Perinatal Disparities for Black Mothers and Their Newborns
Ian M. Paul Æ Æ Erik B. Lehman Æ Æ Alawia K. Suliman Æ Æ
Marianne M. Hillemeier
Published online: 22 August 2007
? Springer Science+Business Media, LLC 2007
ethnic and racial health and healthcare disparities exist
among our most vulnerable populations, new mothers and
newborns. We sought to determine disparities in socio-
economic status, perinatal health, and perinatal healthcare
for black mothers and their newborns cared for in well-
baby nurseries compared with white mother/baby pairs in
Pennsylvania. Methods A retrospective analysis of a
merged data set containing birth and clinical discharge
records was conducted. Perinatal data from 44,105 black
mothers and their singleton newborns, ?35 weeks gesta-
tional age cared for in Pennsylvania well-baby nurseries
from 1998–2002 were compared with 88,210 white
mother/baby pairs. Results Black mothers were younger
and were much more likely to receive Medicaid or be
uninsured compared with white mothers. They were less
likely to be college-educated, married, or have prenatal
care beginning in the first trimester. Infants born to black
mothers were less likely to be delivered via Cesarean
section, but were more likely to be born between 35 and
38 weeks gestation and be of low birth weight. Conclu-
sions Numerous significant disparities exist for black
Objectives In the United States, significant
mothers and their newborns cared for in well-baby nurs-
eries in Pennsylvania. Since most newborns are cared for in
this setting as opposed to intensive care environments,
recognition of the differences that exist for this group when
compared to well newborns of white mothers can help to
improve healthcare and its delivery to this population.
Federal and local initiatives must continue efforts to
eliminate racial disparities.
Health disparities ? Newborns ? Mothers ?
American Academy of Pediatrics
Pennsylvania Department of Health
Pennsylvania Health Care Cost Containment
Length of stayLOS
It is widely recognized that significant ethnic and racial
health and healthcare disparities exist in the United States
(U.S.) [1–4]. These disparities are also known to affect our
most vulnerable populations, new mothers and their new-
borns, and the U.S. Department of Health and Human
Services specifically cite perinatal racial and ethnic dis-
parities as a target for improvement in their publication,
Healthy People 2010 .
Clearly demonstrating these disparities, blacks have
significantly higher fetal, neonatal, infant, and maternal
mortality rates compared with whites [5–8] Black/white
infant mortality disparities are seen not only in low birth
I. M. Paul (&) ? A. K. Suliman
Department of Pediatrics, Penn State University College of
Medicine, Pediatrics, H085, 500 University Dr., Hershey, PA
I. M. Paul ? E. B. Lehman ? M. M. Hillemeier
Department of Public Health Sciences, Penn State University
College of Medicine, Hershey, PA, USA
M. M. Hillemeier
Department of Health Policy and Administration, Penn State
University College of Health and Human Development,
University Park, PA, USA
Matern Child Health J (2008) 12:452–460
weight infants, but among those with normal birth weights
as well . Blacks also have higher rates of other perinatal
morbidities and socioeconomic characteristics associated
with adverse pregnancy outcomes. Examples of this
include a high teen birth rate, a high rate of births to
unmarried mothers, increased preterm delivery, and the
delivery of low birth weight infants [7, 10, 11] The dif-
ferences in outcomes may be partially attributable to a lack
of or suboptimal prenatal care, which is known to occur
more frequently among U.S. resident blacks [7, 12–15].
blacks have been the subject of numerous reports, less
newborns cared for in non-intensive care environments.
for black mothers, the vast majority of black newborns will
be cared for in well baby nurseries. Black mothers are more
likely to feel that they or their newborns are unready to go
home at the time of hospital discharge , and therefore,
the differences between black mothers and newborns and
their white counterparts in these care settings require
exploration. As such, we sought to determine perinatal
health and healthcare disparities between black and white
mothers and their newborns ?35 weeks gestational age
cared for in non-intensive care newborn nurseries in Penn-
sylvania between 1998 and 2002. Because maternity and
nursery hospital stays after pregnancies average about two
daysnationally,thereislimitedtime forinpatient evaluation
and detection of differential risks. A description of these
lead to improved pre and postnatal care for black mothers
and their newborns. These analyses could help public or
private agencies or organizations seeking to reduce racial
disparities target areas for intervention.
