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Pandemic widened disparities in postpartum care, study of Boston-area women finds

According to a new study by researchers at Brigham and Women’s Hospital, Black and Hispanic women in the Boston area who delivered babies during the pandemic were less likely than their white counterparts to schedule doctor's appointments after giving birth.John Tlumacki/Globe Staff

Black and Hispanic women in the Boston area who delivered babies during the pandemic were less likely than their white counterparts to schedule doctor’s appointments after giving birth, according to a recent study by researchers at Brigham and Women’s Hospital.

The research found that postpartum care, after dropping among all races in the first quarter of 2020, rebounded more slowly among Black and Hispanic parents.

“The COVID-19 pandemic changed everything,” said Dr. Jie Zhou, the study’s senior author, in an e-mail. “We initially hoped that postpartum care would return to normal. But the reality and the study confirmed that the effect could last longer.”

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Experts in maternal health care said the findings, published in the journal JAMA Network Open, reinforced previous research. But they welcomed the added detail and attention the study brings to the importance of individuals’ visiting their own doctor in the year after giving birth, as well as to the pandemic’s effects on racial and ethnic disparities.

“I am really excited about this kind of work because I’m so glad these issues are being raised,” said Dr. Audra Robertson Meadows, an obstetrician-gynecologist at UC San Diego Health, who previously served on the Special Commission on Racial Inequities in Maternal Health in Massachusetts.

Black women are three to four times more likely than white women to die of pregnancy-related complications. Many of these deaths occur during the postpartum period when complications triggered or worsened by pregnancy, such as diabetes and hypertension, can flare up. Postpartum depression is also common, but can be missed if people don’t seek care.

“As a society we need to be aware that such disparities exist, probably much greater than we all think,” Zhou said. “Health care in the twenty-first century should be for community and society. No one should be left behind.”

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In the new study, Zhou’s team analyzed the electronic medical records of 45,588 women who delivered babies between January 2019 and November 2021 at eight hospitals in the Mass General Brigham system.

They documented a sharp drop-off in postpartum visits by all races at the start of the pandemic. Those visits rebounded beginning in April 2020, but less so for Black and Hispanic mothers, who were more likely to cancel doctor’s visits or fail to schedule them.

For example, between April 2020 and November 2021, 3.7 percent of white women canceled their postpartum visits, compared with 10 percent of Black women and 7.9 percent of Hispanic women.

The findings build on previous research showing that Black and Hispanic families suffered disproportionately during the pandemic, said Maria Steenland, an assistant research professor at Brown University who studies Medicaid policy and pregnancy health care.

But she added, “There hasn’t been a lot of large-scale research on the effect of the pandemic on postpartum care, and especially by race and ethnicity.”

Steenland said the study left unanswered questions about what’s driving the differences in women’s health care. “Is it job types? Ability to work from home? Access to telehealth? [Lack of] paid leave?… Just not having someone at home to take care of your child during the visit is a big issue,” she said.

Dr. Rose L. Molina, an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School who studies disparities in maternal health, said the postpartum months are a critical transitional period physically, socially, and emotionally — but parents caring for a newborn often have difficulty focusing on their own health.

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“The COVID pandemic was an important crucible in bringing this to light” because parents were especially isolated, she said. ”There’s been increasing focus on postpartum care. This study puts a magnifying glass particularly on the pandemic.”

Meadows, the San Diego ob-gyn, praised the study for deploying data to deepen the knowledge on health disparities. “If we don’t use data in that way, we won’t uncover those nuances that explain the differences in those populations,” she said.

Until recently, Meadows held a leadership position in obstetrics at the Brigham, where she witnessed how the system can make it difficult for people to access care. During the pandemic, the hospital had to adjust its no-child policy after women coming for postpartum visits were turned away because they brought their newborns with them. Meadows recalls a patient with limited English proficiency who was advised to come for a visit because she had a fever probably caused by a postpartum infection. But she was turned away at the door when, in response to a COVID-19 screening question, she said she had a fever.

These examples illustrate how systemic issues, rather than individual choices, contribute to disparities, Meadows said.

“We need to think about that and ensure we take these issues into consideration as we put forward policies,” she said.


Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.