Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance

In this report, we evaluate health equity across race and ethnicity, both within and between states, to illuminate how state health systems perform for Black, white, Latinx/Hispanic, AIAN, and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations. Our hope is that policymakers and health system leaders will use this tool to investigate the impact of past policies on health across racial and ethnic groups, and that they will begin to take steps to ensure an equitable, antiracist health care system for the future

How Expanding the Role of Midwives in U.S. Health Care Could Help Address the Maternal Health Crisis

Midwives are licensed health care providers who offer a wide range of essential reproductive and sexual health care services, from birth and newborn care to Pap tests and contraceptive care. Research consistently demonstrates that when midwives play a central role in the provision of maternal care, patients are more satisfied, clinical outcomes for parents and infants improve, and costs decrease. Use of midwives is also associated with fewer cesarean sections, lower preterm birth rates, lower episiotomy rates, higher breastfeeding rates, and a greater sense of respect and autonomy for the patient.Given the many benefits of midwives, and the profound maternal care inequities affecting Black and Indigenous families in the U.S., it's important to understand how they could be better integrated into the U.S. health care system. This includes the intentional integration of midwifery across the complex health care ecosystem in order to ensure midwifery care is accessible, affordable, and equitable to all childbearing people

The U.S. Maternal Health Divide: The Limited Maternal Health Services and Worse Outcomes of States Proposing New Abortion Restrictions

Issue: In response to the U.S. Supreme Court's overturning of Roe v. Wade, a number of states have passed, or are planning to pass, partial or complete bans on abortion. A key question is whether these restrictions will result in reduced overall access to maternal and infant care, as well as worse health outcomes, in these states.Goals: Compare the current status of maternal and infant health in states that have or are likely to have bans or restrictions on abortion access with states that will preserve abortion access and consider how new abortion restrictions could affect maternal and infant health in the future.Methods: We drew on public data sources such as the CDC WONDER birth and death files, Area Health Resources Files, and the March of Dimes maternity care deserts report. We stratified states based on Guttmacher Institute ratings of the restrictiveness of state abortion policies.Key Findings and Conclusions: Compared to states where abortion is accessible, states that have banned, are planning to ban, or have otherwise restricted abortion have fewer maternity care providers; more maternity care "deserts"; higher rates of maternal mortality and infant death, especially among women of color; higher overall death rates for women of reproductive age; and greater racial inequities across their health care systems

Inequities in Health and Health Care in Black and Latinx/Hispanic Communities: 23 Charts

COVID-19 has devastated Black and Latinx/Hispanic communities in the United States during the past year, erasing recent life expectancy gains and reinforcing racism as a potent, structural driver of health and human inequity.The health disparities contributing to this burden are long-standing. They reach well beyond the pandemic and have left many communities of color with historically worse outcomes. This chartbook details inequities between white, Black, and Latinx/Hispanic communities across a range of health indicators in four main areas:insurance coverage and access to carereceipt of health serviceshealth statusmortality

Counseling of female veterans about risks of medication-induced birth defects.

BackgroundMedications that may increase risk of birth defects if used during pregnancy or immediately preconception are dispensed to approximately half of female Veterans who fill prescriptions at a VA pharmacy.ObjectiveTo assess receipt of counseling about risk of medication-induced birth defects among female Veterans of reproductive age and to examine Veterans' confidence that their healthcare provider would counsel them about teratogenic risks.Design and participantsCross-sectional analysis of data provided by 286 female Veterans of Operation Iraqi Freedom and/or Operation Enduring Freedom who completed a mailed survey between July 2008 and October 2010.Main measuresWe examined associations between demographic, reproductive, and health service utilization variables and female Veterans' receipt of counseling and confidence that they would receive such counseling.Key resultsThe response rate was 11 %; the large majority (89 %) of responding female Veterans reported use of a prescription medication in the last 12 months. Most (90 %) of the 286 female Veterans who reported medication use were confident that they would be told by their healthcare provider if a medication might cause a birth defect. However, only 24 % of women who received prescription medications reported they had been warned of teratogenic risks. Female Veterans who used medications that are known to be teratogenic were not more likely than women using other medications to report having been warned about risks of medication-induced birth defects, and fewer were confident that their health care providers would provide teratogenic risk counseling when needed.ConclusionsFemale Veterans may not receive appropriate counseling when medications that can cause birth defects are prescribed