521,656 birth records from singleton newborns ?35 weeks
gestation born in Pennsylvania between 1998 and 2002
were obtained from the Pennsylvania Department of Health
(PDOH) birth registry for retrospective analysis. 418,991
(80.3%) of these birth records were successfully matched
with and then merged with the clinical discharge records
for each newborn collected by the Pennsylvania Health
Care Cost Containment Council (PHC4) through a
matching procedure using date of birth, gender, subject
reported race and ethnicity, zip code, death status, hospital,
gestation, and birth weight as variables in the absence of a
social security number. To exclude those newborns not
typically cared for in a ‘‘well baby’’ newborn nursery, the
only records selected for analysis were those with diag-
nosis-related groups (DRG) 391 (normal newborn) and 388
(preterm newborn without major problems) at discharge.
Those newborns with hospital charges greater than $8,000
([98th %ile) and those with MediQual severity of illness
ratings that were not ‘‘None’’ were excluded because they
were unlikely to represent the typical newborn nursery
population. MediQual is a quality and performance ana-
lytical system required for all Pennsylvania hospitals that is
used to report risk adjusted outcomes . Additionally,
newborns with significant problems that could result in a
complicated, prolonged, or atypical newborn nursery stay
such as respiratory distress syndrome, meconium aspiration
syndrome, seizures, central nervous system anomalies,
heart malformations, Downs syndrome, and other chro-
mosomal anomalies were excluded as has been done in
previous studies [18–24]. Of the remaining records, only
those with maternal self-reported race and ethnicity were
selected for further analysis resulting in a cohort of
374,649 mother/newborn pairs (89.4% of those with
merged PDOH/PHC4 records). 44,105 (11.8%) self-
reported that their race and ethnicity was non-Hispanic
Black, and this sub-group was matched 1:2 with those self-
reporting themselves to be non-Hispanic White for the
The Human Subjects Protection Office of the Penn State
University College of Medicine approved this study.
The merged datasets from PDOH and PHC4 contained an
extensive set of variables related to maternal health status
and hospitalization, newborn health status and hospital-
ization, and socioeconomic variables. Data from the
prenatal period included timing and number of prenatal
care visits, pregnancy weight gain, tobacco and alcohol
use, and pregnancy complications including conditions
such as hypertension, pregnancy-induced hypertension, and
diabetes. Maternity and newborn hospital data included
information on delivery type and complications, length of
stay (LOS) in hours since delivery, infant birth weight, sex,
gestational age, Apgar scores, and neonatal complications.
Socioeconomic data and maternal characteristics included
maternal race, ethnicity, age, parity, education, marital
status, and insurance type. Information on newborn feeding
type was not available.
Perinatal data from mothers self-classified as non-Hispanic
black on the Pennsylvania Certificate of Live Birth and
Matern Child Health J (2008) 12:452–460 453
data on their infants were compared with data from
mothers who reported that they were non-Hispanic white
and their infants. To determine what variables are associ-
ated with differences between black and white mothers, a
bivariate analysis was conducted on the previously men-
tioned list of maternal and infant characteristics of interest
from the matched data. Categorical variables were sum-
marized with frequencies and percentages, and their
associations with mother’s race were tested with chi-square
tests and odds ratios. Two-sample t-tests with means and
95% confidence intervals were used to test for differences
in continuous variables in terms of mother’s race. Where
possible, odds ratios with 95% confidence intervals or
means with 95% confidence intervals are reported.
A mixed model regression analysis was then performed
with hospital LOS as the outcome and mother’s race as the
primary independent variable. Based on the results of our
bivariate analysis and an analysis of associations of the
same set of maternal and infant characteristics with LOS, a
statistically and/or clinically significant set of covariates
mother’s race was included in the model to adjust for
unwanted variation that they may account for in the main
comparison of mother’s race in terms of hospital LOS.
