Intervention Research to Reduce Disparities in Severe Maternal Morbidity and Mortality in the United States: A Scoping Review.

Abstract

Persistent inequities in severe maternal morbidity (SMM) and maternal mortality in the United States have received national attention over the past decade. This scoping review aimed to outline evidence-based interventions to decrease these inequities. We adapted a socioecologic framework of SMM and maternal mortality to integrate three equity approaches: 1) interventions across subpopulations, 2) analytic strategies, such as subanalyses or reporting outcomes among priority groups, and 3) assessing risk factors unique to priority groups. We conducted a structured search of peer-reviewed medical databases then assessed findings qualitatively. We included studies of SMM or its components, mortality, and postpartum rehospitalization that used an equity approach and focused on groups disproportionately affected by maternal mortality, such as Black, Indigenous, and rural populations and those with low income. Our findings revealed a lack of rigorous peer-reviewed interventions in many areas but identified key findings in multiple domains of our model, especially at the health system level. Although evidence is too nascent for firm conclusions on effective interventions, our review provides examples of best practices to guide future design and reporting of maternal health equity interventions.