Counseling of female veterans about risks of medication-induced birth defects

BACKGROUND: Medications that may increase risk of birth defects if used during pregnancy or immediately preconception are dispensed to approximately half of female Veterans who fill prescriptions at a VA pharmacy. OBJECTIVE: To assess receipt of counseling about risk of medication-induced birth defects among female Veterans of reproductive age and to examine Veterans\u27 confidence that their healthcare provider would counsel them about teratogenic risks. DESIGN AND PARTICIPANTS: Cross-sectional analysis of data provided by 286 female Veterans of Operation Iraqi Freedom and/or Operation Enduring Freedom who completed a mailed survey between July 2008 and October 2010. MAIN MEASURES: We examined associations between demographic, reproductive, and health service utilization variables and female Veterans\u27 receipt of counseling and confidence that they would receive such counseling. KEY RESULTS: The response rate was 11 %; the large majority (89 %) of responding female Veterans reported use of a prescription medication in the last 12 months. Most (90 %) of the 286 female Veterans who reported medication use were confident that they would be told by their healthcare provider if a medication might cause a birth defect. However, only 24 % of women who received prescription medications reported they had been warned of teratogenic risks. Female Veterans who used medications that are known to be teratogenic were not more likely than women using other medications to report having been warned about risks of medication-induced birth defects, and fewer were confident that their health care providers would provide teratogenic risk counseling when needed. CONCLUSIONS: Female Veterans may not receive appropriate counseling when medications that can cause birth defects are prescribed

Unintended Pregnancy and Contraceptive Use Among Women Veterans: The ECUUN Study

BackgroundLittle is known about contraceptive care for the growing population of women veterans who receive care in the Veterans Administration (VA) healthcare system.ObjectiveTo determine rates of contraceptive use, unmet need for prescription contraception, and unintended pregnancy among reproductive-aged women veterans.Design and participantsWe conducted a cross-sectional, telephone-based survey with a national sample of 2302 women veterans aged 18-44 years who had received primary care in the VA within the prior 12 months.Main measuresDescriptive statistics were used to estimate rates of contraceptive use and unintended pregnancy in the total sample. We also estimated the unmet need for prescription contraception in the subset of women at risk for unintended pregnancy. For comparison, we calculated age-adjusted US population estimates using data from the 2011-2013 National Survey of Family Growth (NSFG).Key resultsOverall, 62% of women veterans reported current use of contraception, compared to 68% of women in the age-adjusted US population. Among the subset of women at risk for unintended pregnancy, 27% of women veterans were not using prescription contraception, compared to 30% in the US population. Among women veterans, the annual unintended pregnancy rate was 26 per 1000 women; 37% of pregnancies were unintended. In the age-adjusted US population, the annual rate of unintended pregnancy was 34 per 1000 women; 35% of pregnancies were unintended.ConclusionsWhile rates of contraceptive use, unmet contraceptive need, and unintended pregnancy among women veterans served by the VA are similar to those in the US population, these rates are suboptimal in both populations, with over a quarter of women who are at risk for unintended pregnancy not using prescription contraception, and unintended pregnancies accounting for over a third of all pregnancies. Efforts to improve contraceptive service delivery and to reduce unintended pregnancy are needed for both veteran and civilian populations

Health-Related Quality of Life in HIV-Infected Patients: The Role of Substance Use

HIV infection and substance use disorders are chronic diseases with complex contributions to health-related quality of life (HRQOL). We conducted a cross-sectional survey of 951 HIV-infected adults receiving care at 14 HIV Research Network sites in 2003 to estimate associations between HRQOL and specific substance use among HIV-infected patients. HRQOL was assessed by multi-item measures of physical and role functioning, general health, pain, energy, positive affect, anxiety, and depression. Mental and physical summary scales were developed by factor analysis. We used linear regression to estimate adjusted associations between HRQOL and current illicit use of marijuana, analgesics, heroin, amphetamines, cocaine, sedatives, inhalants, hazardous/binge alcohol, and drug use severity. Current illicit drug use was reported by 37% of subjects. Mental HRQOL was reduced for current users [adjusted β coefficient −9.66, 95% confidence interval [(CI]) −13.4, −5.94] but not former users compared with never users. Amphetamines and sedatives were associated with large decreases in mental (amphetamines: β = −22.8 [95% CI −33.5, −12.0], sedatives: β = −18.6 [95% CI −26.2, −11.0]), and physical HRQOL (amphetamines: β = −11.5 [95% CI −22.6, −0.43], sedatives: β = −13.2 [95% CI −21.0, −5.36]). All illicit drugs were associated with decreased mental HRQOL: marijuana (β = −7.72 [95% CI −12.0, −3.48]), non-prescription analgesics (β = −13.4 [95% CI −20.8, −6.07]), cocaine (β = −10.5 [95% CI −16.4, −4.67]), and inhalants (β = −14.0 [95% CI −24.1, −3.83]). Facilitating sobriety for patients with attention to specific illicit drugs represents an important avenue for elevating HRQOL in patients living with HIV