Goodness of fit statistics were used to assess the fit of the
model in the presence and absence of each covariate and
interaction in determining the final model.
Among the eligible subjects, 44,105 (11.8%) newborns in
Pennsylvania between 1998 and 2002 were born to non-
Hispanic black mothers. Table 1 presents comparisons of
perinatal characteristics of black and white mothers in the
study. Frequency distributions or percentages are shown
for blacks in the first column and for whites in the second
column. The third column presents black/white crude odds
ratios, calculated with regard to the indicated reference
category in cases where there are multiple categories. For
example, compared with 25–29 year olds, those under age
20 were 3.77 times more likely to be black than to be
white. For the entire cohort, black mothers were signifi-
cantly younger than non-Hispanic white mothers with a
mean age at delivery of 25.0 years compared with
28.6 years for white mothers (P\0.001). The percentage
born to teen mothers (\20 years of age) was higher for
black mothers (21.0%) compared with white mothers
(6.9%; odds ratio (OR) 3.58; 95% confidence limit (CL)
3.46–3.71). Differences in marital status also existed with
25.8% of black mothers reported being married as
compared with 76.7% of white mothers (OR 0.11; 95% CL
0.10–0.11). Black mothers were also significantly less
likely to have 4 or more years of college (OR 0.25; 95%
CL 0.24–0.26), and were more likely to have Medicaid
(OR 5.09; 95% CL 4.96–5.22) or be uninsured (OR 2.56;
95% CL 2.37–2.76) as opposed to having private
Black mothers were significantly less likely than white
mothers to have prenatal care beginning in the first tri-
mester (OR0.31; 95%
significantly more likely to have chronic hypertension, to
use alcohol, and have pregnancy weight gain at both
extremes of the spectrum compared to more normal pat-
terns of weight gain. In contrast, maternal smoking,
diabetes (chronic or gestational), and pregnancy-induced
hypertension were less common among black than among
CL0.30–0.32), but were
Infants born to black mothers were less likely to be
delivered via Cesarean section (OR 0.82; 95% CL 0.79–
0.84) or assisted vaginal delivery (OR 0.61; 95% CL 0.58–
0.64) and more likely to be born on a weekend (OR 1.22;
95% CL 1.18–1.25).
The mean birth weight for infants ?35 weeks gestational
age born to black mothers was 3252 g. This was signifi-
cantly lower than the infants born to white mothers whose
mean weight was 3454 g (P\0.001). Similarly, infants of
black mothers were more likely to have low birth weight
\2500 g (OR 2.36; 95% CL 2.21–2.51) and they were
more likely to be born between 35 weeks and 36 weeks
(OR 1.80; 95% CL 1.71–1.90) and 37 and 38 weeks ges-
tation (OR 1.27; 95% CL 1.24–1.31) as opposed to 39 or
40 weeks gestation.
Mean nursery LOS was significantly longer for infants
born to black mothers (55.0 h vs. 51.5 h; P\0.001)
despite the fact that there were fewer Cesarean sections.
Short nursery stays\48 h were also less likely to occur for
infants born to black mothers (P\0.001). Black newborns
had longer nursery stays after unassisted and assisted
vaginal deliveries as well as Cesarean sections with and
without stratification for gestational age (Table 2).
