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Published July 21, 2024

Opinion: Advancing health equity must include eliminating racial inequalities in preterm birth

Group prenatal care could help to eliminate these inequalities.
Image by Sarah Mai

Children are the future, so we must give them the best shot at health possible. Being born preterm, which is prior to 37 weeks, can set children up for serious health problems like infection, neurological challenges, lung underdevelopment and low birth weight. Being born preterm may even rob a child’s potential before they begin: preterm birth is the second-leading cause of death for kids under 5 years old. Unfortunately, racism also harms families and hurts their chances to live a healthy life. That’s why Minnesota must eliminate its racial inequalities in preterm birth rates. Preterm births in Ramsey County, for example, occur in 11.3% of births to Black people, while only 8.7% of births to white people are preterm.

Researchers are working hard to figure out what causes higher rates of preterm births in Black people compared to white people. A University of Minnesota research team discovered living in overly-policed neighborhoods increases preterm births by nearly 100%. This hurts both Black and white people, but the racialized nature of policing means Black pregnant people have more contact episodes with police throughout their lifetime, which creates stress and trauma.

Hypertension, which is high blood pressure, before pregnancy has also been linked to preterm birth.  About 18.7% of Black pregnant people have been previously diagnosed with hypertension, while only 8.7% of white pregnant people have been diagnosed.

Prenatal care is an important part of preventing preterm births. Unfortunately, Minnesota has large inequality problems in prenatal care. The Minnesota Department of Health found in 2019 that 6% of white pregnant people had no or inadequate prenatal care, however, about 20% of Black Minnesotans received no or inadequate prenatal care.

My vision for health equity is that all pregnant Minnesotans have prenatal care that nurtures them during pregnancy, so children are not being born preterm at different rates between races. My vision would also include as few preterm births as possible in Minnesota overall.

To mitigate the higher and racially inequitable rate of preterm births to Black people, the Minnesota Legislature should amend Minnesota statute to allow Medicaid reimbursement for group prenatal care models.  Currently, prenatal care visits are mostly short, one-on-one visits between the pregnant person and health care provider.  These types of visits can be intimidating to some newly pregnant people, especially if the provider does not show sensitivity and acceptance of the pregnant person’s culture.

In contrast, group prenatal care brings together groups of eight to 10 pregnant people who receive standard prenatal visits and individualized time with their provider. They also partake in group discussions and activities to address topics such as common discomforts and concerns, labor and delivery, breastfeeding, infant care, nutrition and stress management. This group model allows for relationship building and provides pregnant people with a safe, supportive community.

This solution would be effective at reducing preterm birth rates for Black people in Minnesota. Clinical trials have shown a group prenatal care model can almost eliminate racial disparities in preterm births. Using Medicaid as the vehicle would specifically benefit Black people in Minnesota because 71.2% of Black pregnant people in the state were covered by Medicaid from 2018-2020. Passing this policy would benefit low-income pregnant Black people in Minnesota by increasing their choices for types of prenatal care available, so they can choose between individual or group prenatal care models. With better prenatal care, we can reduce the preterm birth rates in Minnesota and fight for racial equality.

It’s important to acknowledge the economic and social context of this problem in Minnesota. The income gap between Black and white people in Minnesota is the second highest in the nation: 25.4% of Black people in the Twin Cities metro live below the poverty line, as compared to 5.3% of white people. Discriminatory treatment of Black people in medical settings has also been normalized through historical and current acts of violence, including the chattel slavery system, forced gynecological experimentation and racial stereotypes.

Critics might be concerned about the costs of allowing Medicaid reimbursement for group prenatal care. However, long-term savings would outweigh the costs: every preterm birth prevented through a group prenatal care program in South Carolina saved that state an average of $22,667 in health care costs. George Floyd’s 2020 murder has amplified concerns about racial injustice in all parts of society, including health care.  The time is now for the Minnesota Legislature to address the racially inequitable rates of preterm births in Minnesota through Medicaid reimbursement for group prenatal care.

Diane Sherwin is a first-year Master of Public Health student at the University of Minnesota School of
Public Health, concentrating in public health administration and policy.

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