Intersectional inequities in maternal mortality: Examining the compounded risks for black birthing individuals with physical disabilities

Ilhom Akobirshoev; Sarah Jerome; Jonathan M Snowden; Jaime Slaughter-Acey; Anne Valentine; Willi Horner-Johnson; Monika Mitra

doi:10.1016/j.dhjo.2024.101765

Intersectional inequities in maternal mortality: Examining the compounded risks for black birthing individuals with physical disabilities

Disabil Health J. 2024 Dec 3:101765. doi: 10.1016/j.dhjo.2024.101765. Online ahead of print.

Authors

Ilhom Akobirshoev¹, Sarah Jerome², Jonathan M Snowden³, Jaime Slaughter-Acey⁴, Anne Valentine², Willi Horner-Johnson³, Monika Mitra²

Affiliations

¹ Brandeis University, The Lurie Institute for Disability Policy, 415 South Street, Waltham, MA, 02453, USA. Electronic address: [email protected].
² Brandeis University, The Lurie Institute for Disability Policy, 415 South Street, Waltham, MA, 02453, USA.
³ Oregon Health & Science University, Institute on Development and Disability, 3181 S.W. Sam Jackson Park Road Portland, OR, 97239, USA.
⁴ UNC Gillings School of Global Public Health, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC 27599-7400, USA.

PMID: 39643523
DOI: 10.1016/j.dhjo.2024.101765

Abstract

Background: People who are Black and have physical disabilities likely face a dual burden of risk for maternal mortality due to enduring systemic oppression rooted in racism and ableism.

Objective: To investigate maternal mortality risks among Black birthing individuals with physical disabilities in the United States and assess the potential compounding effect when these marginalized identities intersect.

Methods: We conducted a historical cohort study using the 2004-2021 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. The study included 8,263,997 delivery hospitalizations. We used modified Poisson regression to estimate unadjusted and adjusted relative risks (RR) of maternal mortality by race and physical disability status. We calculated the Relative Excess Risk due to Interaction (RERI) and Attributable Proportion (AP) to assess additive interaction between Black race and physical disability status.

Results: After adjusting for covariates, compared to their White birthing individuals, their Black peers experienced about 2.5 times (RR = 1.48,95%CI:2.08-2.96) the risk of maternal mortality. Compared to birthing individuals without physical disabilities, those with physical disabilities experienced nearly 11 times the (RR = 10.72,95%CI:8.15-14.10) risk of maternal mortality. Our adjusted additive interaction analysis revealed a significant super-additive effect (RERI = 11.3; AP = 0.47); suggesting that the combined effect of having both marginalized identities was greater than the sum of the individual effects of each identity.

Conclusions: Our findings provide evidence for substantial inequities in maternal mortality by Black race and physical disability status, with evidence of a compounding effect when these marginalized identities intersect. These results underscore the urgent need for intersectional approaches in maternal health interventions and policies.

Keywords: Ableism; Intersectional inequities physical disability; Maternal mortality; Racism.