Multivariate Analysis of Length of Stay
Race differences in terms of LOS remained statistically
significant in a multivariable model even after adjusting for
454Matern Child Health J (2008) 12:452–460
Table 1 Comparison of perinatal variables between non-Hispanic Blacks and non-Hispanic Whites
Black* N = 44,105 (%) White* N = 88,210 (%)Crude odds ratioP
Age in years
9,244 (21.0)6,088 (6.9) 3.77 (3.62–3.92)
14,035 (31.8) 16,736 (19.0)2.08 (2.01–2.15)
25–2910,059 (22.8)24,952 (28.3) 1.00 (ref)
30–346,777 (15.4)26,227 (29.8) 0.64 (0.62–0.66)
35–393,273 (7.4) 11,979 (13.6)0.68 (0.65–0.71)
Married to newborn’s father
701 (1.6)2,170 (2.5)0.80 (0.73–0.88)
11,369 (25.8)67,683 (76.7)0.11 (0.10–0.11)
\0.001 Primiparous 16,634 (37.9)35,531 (40.4)0.90 (0.88–0.92)
High school graduate or less26,914 (64.0) 37,761 (43.5)1.00 (ref)
Some college9,876 (23.5) 19,623 (22.6)0.71 (0.69–0.73)
?4 years college
5,252 (12.5) 29,485 (33.9)0.25 (0.24–0.26)
Private 17,607 (41.8)66,463 (77.4)1.00 (ref)
Medicaid 23,112 (54.8)17,149 (20.0) 5.09 (4.96–5.22)
Uninsured 1,138 (2.7) 1,681 (2.0)2.56 (2.37–2.76)
Other293 (0.7)560 (0.7)1.98 (1.71–2.28)
Trimester began prenatal care
1st trimester30,482 (74.0)76,898 (90.2) 1.00 (ref)
2nd trimester 8,126 (19.7)6,814 (8.0) 3.01 (2.91–3.12)
3rd trimester 1,890 (4.6) 1,265 (1.5)3.77 (3.51–4.05)
No prenatal care669 (1.6)324 (0.4)5.21 (4.56–5.95)
Diabetes1,011 (2.3)2,695 (3.1)0.75 (0.69–0.80)
Chronic hypertension 636 (1.4)649 (0.7)1.97 (1.77–2.20)
Pregnancy-induced hypertension1,527 (3.5)3,313 (3.8)0.92 (0.86–0.98)
Tobacco use during pregnancy6,758 (15.6)15,344 (17.5)0.87 (0.84–0.90)
Alcohol use during pregnancy757 (1.7)1,120 (1.3)1.37 (1.25–1.50)
Pregnancy weight gain in pounds
0–197,461 (21.1)12,425 (15.1)1.55 (1.50–1.60)
20–3919,312 (54.6)49,823 (60.4)1.00 (ref)
?408,587 (24.3)20,179 (24.5) 1.10 (1.07–1.13)
Unassisted vaginal delivery33,609 (76.8)62,723 (71.2) 1.00 (ref)
Assisted vaginal delivery 2,800 (6.4)8,568 (9.7)0.61 (0.58–0.64)
Cesarean section delivery7,349 (16.8)16,763 (19.0)0.82 (0.79–0.84)
Day of the week of delivery/birth
Weekday (Monday–Friday)33,291 (75.5)69,621 (78.9)1.00 (ref)
Weekend (Saturday–Sunday)10,814 (24.5)18,589 (21.1)1.22 (1.18–1.25)
Female21,891 (49.6)44,028 (49.9)0.99 (0.97–1.01)0.34
Male22,214 (50.4)44,182 (50.1)1.00 (ref)
Matern Child Health J (2008) 12:452–460455
numerous maternal and neonatal covariates that are also
associated with mother’s race and LOS (Table 3). After
adjusting for the covariates and first-order interactions
between the covariates and mother’s race, the mean LOS
for newborns of black mothers was still significantly longer
than the mean LOS for newborns of white mothers by 4.7 h
(P\0.001). Maternal covariates left in the model and
significantly associated with a longer stay were health
insurance, higher education, not married, primiparity,
Delivery and infant covariates significantly associated with
a longer stay were Cesarean section delivery, low birth
weight, young gestational age at birth, male sex, weekend
birth, weekday discharge, and no prenatal care. Variables
not significantly associated with LOS in the final model
were chronic hypertension, diabetes, and age. Significant
interactions existed between race and delivery type, ges-
tational age, birth weight, age, insurance type, education,
Multivariate analyses for LOS were also conducted
after stratifying for delivery type. For unassisted and
assisted vaginal deliveries, race remained highly signifi-
cant (P\0.001 for both) with Black newborns having
longer stays. However, for Cesarean deliveries, though
Black newborns had a longer mean LOS, race was not
marital status (allwith
Table 2 Comparison of nursery length of stay (LOS) between blacks and non-blacks stratified by delivery type and gestational age
Gestational age (weeks) Unassisted vaginal deliveryAssisted vaginal deliveryCesarean section delivery
Mean LOS in hours
Mean LOS in hours
Mean LOS in hours
50.0 52.4 0.1683.879.8 0.008
37–3850.045.9 49.5 48.1 0.01
39–40 49.445.449.9 47.280.1 74.7
