Advertisement

Society for Maternal-Fetal Medicine Special Statement: Race in maternal-fetal medicine research- Dispelling myths and taking an accurate, antiracist approach

Published:November 10, 2021DOI:https://doi.org/10.1016/j.ajog.2021.11.023
      Profound inequities in maternal and infant outcomes based on race exist, and the maternal-fetal medicine community has an important role in eliminating these disparities. Accurately employing race and ethnicity as social constructs within research that guides clinical practice is essential to achieving health equity. We must abandon commonly propagated myths that race is a surrogate for genetics or economic status and that data are exempt from potential bias. These myths can lead to harmful misconceptions that exacerbate racial disparities in maternal and infant health outcomes. Furthermore, these myths obscure racism as the true underlying etiology of racial disparities. Understanding that race is a social construct and using an antiracist approach to research are essential in combating racism and eliminating unacceptable disparities in maternal and infant health. This document provides specific suggestions to approach the research process with an antiracist framework.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Howell E.A.
        Reducing disparities in severe maternal morbidity and mortality.
        Clin Obstet Gynecol. 2018; 61: 387-399
        • Matoba N.
        • Collins Jr., J.W.
        Racial disparity in infant mortality.
        Semin Perinatol. 2017; 41: 354-359
        • Corbie-Smith G.
        • Henderson G.
        • Blumenthal C.
        • Dorrance J.
        • Estroff S.
        Conceptualizing race in research.
        J Natl Med Assoc. 2008; 100: 1235-1243
        • Knerr S.
        • Wayman D.
        • Bonham V.L.
        Inclusion of racial and ethnic minorities in genetic research: advance the spirit by changing the rules?.
        J Law Med Ethics. 2011; 39: 502-512
        • Wailoo K.
        Historical aspects of race and medicine: the case of J. Marion Sims.
        JAMA. 2018; 320: 1529-1530
        • Bonham V.L.
        • Green E.D.
        • Pérez-Stable E.J.
        Examining how race, ethnicity, and ancestry data are used in biomedical research.
        JAMA. 2018; 320: 1533-1534
        • Cooper R.S.
        • Nadkarni G.N.
        • Ogedegbe G.
        Race, ancestry, and reporting in medical journals.
        JAMA. 2018; 320: 1531-1532
        • Ellison G.T.
        • Smart A.
        • Tutton R.
        • Outram S.M.
        • Ashcroft R.
        • Martin P.
        Racial categories in medicine: a failure of evidence-based practice?.
        PLoS Med. 2007; 4: e287
        • Braun L.
        • Fausto-Sterling A.
        • Fullwiley D.
        • et al.
        Racial categories in medical practice: how useful are they?.
        PLoS Med. 2007; 4: e271
        • Boyd R.W.
        • Lindo E.G.
        • Weeks L.D.
        • McLemore M.R.
        On racism: a new standard for publishing on racial health inequities.
        (Available at:) (Accessed November 30, 2021)
        • Flanagin A.
        • Frey T.
        • Christiansen S.L.
        • Bauchner H.
        The reporting of race and ethnicity in medical and science journals: comments invited.
        JAMA. 2021; 325: 1049-1052
      1. Merriam-Webster dictionary. Race.
        (Available at:)
        https://www.merriam-webster.com/dictionary/race
        Date accessed: September 2, 2021
      2. Merriam-Webster dictionary. Ancestry.
        (Available at:)
      3. Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care.
        in: Smedley B.D. Stith A.Y. Nelson A.R. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press, Washington, DC2003
        • World Health Organization
        Social determinants of health: health equity.
        (Available at:)
        • Braveman P.
        What are health disparities and health equity? We need to be clear.
        Public Health Rep. 2014; 129: 5-8
        • Jones C.P.
        Levels of racism: a theoretic framework and a gardener’s tale.
        Am J Public Health. 2000; 90: 1212-1215
        • Braveman P.
        • Arkin E.
        • Orleans T.
        • Proctor D.
        • Plough A.
        What Is Health Equity? And What Difference Does à Definition Make?.
