Compared to most other developed nations, the United States fares worse in preventing pregnancy-related deaths. Despite spending more than any other country on hospital-based maternity care, the maternal mortality ratio in the U.S. remains at about 17 deaths per 100,000 live births. However, the most notable disparity in mortality rates in the U.S. is defined by race: Pregnant black women die at a rate that ranges from three to four times the rate of their white counterparts—41 deaths per 100,000 live births among black women versus 13 deaths per 100,000 live births among white women as of 2010. Sadly, this difference in risk has remained unchanged for the past 60 years.1
VA pregnancy benefits cover prenatal, birth, and postpartum care. Use of these benefits increased approximately 14-fold between 2000 and 2015. Nearly all pregnancy-related medical care provided to Veterans is purchased by VA from non-VA community providers. Approximately 25% of pregnant Veterans receiving pregnancy-related care in the community, paid for by VA, are Black compared to 15% of births in the general population. Thus, it is important to assess racial disparities in care and outcomes for women Veterans who become pregnant and receive care provided or purchased by VA.
Findings from a recent study conducted by Jodie Katon, PhD, a core investigator with HSR&D’s Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), were highlighted in a brief published by the VA Office of Health Equity (OHE) for Black Maternal Health Week. This public-facing brief serves to raise overall awareness about the health of pregnant Veterans. Findings indicate that despite enhanced access to healthcare and maternity care coordination, racial disparities in pregnancy outcomes persist among Veterans. For example, compared with white Veterans, Black Veterans had a higher prevalence of low birth weight (11% vs. 16%) and postpartum hospitalization (7% vs 10%). These disparities persisted even after adjustment for age, the number of babies a Veteran may have had previously, and whether they lived in a rural or urban area. Given the lack of racial disparities in access to prenatal care, the disparities in outcomes that pregnant Veterans are experiencing are likely related to other factors, such as social determinants of health.
VA provides two national programs to assist Veterans with their maternity care needs and to improve maternal and infant health outcomes: VA Maternity Care Coordinators and the Women Veterans Call Center. For more information on these programs and how to contact them, visit https://www.womenshealth.va.gov .