Table 1 continued
Black* N = 44,105 (%) White* N = 88,210 (%)Crude odds ratioP
Gestational age (weeks)
35–362,726 (6.2)3,293 (3.8) 1.80 (1.71–1.90)
37–3811,581 (26.5)19,746 (22.5)1.27 (1.24–1.31)
39–40 24,235 (55.4)52,618 (60.0)1.00 (ref)
?41 5,232 (12.0)12,103 (13.8)0.94 (0.91–0.97)
Birth weight in grams
2,153 (4.9)1,880 (2.1)2.09 (1.96–2.23)
10,616 (24.1) 12,173 (13.8)1.59 (1.54–1.64)
3000–349918,762 (42.5)34,218 (38.8) 1.00 (ref)
3500–399910,170 (23.1)29,675 (33.6)0.63 (0.61–0.64)
4000–44992,130 (4.8)8,738 (9.9)0.45 (0.42–0.47)
Day of the week of discharge
272 (0.6) 1,525 (1.7)0.33 (0.29–0.37)
Weekday (Monday–Friday)30,783 (69.8)60,675 (68.8)1.00 (ref)
Weekend (Saturday–Sunday)13,322 (30.2)27,535 (31.2) 0.95 (0.93–0.98)
Nursery length of stay in hours
*Totals of subcategories may not equal the N of the entire cohort due to missing data
105 (0.3)761 (0.9)0.23 (0.19–0.28)
15,204 (35.8)40,477 (46.1)0.63 (0.61–0.65)
21,207 (49.9)35,557 (40.5)1.00 (ref)
4,172 (9.8) 8,532 (9.7)0.82 (0.79–0.85)
1,842 (4.3) 2,467 (2.8)1.26 (1.18–1.33)
456Matern Child Health J (2008) 12:452–460
(P = 0.34).
The findings of this study represent perhaps the most
comprehensive examination to date of perinatal racial
disparities among newborns cared for in well-baby nurs-
eries and their mothers. The results demonstrate numerous
substantial perinatal disparities among non-Hispanic black
mothers and their newborns when compared with non-
Hispanic whites. While much of the literature on disparities
focuses on preterm newborns and their mothers, examining
differences in the normal nursery population is also
important because this is the care setting experienced by
the vast majority of black mothers and their newborns, and
the disparities described impact their health and healthcare
before and after delivery.
Consistent with other reports and national data, black
mothers in Pennsylvania were younger and more likely to
give birth during adolescence [7, 25]. Though the national
rate of teen pregnancy is declining at the fastest rate for
non-Hispanic blacks, the current data suggests that the gap
remains wide as 21% of the newborns from the black
population were to adolescent mothers compared with 7%
in the white population. Though adverse pregnancy out-
comes such as low birth weight and preterm birth are not
the focus of this report, it is notable that younger maternal
age is associated with an increased risk of these outcomes
 Also, the younger age of the mothers likely contributes
to the fact that black mothers are less likely to have
completed college at the time of birth and are less likely to
These data show that black mothers were far less likely
to be married (76.9% married at the time of delivery for
white mothers versus 25.8% for black mothers), and this
striking difference requires discussion. Limited attention
has been paid to this disparity in the medical literature ,
which in part is likely due to the younger maternal age at
delivery. It also is somewhat explained by the increased
likelihood of cohabitation without marriage in the black
population . In such a relationship, a two parent family
union raises children together in a home outside of mar-
riage, but compared with married women, cohabitating
women are more likely to be depressed, be victims of
domestic violence, and have infants that are born preterm
or low birth weight [28–30]. As part of The National
Survey of Family Growth (NSFG), it was shown that black
women were 69% more likely to conceive a child in a
cohabitating relationship than white women . The
majority of the pregnancies in the NSFG were intended,
and it is possible that being unmarried has the financial
benefit of remaining welfare and Medicaid-eligible for
lower income women [31–33]. Data offering alternative
explanations are limited, but particularly for a state whose
former U.S. senator published a book entitled, ‘‘It Takes a
Family,’’ the remarkably disparate findings require further
exploration to understand the reasons behind them and
their relation to cultural norms .
