严重的孕产妇发病率和死亡率是不可接受的高.
- 分析显示,除了产科紧急情况之外的因素对不利的孕产妇结果有很大影响.
- 复杂的医疗保健系统,分散的护理协调和结构性种族主义被确定为关键的非医疗贡献者.
研究的目的:
- 分析高孕产妇死亡率的多方面的原因.
- 界定医生在解决这些原因方面的角色和局限性.
- 强调结构性种族主义和医疗保健系统失败对孕产妇健康结果的影响.
主要方法:
- 几年来重度孕产妇发病率和死亡率病例的审查和分析.
- 讨论医生的能力,种族和种族主义的影响以及系统性医疗保健障碍.
- 检查健康和产妇死亡率的社会决定因素之间的相互作用.
主要成果:
- 孕产妇死亡率是由系统性问题驱动的,包括医疗保健系统的低效和结构性种族主义.
- 护理协调不良,特别是产后,是关键因素.
- 黑人女性面临着由于这些上游的非医学决定因素而增加的风险.
结论:
- 产科医生必须解决上游事件的下游后果,同时教育自己种族主义和社会劣势.
- 改善孕产妇健康需要医生参与解决系统性问题并倡导政策变革.
- 解决孕产妇死亡率差异需要识别和解决风险的根本原因,特别是对于边缘化人口.
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