Addressing reproductive health disparities as a healthcare management priority: pursuing equity in the era of the Affordable Care Act.
OBJECTIVE
To summarize the newest available evidence on maternal and reproductive health disparities, and to describe elements of the Affordable Care Act most likely to impact these disparities.


RESULTS
Significant racial and ethnic disparities in maternal and reproductive health outcomes have persisted in recent years, contributing to poor outcomes and increasing costs. Pregnancy-related mortality ratios are up to three times higher in Black women compared with non-Hispanic White women, with the risk of severe maternal morbidity also significantly higher in Black and Hispanic women. Unintended pregnancy is twice as likely in minority women. Insurance status, socioeconomic status, and broader social determinants of health are implicated in these disparities. Coverage changes associated with the Affordable Care Act may provide some opportunities to reach communities most at risk. Delivery innovation, payment reform, and further public financing of key services are examples of further management approaches that can be used to address reproductive health disparities.


CONCLUSIONS
The Affordable Care Act offers important opportunities to address persistent reproductive health disparities, but significant gaps remain. Efforts must be made to reduce the negative outcomes and high financial and human costs associated with disparities in reproductive health.
Robert Wood Johnson Clinical Scholars Program, Department of Veterans Affairs, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Pooja
P
Mehta
D005260:Female; D018166:Health Care Reform / Q000331:legislation & jurisprudence / Q000639:trends; D006292:Health Priorities / Q000331:legislation & jurisprudence / Q000639:trends; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends; D006801:Humans; D008428:Maternal Mortality / Q000208:ethnology; D054525:Minority Health / Q000191:economics / Q000208:ethnology; D058991:Patient Protection and Affordable Care Act; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000208:ethnology; D011295:Prenatal Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends; D060728:Reproductive Health / Q000191:economics / Q000208:ethnology; D034121:Reproductive Health Services / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends; D012959:Socioeconomic Factors; D014481:United States