Consistent with other reports, the current data from
Pennsylvania indicate that black women are significantly
more likely to have later onset of prenatal care than white
women [7, 12–15]. Though black women may be less
likely to report barriers to prenatal care , the psycho-
social and structural barriers that do exist may account for
the disparities in initiation of prenatal care that are seen in
our analyses. Structural barriers that have been reported by
black women include transportation difficulties, long waits
at clinics, and inability to get an appointment in a timely
fashion . Among the psychosocial barriers that have
been reported by black women are having too many other
Table 3 Results of multivariate linear regression modeling length of
Black race versus White racea
Not married versus married
Primiparity versus Multiparity
Pregnancy-induced hypertension versus none
0.07Chronic hypertension versus one
Diabetes versus None0.21
No prenatal care versus prenatal care
No tobacco use versus tobacco use
Cesarean delivery versus vaginal delivery
0.035Weekend delivery/birth versus Weekday delivery/birth
Birth weight\2500 g versus Birth weight ? 2500 g
Young gestational age at birthd
Male sex versus female sex
Weekday discharge versus Weekend discharge
aSignificant interactions existed between Race and delivery type,
Gestational age, Birth weight, Age, Insurance type, Education, Parity,
Prenatal care, and Marital status (all with P\0.001)
bLongest to shortest: Private Insurance, Medicaid, Other, Uninsured
cLongest to shortest: ?4 years of college, Some college, High
School Education or less
dLongest to shortest: 35–36 weeks, 37–38 weeks, 39–40 weeks,
Matern Child Health J (2008) 12:452–460457
problems, having no problems in a previous pregnancy,
being afraid of the medical exam or of substance use dis-
covery, consideration of abortion, and previous abortion
experience [36, 37]. Later onset of prenatal care can lead to
diminished maternal and fetal monitoring and therefore a
lack of detection of maternal and/or fetal problems during
pregnancy. Additionally, with later onset of care there are
fewer opportunities for healthy lifestyle counseling which
could contribute to the birth weight differences detected in
the current data [38–43]. Also notable, late onset of pre-
natal care has also been associated with decreased
postpartum preventive health care for mothers and insuf-
ficient preventive care for their infants [44–48].
As for delivery outcomes, racial differences in Cesarean
section rates have been described previously [49, 50].
Much of the difference has been related to lower socio-
economic status rather than race, and many of the operative
deliveries particularly in white women could be judged as
unnecessary. Either way, the absence of a biological
explanation for this disparity leaves a difference that could
be disadvantageous to one group. Despite the lower rate of
Cesarean sections found in Pennsylvania, black women
were more likely to deliver newborns earlier than 37 or
39 weeks gestation and at lower birth weights than white
women, results that also have been reported elsewhere [15,
The findings reported by this analysis have several
limitations, which limit its generalizability. First, these data
describe the disparities between mothers and their ‘‘well’’
newborns ?35 weeks gestation only in Pennsylvania. It is
possible that states with different racial, urban/rural, and
insurance compositions could have different results, but it
is probable that similar findings would be found elsewhere
in the U.S. based on the similarities between some of the
current data presented and those from national reports. A
second limitation relates to how race was reported for this
analysis since multiple races were not reported prior to
2003, and this is now possible under the guidance of the
U.S. Standard Certificate of Live Birth. Thirdly, nearly
20% of newborns did not have birth records that could be
matched to and merged with a clinical discharge record. It
is probable that this occurred more frequently for black
mother/baby pairs because matching success was less
likely in more highly populated zip codes, which tend to
have a relatively larger black population. Fourth, though
the intent of this analysis was to study the majority of
mother/newborn pairs that do not include those with major
neonatal morbidity, the exclusion criteria involving pre-
mature delivery and major neonatal morbidity do limit the
ability to describe disparities between all black mothers
and their newborns. Fifth, this report describes perinatal
data from 1998 to 2002, and the perinatal care environment
is constantly evolving. That noted, there have been no
major legislative or medical policy changes affecting the
maternity or newborn hospitalization since 1996 meaning
that the general care model has not changed substantially.
