Conceptualization and measurement of postpartum health inequities in the United States: A scoping review
Christina X. Marea, Emma Clark, Damali M. Wilson, Lauren Aslami, Noelene K. Jeffers, Ashley Gresh, Gabriela F. Gil, Aanya Agarwal, Sanjana Chimata, Octavia Allen Whitfield, Heather M. BradfordBackground
Postpartum health inequities are understudied yet can have profound effects on physical, mental, and social well-being. The majority of pregnancy-related deaths occur in the postpartum period among historically oppressed and racialized groups. The evidence regarding these inequities is impacted by how research conceptualizes and measures them.
Methods
We conducted a scoping review guided by PRISMA-ScR of 5 databases (MEDLINE®, Embase, CINAHL, Web of Science, and PsychInfo) of U.S. research measuring postpartum maternal outcomes from hospital discharge to one year that compared outcomes across at least 2 groups. The National Institute for Minority Health and Health Disparities (NIMHD) Research and PROGRESS-Plus Frameworks guided data extraction.
Result
Among 120 studies (113 quantitative, 7 qualitative), 105 (87.5%) identified at least one postpartum health inequity. Sample Characteristics (PROGRESS-Plus): studies reported between 0 and 11 of the 23 PROGRESS-Plus variables, with race, ethnicity, and age most commonly reported. Postpartum outcomes (NIMHD): clustered at the individual level, most in the behavioral and biological domains. Few studies measured outcomes at the community or societal level. Variables explored for association (NIMHD): independent variables concentrated at the individual level, with sociodemographic (e.g. race, ethnicity, age) most frequent. Race and ethnicity were typically operationalized as fixed individual characteristics and rarely referenced as proxies for exposure to racism, bias, or discrimination. Equity-centered practices that shape knowledge construction were uncommon. Only 26 (21.56%) studies included a theoretical/conceptual framework and 2 (both qualitative) included author positionality statements.
Conclusion
Postpartum health equity research can benefit from expanded use of theoretical frameworks that hypothesize drivers of inequity, examines measurement beyond individual characteristics to capture interpersonal, community and societal exposures, and adopts equity-centered publication practices. This review can inform conceptualization and measurement of postpartum health inequities to interrupt reductionist narratives that may harm historically oppressed and racialized groups and address intersectional axes.