Sexual and Reproductive Health Disparities in Massachusetts and How to Combat Them Through Research and Evaluation- Part 2: Disparities in Maternal and Infant Health and Mortality and STI Prevalence, and Causes of Sexual and Reproductive Health Disparities

Note: In this blog series, we aim to provide an overview of key areas within sexual and reproductive health, but the posts will not include all elements of this broad topic. We also acknowledge that these posts talk about gender in a binary way, as there is currently limited data on these topics specific to nonbinary and trans people.

Maternal and infant health and mortality is an area of sexual and reproductive health (SRH) where many startling health disparities exist, not only in Massachusetts but throughout the country.

In Massachusetts, Black women are two times more likely to die of pregnancy related causes compared to white women (1). In a study done on Arab American non-US born mothers in Massachusetts, they were shown to be at higher odds for having gestational diabetes, and less likely to initial prenatal care compared to non-Hispanic white US-born mothers. Additionally, the Arab mothers’ infants were more likely to have a lower birth weight compared to the white mothers (2). A study done in Worcester, showed that infant mortality hotspots existed among minority, low income and low English literacy communities (3). Finally, there are higher rates of teen pregnancy amongst Hispanic teens in Massachusetts compared to Non-Hispanic Black and white teens, meaning that Hispanic teen mothers are more at risk for mental health conditions such as depression and PTSD, and their infants are at greater risk for low birth weight and mortality (4).

Multiple disparities in sexually transmitted infection (STI) prevalence exist in Massachusetts as well. People struggling with drug addiction and homelessness or housing insecurity are more at risk for contracting STIs and have a higher prevalence rate of STIs compared to the general population (5). Specifically for HIV, Hispanic and Non-Hispanic Black people have a much higher age-adjusted prevalence rate compared to white people (1262/100,000 and 1625/100,000 compared to 148/100,000). And Non-Hispanic Black women comprise 51% of HIV infection diagnoses in MA, almost two times more than both Hispanic and Non-Hispanic white women (6).

Two issues that likely contribute to these SRH disparities are a lack of knowledge, education and resources, and a lack of culturally competent healthcare. In a CPBR study done with youth in Springfield and Lynn, MA, two cities with large Black and Hispanic populations (Lynn also has a large Asian population), many of the participants felt that they did not receive culturally competent SRH education, due to teachers being of a different race and/or culture, and teachers only speaking English. They also did not seek SRH care in some instances due to fear of providers finding out their immigration status, because they did not know that the state of Massachusetts provides free healthcare services for undocumented individuals (7). Another study of Brazilian immigrant women in Somerville and Brighton revealed that non-English speaking patients have communication challenges with healthcare providers, especially when interpreters are not available. They also sometimes had different ideas of what they wanted their care to look like based on their experiences in their previous countries, specifically labor and childbirth practices, and had faced discrimination from hospital staff because they did not speak English and/or were from a different culture (8).

These statistics and studies show the need for improved education and spread of SRH resources in schools. They also show that there is a need for a shift in healthcare provider training and practice, as well as systemic change in healthcare facilities to better accommodate and serve diverse populations. These changes will hopefully lessen and eventually eliminate the the disparities in care that lead to disparities in maternal/infant mortality and STI prevalence.

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