Despite Equal Access and Use of VA Care, Black Veterans are More Likely to Experience Postpartum Rehospitalization and Low-Birthweight Infants
BACKGROUND:
Racial disparities in pregnancy care and outcomes in the U.S. are well documented. Compared with white women, Black women are less likely to have timely prenatal care, less likely to have a vaginal birth versus a cesarean section, less likely to breast-feed, and more likely to experience postpartum depression. This study sought to determine whether Black/white racial disparities in access, use, and outcomes are present among pregnant and postpartum Veterans and their infants using VA maternity care. Adapted from a CDC survey, the VA National Veteran Pregnancy and Maternity Care Survey (VETPRAMS) included all Veterans with a VA paid live birth between June 2018 and December 2019 under VA care. Veterans (Black = 916; white = 304; total = 1,220) completed the survey online or by phone. Measured outcomes included: timely initiation of prenatal care, perceived access to timely prenatal care, attendance at a postpartum check-up, receipt of needed mental healthcare, cesarean section, postpartum rehospitalization, low birthweight, preterm birth, admission to a neonatal intensive care unit, and breastfeeding. The independent variable was self-reported race.
FINDINGS:
- No statistically significant racial disparities in access or use of care during the perinatal period were detectable; nevertheless, Black Veterans were more likely than white Veterans to experience postpartum rehospitalization and to have a low-birthweight infant.
- After adjusting for age, rurality, and parity, Black Veterans were 67% more likely than white Veterans to have a postpartum rehospitalization and 67% more likely to have a low-birthweight infant. No other racial disparities in outcomes for birthing Veterans or their infants were detected.
- Approximately one-third of both Black and white Veterans reported needing mental healthcare during pregnancy. However, one in five Veterans were unable to access needed mental healthcare indicating there may be a persistent unmet need for perinatal mental healthcare.
IMPLICATIONS:
- Study findings underscore the idea that access is necessary but not sufficient for ensuring health equity. Future policies and programs should continue to strengthen perinatal mental healthcare access and services for all pregnant and postpartum Veterans, and future research should consider a life-course perspective and partnering with community-based organizations to ensure Black Veterans have access to culturally competent continual support throughout all stages of pregnancy.
LIMITATIONS:
- Linkage with infant medical data was not possible.
- The survey asked specifically about racial identity from the perspective of the respondent – and did not include an option to check more than one race.
AUTHOR/FUNDING INFORMATION:
Dr. Katon is part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), Los Angeles, CA. She was supported by an HSR&D Career Development Award (CDA).
Katon J, Bossick A, Tartaglione E, et al. Assessing Racial Disparities in Access, Use, and Outcomes for Pregnant and Postpartum Veterans and Their Infants in Veterans Health Administration. Journal of Women’s Health. July 2023;32(7):757-766.
