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Release: Sept. 6, 2000

UI researcher: better, more accessible prenatal services needed for African-American women

IOWA CITY, Iowa -- Reproductive health care professionals need to develop better strategies to reduce pregnancy-related deaths among African-American women, according to a study led by a researcher at the University of Iowa College of Public Health.

The study included investigators from the Centers for Disease Control and Prevention in Atlanta, Ga. The results were published in the Sept. 1 issue of the American Journal of Epidemiology.

According to Audrey Saftlas, Ph.D., UI associate professor of epidemiology and the study's lead author, the study was designed to determine whether the fourfold increased risk of pregnancy-related deaths for black women compared to white women in the United States can be explained by racial differences in sociodemographic and reproductive factors.

The investigators examined the cases of 840 white women and 448 black women whose pregnancies resulted in a live birth and who died of a pregnancy-related cause between 1979 and 1986. The control group consisted of 5,437 randomly selected white and black women who delivered live babies in the United States during the same time period and did not die from a pregnancy-related cause.

Although the researchers adjusted for risk factors, it did not explain the racial gap in pregnancy-related deaths.

"We found that the racial gap differed substantially by parity and birth weight," Saftlas said. Parity is a term used to denote a woman's reproductive history, specifically the number of children she has delivered. In the study, women who bore one to three children were classified as having low to moderate parity, and women who bore four or more children were classified as having high parity.

The study found that high-parity black and white women who delivered low birth weight babies had the highest rates of maternal death, yet showed no racial disparity. In other words, the rates of pregnancy-related death for high-risk white women were just as high as those for their high-risk black counterparts.

"We found that the women in the low-birth weight, high-parity group had a higher rate of maternal mortality," Saftlas said. "All the women in this group -- black and white -- were at a higher risk of dying."

In contrast, a racial gap exists among women at lower risk of maternal mortality, Saftlas said.

The study revealed that the greatest racial disparity occurred among low-risk women: those who delivered normal birth weight babies and had low to moderate parity. The rate of maternal mortality was three and one-half times higher for low-risk black women than for their white counterparts.

In response to these findings, the authors of the study call for the health care system to make comprehensive reproductive health services more available to black and other minority women and to ensure that women are able and willing to use the services.

"With current medical knowledge and technology, more than half of maternal deaths can be prevented," Saftlas said. "We need to develop strategies to improve the content of and access to prenatal care for all black women -- not just black women at high risk, but also those considered at low risk."

The American Journal of Epidemiology is the premier scientific journal devoted to the publication of empirical research findings and methodologic developments in the field of epidemiologic research.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.