Obstetrics & Gynecology (lww.com)

Abstract

Disparate health outcomes and unequal access to care have long plagued many communities in the United States. Individual demographic characteristics, such as geography, income, education, and race, have been identified as critical factors when seeking to address inequitable health outcomes. To provide the best care possible, obstetrician–gynecologists should be keenly aware of the existence of and contributors to health inequities and be engaged in the work needed to eliminate racial and ethnic health inequities. Obstetrician–gynecologists should improve their understanding of the etiologies of health inequities by participating in lifelong learning to understand the roles clinician bias and personally mediated, systemic, and structural racism play in creating and perpetuating adverse health outcomes and health care experiences.

SUMMARY OF RECOMMENDATIONS AND CONCLUSIONS

Reducing racial and ethnic inequities in health and health care should be a priority for all obstetrician–gynecologists and other health care professionals. Obstetrician–gynecologists can help meet this objective by:

Participating in lifelong learning to understand the roles clinician bias and personally mediated, systemic, and structural racism play in creating and perpetuating adverse health outcomes and health care experiences.

Adopting federal standards, at a minimum, for collection of race and ethnicity information in clinical and administrative data to analyze and identify drivers of inequities and targets for quality improvement.

Effectively engaging those with lived experiences of minoritization and marginalization in developing research, institutional and organizational policies, and clinical protocols and practice to advance equity.

Providing care with cultural humility and in a historically informed manner in efforts to build understanding, trust, and respect for patients.

Fostering an anti-racist culture of learning, belonging, accountability, and continued improvement for colleagues, learners, staff, and hospital administrators.

Acknowledging that the current system providing care for obstetric and gynecologic patients causes harm, particularly for marginalized and minoritized communities, and contributes to preventable and premature death.

Supporting and assisting in the recruitment, retention, and advancement of obstetrician–gynecologists and other health care professionals from racial and ethnic communities that are underrepresented in health care.

Promoting research that not only identifies structural and cultural barriers to care, but also prioritizes understanding these barriers and creating solutions, actively engages minoritized communities with lived experiences, and tests for the effectiveness of community-informed interventions to address racial and ethnic inequities.

Prioritizing policy changes that affect social and structural determinants of health and dismantle systemic racism at all levels and in all settings, such as voting rights; housing discrimination; living wages; affirmative action; and diversity, equity, and inclusion programs, with the understanding that these systems affect reproductive health outcomes for individuals and communities