        Robert Wood Johnson Foundation, Princeton, NJ2017
        • Nelson A.
        Unequal treatment: confronting racial and ethnic disparities in health care.
        J Natl Med Assoc. 2002; 94: 666-668
        • McGuire T.G.
        • Alegria M.
        • Cook B.L.
        • Wells K.B.
        • Zaslavsky A.M.
        Implementing the Institute of Medicine definition of disparities: an application to mental health care.
        Health Serv Res. 2006; 41: 1979-2005
      4. Healthy People 2020. Disparities.
        (Available at:)
        • Crenshaw K.
        On Intersectionality: Essential Writings.
        The New Press, New York2019
        • Outram S.M.
        • Ellison G.T.
        Anthropological insights into the use of race/ethnicity to explore genetic contributions to disparities in health.
        J Biosoc Sci. 2006; 38: 83-102
        • Jorde L.B.
        • Wooding S.P.
        Genetic variation, classification and ’race’.
        Nat Genet. 2004; 36: S28-S33
        • Kittles R.A.
        • Weiss K.M.
        Race, ancestry, and genes: implications for defining disease risk.
        Annu Rev Genomics Hum Genet. 2003; 4: 33-67
        • Mukherjee S.
        The Gene: An Intimate History. First Scribner hardcover edition.
        Scribner, New York2016
        • Rothman J.D.
        Notorious in the Neighborhood: Sex and Families Across the Color Line in Virginia, 1787-1861.
        University of North Carolina Press, Chapel Hill2003
        • Omi M.
        • Winant H.
        Racial Formation in the United States: From the 1960s to the 1990s.
        2nd ed. Routledge, New York1994
      5. American Association of Physical Anthropologists. AAPA statement on biological aspects of race..
        Am Anthropol. 1998; 100: 714-715
        • Swartz T.H.
        • Palermo A.S.
        • Masur S.K.
        • Aberg J.A.
        The science and value of diversity: closing the gaps in our understanding of inclusion and diversity.
        J Infect Dis. 2019; 220: S33-S41
        • Frazier T.
        • Hogue C.J.R.
        • Bonney E.A.
        • Yount K.M.
        • Pearce B.D.
        Weathering the storm; a review of pre-pregnancy stress and risk of spontaneous abortion.
        Psychoneuroendocrinology. 2018; 92: 142-154
        • Black Mammas Matters Alliance
        Setting the Standard for Holistic Care of and for Black Women.
        (Available at:) (Accessed November 30, 2021)
        • McEwen B.S.
        • Stellar E.
        Stress and the individual. Mechanisms leading to disease.
        Arch Intern Med. 1993; 153: 2093-2101
        • Fava G.A.
        • McEwen B.S.
        • Guidi J.
        • Gostoli S.
        • Offidani E.
        • Sonino N.
        Clinical characterization of allostatic overload.
        Psychoneuroendocrinology. 2019; 108: 94-101
        • McEwen B.S.
        Protective and damaging effects of stress mediators.
        N Engl J Med. 1998; 338: 171-179
        • Geronimus A.T.
        Black/white differences in the relationship of maternal age to birthweight: a population-based test of the weathering hypothesis.
        Soc Sci Med. 1996; 42: 589-597
        • Geronimus A.T.
        • Hicken M.T.
        • Pearson J.A.
        • Seashols S.J.
        • Brown K.L.
        • Cruz T.D.
        Do US black women experience stress-related accelerated biological aging? A novel theory and first population-based test of black-white differences in telomere length.
        Hum Nat. 2010; 21: 19-38
        • Hantsoo L.
        • Kornfield S.
        • Anguera M.C.
        • Epperson C.N.
        Inflammation: a proposed intermediary between maternal stress and offspring neuropsychiatric risk.
        Biol Psychiatry. 2019; 85: 97-106
        • Picard M.
        • McEwen B.S.
        Psychological stress and mitochondria: a systematic review.
        Psychosom Med. 2018; 80: 141-153
        • Weaver I.C.
        Epigenetic programming by maternal behavior and pharmacological intervention. Nature versus nurture: let’s call the whole thing off.
