Hospital Variations in Postpartum Care Access, Quality, and Outcome: The Intersectionality of
Residence Location and Race/Ethnicity
Summary
The United States (U.S.) is amid a maternal health crisis, with increasing postpartum readmissions (PPR)
and maternal mental and substance use disorders. Rural and racial disparities in these postpartum care and
health outcomes especially persistent in the Southern U.S.. Most importantly, South Carolina (SC) ranked top
7th for the highest maternal mortality rate in the U.S.. In such a rural state where nearly 30% of reproductive-
age women were Black population and where racial inequities in adverse maternal outcomes have been
unacceptably persistent, the need to improving postpartum health outcomes is acute. Yet, addressing the
increase in PPR requires a localized holistic approach that encompasses improved preconception, antenatal,
and perinatal care to reduce healthcare disparities. Our primary goal is to quantify hospital variations
in postpartum health and health care inequities in racial underrepresented and rural
postpartum women. We will analyze >300,000 childbirths in SC from 2018-2023 by leveraging statewide
population-based vital records and hospital-based inpatient, outpatient, and emergency department records
from preconception, pregnancy, through 12 months postpartum. These data will also be linked to hospital
surveys for a variety of hospital factors. The aims of our study are to: Aim 1: Investigate the intersections of
residential rurality and race/ethnicity on the postpartum care access, quality, and outcomes throughout 1-year
post-birth. Aim 2: Examine the roles of hospital attributes (obstetric patient race/ethnicity mix, perinatal care
level [Level I-IV], obstetric workforce models [obstetricians, family physicians, and/or nurse midwives],
annual delivery volume) play on health inequities in postpartum outcomes. The proposed research is
significant by identifying hospital factors for postpartum inequities, to inform targeted sustainable practice
and policies for the improvement of maternal health and elimination of rural and racial/ethnic inequities at
hospital maternity care settings. It builds on our multidisciplinary research team from U01HD110062 and
3R01AI127203-05S2 with extensive experience in 1) rurality and race/ethnicity, 2) social and structural
determinants of health, 3) perinatal care equity, 4) mental health and substance use disorder, and 5) health
behaviors. This research is innovative in leveraging population-based all-payer healthcare records-vital
statistics linkage data that captures underrepresented and underserved perinatal populations that were often
underreported in health care claims data from preconception, pregnancy, intrapartum, through 12-month
postpartum, allowing us to identify postpartum inequities resulting from different perinatal periods.
Considering striking racial disparities in postpartum outcomes, racially diverse population, and historical
systemic racism in SC, the results will highlight opportunities for improvement in postpartum discharge
planning especially for marginalized people who are at highest risk of adverse postpartum outcomes.