Finally, this study contains no information about the
postnatal and postpartum care that the mother/baby pairs
received, which has the potential to affect, positively or
negatively, the health and well being of new families.
Despite the limitations of this report, clear perinatal
disparities are apparent for black mothers and their well
newborns in this sample, and clinicians caring for them
could improve their care by recognizing that such differ-
ences exist on a population level. The current data provide
perhaps the most detailed description to date of a large
population of black mothers and their newborns who are
cared for on normal maternity wards and well baby nurs-
eries. These data also provide valuable insight into the
numerous and often large differences between them and the
white population of mothers and their newborns.
It has been written that the day-to-day lives of black
Americans differ in many respects from the lives of whites
, and that their perception that national institutions
serve them poorly extend to the healthcare system and
access to that system. To improve this perception and
health disparities for blacks it has been suggested that the
three modifiable factors that would lead to improved health
care for this minority population would be poverty, unin-
surance, and having a primary medical home . All three
certainly affect perinatal disparities and the health of
mothers and their newborns.
Several federal initiatives have been established to
address these issues including the Minority Health and
Health Disparities Research and Education Act of 2000 and
the Closing the Health Gap campaign of the U.S. Depart-
ment of Health and Human Services , but correction of
these modifiable factors would clearly require a monu-
mental federal commitment. For healthcare providers and
health systems, the American College of Physicians has
made suggestionsto improve
including the provision of culturally competent care,
improved communication with patients, involvement of
communities in healthcare activities to integrate cultural
beliefs and perspectives into care, and diversifying the
workforce of healthcare providers . These recommen-
disparities presented here and improve the health and
healthcare for black mothers and their newborns.
from the Maternal Child Health Bureau (Title V, Social Security Act),
Health Resources and Services Administration, Department of Health
and Human Services. A Penn State College of Medicine Dean’s
Feasibility Grant as well as a grant from the Children’s Miracle
Network awarded to Dr. Paul also supported this work. Co-author,
Erik Lehman, MS, had full access to all of the data in the study and
Dr. Paul is supported by grant R40 MC 06630
458 Matern Child Health J (2008) 12:452–460
takes responsibility for the integrity of the data and the accuracy of
the data analysis. The authors thank Maxine Vance and Rosalind
German for their review and editorial comments, and Edward Hain
from the Pennsylvania Healthcare Cost Containment Council (PHC4)
for his extensive technical assistance. Additional assistance was
provided by Craig Edelman from the Pennsylvania Department of
Health. PHC4, who provided the clinical discharge records, is an
independent state agency responsible for addressing the problem of
escalating health costs, ensuring the quality of healthcare, and
increasing access to health care for all citizens regardless of ability to
pay. PHC4 provided their data in an effort to further PHC4’s mission
of educating the public and containing health care costs in Pennsyl-
vania. PHC4, its agents, and staff, have made no representation,
guarantee, or warranty, express or implied, that the data: financial,
patient, payor, and physician specific information provided to this
entity, are error-free, or that the use of the data will avoid differences
of opinion or interpretation. The authors of this manuscript conducted
this analysis without the assistance of PHC4, which bears no
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