        Epigenetics. 2007; 2: 22-28
        • Rothstein R.
        The Color of Law: a Forgotten History of How Our Government Segregated America.
        1st ed. Liveright Publishing Corporation, New York2017
        • Thompson J.
        The GI Bill should’ve been race neutral, politicos made sure it wasn’t. Military Times.
        (Available at:) (Accessed November 30, 2021)
        • Krieger N.
        • Van Wye G.
        • Huynh M.
        • et al.
        Structural racism, historical redlining, and risk of preterm birth in New York City, 2013–2017.
        Am J Public Health. 2020; 110: 1046-1053
        • Nardone A.L.
        • Casey J.A.
        • Rudolph K.E.
        • Karasek D.
        • Mujahid M.
        • Morello-Frosch R.
        Associations between historical redlining and birth outcomes from 2006 through 2015 in California.
        PLoS One. 2020; 15e0237241
        • Petersen E.E.
        • Davis N.L.
        • Goodman D.
        • et al.
        Racial/ethnic disparities in pregnancy-related deaths - United States, 2007–2016.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 762-765
        • Harper M.A.
        • Espeland M.A.
        • Dugan E.
        • Meyer R.
        • Lane K.
        • Williams S.
        Racial disparity in pregnancy-related mortality following a live birth outcome.
        Ann Epidemiol. 2004; 14: 274-279
        • Cook B.L.
        • McGuire T.G.
        • Zaslavsky A.M.
        Measuring racial/ethnic disparities in health care: methods and practical issues.
        Health Serv Res. 2012; 47: 1232-1254
        • Cunningham F.G.
        Williams Obstetrics.
        24th ed. McGraw-Hill Medical, New York2014
        • Todd T.W.
        • Lindala A.
        Dimensions of the body: whites and American negroes of both sexes.
        Am J Phys Anthropol. 1928; 12: 35-119
        • Caldwell W.E.
        • Moloy H.C.
        Anatomical variations in the female pelvis: their classification and obstetrical significance: (Section of Obstetrics and Gynaecology).
        Proc R Soc Med. 1938; 32: 1-30
        • Vyas D.A.
        • Jones D.S.
        • Meadows A.R.
        • Diouf K.
        • Nour N.M.
        • Schantz-Dunn J.
        Challenging the use of race in the vaginal birth after cesarean section calculator.
        Womens Health Issues. 2019; 29: 201-204
        • Washington H.A.
        Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.
        1st ed. Doubleday Publishing, New York2006
        • Roberts D.
        Killing the Black Body: Race, Reproduction, and the Meaning of Liberty.
        1st ed. Pantheon Books, New York1997
        • Davis D.-A.
        Reproductive Injustice: Racism, Pregnancy, and Premature Birth.
        New York University Press, New York2019
        • Braun L.
        Breathing Race Into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics.
        University of Minnesota Press, Minneapolis2014
        • Lietz M.
        Not that kind of racism: how good people can be racist without awareness or intent.
        (Available at:)
        • Morgan J.D.
        • De Marco A.C.
        • LaForett D.R.
        • et al.
        What racism looks like: an infographic. Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill.
        (Available at:)
        • American Public Health Association
        Racism and health.
        (Available at:)
        • Ford C.L.
        • Airhihenbuwa C.O.
        The public health critical race methodology: praxis for antiracism research.
        Soc Sci Med. 2010; 71: 1390-1398
        • @IjeomaOluo
        The beauty of anti-racism is that you don’t have to pretend to be free of racism to be an anti-racist anti-racism is the commitment to fight racism wherever you find it, including in yourself and it’s the only way forward.
        (Available at:)
        https://twitter.com/ijeomaoluo/status/1150565193832943617
        Date: 2019
        Date accessed: September 28, 2021
        • National Institutes of Health
        Racial and ethnic categories and definitions for NIH diversity programs and for other reporting purposes.
        (Available at:)
        • Ghidei L.
        • Murray A.
        • Singer J.
        Race, research, and women’s health: best practice guidelines for investigators.
        Obstet Gynecol. 2019; 133: 815-818
        • Wheeler S.M.
        • Bryant A.S.
        Racial and ethnic disparities in health and health care.
        Obstet Gynecol Clin North Am. 2017; 44: 1-11
        • Barr D.A.
        Health Disparities in the United States: Social Class, Race, Ethnicity, and the Social Determinants of Health.
        3rd ed. Johns Hopkins University Press, Baltimore2019
        • Kosoko-Lasaki S.
        • Cook C.T.
        • O’Brien R.L.
        Cultural Proficiency in Addressing Health Disparities.
        Jones and Bartlett Publishers, Sudbury, UK2009
        • Delgado R.
        • Stefancic J.
        Critical Race Theory: An Introduction.
        3rd ed. New York University Press, New York2017
        • Ford C.L.
        • Takahashi L.M.
        • Chandanabhumma P.P.
        • Ruiz M.E.
        • Cunningham W.E.
        Anti-racism methods for big data research: lessons learned from the HIV testing, linkage, & retention in care (HIV TLR) study.
        Ethn Dis. 2018; 28: 261-266
        • McLemore M.R.
        • Asiodu I.
        • Crear-Perry J.
        • et al.
        Race, research, and women’s health: best practice guidelines for investigators.
        Obstet Gynecol. 2019; 134: 422-423
        • Gomez L.E.
        • Bernet P.
        Diversity improves performance and outcomes.
        J Natl Med Assoc. 2019; 111: 383-392
        • Behera A.
        • Tan J.
        • Erickson H.
        Diversity and the next-generation physician-scientist.
        J Clin Transl Sci. 2019; 3: 47-49
        • Resar L.M.
        • Jaffee E.M.
        • Armanios M.
        • et al.
        Equity and diversity in academic medicine: a perspective from the JCI editors.
        J Clin Invest. 2019; 129: 3974-3977
        • Hall A.K.
        • Mills S.L.
        • Lund P.K.
        Clinician-investigator training and the need to pilot new approaches to recruiting and retaining this workforce.
        Acad Med. 2017; 92: 1382-1389
        • Wendler D.
        • Kington R.
        • Madans J.
        • et al.
        Are racial and ethnic minorities less willing to participate in health research?.
        PLoS Med. 2006; 3: e19
        • Goff S.L.
        • Youssef Y.
        • Pekow P.S.
        • et al.
        Successful strategies for practice-based recruitment of racial and ethnic minority pregnant women in a randomized controlled trial: the IDEAS for a healthy baby study.
        J Racial Ethn Health Disparities. 2016; 3: 731-737
        • Van Ryn M.
        Avoiding unintended bias: strategies for providing more equitable health care.
        Minn Med. 2016; 99 (40–3, 46)
        • DataCenter: Research for Justice
        Research Justice: a strategic framework to achieve self-determination for marginalized communities.
        (Available at:)
      6. Coalition of Communities of Color. Research and Data Justice.
        (Available at:)
      7. Clinical and Translational Science Awards Consortium Community Engagement Key Function Committee Task Force on the Principles of Community Engagement, United States Washington Department of Health and Human Services, National Institutes of Health, Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry, eds. Principles of Community Engagement, Second Edition. 2011. Available at: https://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf. Accessed October 7, 2021.

        • Grobman W.A.
        • Sandoval G.
        • Rice M.M.
        • et al.
        Prediction of vaginal birth after cesarean delivery in term gestations: a calculator without race and ethnicity.
        Am J Obstet Gynecol. 2021; ([Epub ahead of print])
        • Wolff R.F.
        • Moons K.G.M.
        • Riley R.D.
        • et al.
        PROBAST: a tool to assess the risk of bias and applicability of prediction model studies.
        Ann Intern Med. 2019; 170: 51-58
        • Moons K.G.M.
        • Wolff R.F.
        • Riley R.D.
        • et al.
        PROBAST: a tool to assess risk of bias and applicability of prediction model studies: explanation and elaboration.
        Ann Intern Med. 2019; 170: W1-W33
        • Ellis D.
        The arc of the moral universe is long, but it bends toward justice.
        (Available at:)