Introduction
The cost of health care has been on a steady rise over the past three decades amidst limited resources. Adequate access and universal provision of health care is, thus, still a dream to many people and governments across the world. Moreover, there is a huge variation in the use and availability of health care by point of provision and geographical area. There tends to be an inverse proportionality in availability and the needs of populations to be served. Furthermore, consumerism is also forcing members of the public to demand better, more effective, and more quality healthcare services.
All these factors have contributed to the need to develop and refine well-established approaches to aid in understanding the healthcare needs of respective local populations. A health needs assessment refers to a systematic method applied in the identification of unmet health care needs of particular populations and making the necessary changes to meet those needs. Health needs assessments are primarily used to mission health care planning, priority setting, and improve health. Health needs assessments are intended to achieve consensus in resource allocation and priorities that will eventually help plan services, address healthcare inequalities, and improve health (Ake et al., 2018). In addition, these needs assessments encourage innovation and partnership work and encourage the contribution of target populations.
Since health needs assessments occupy a central position in public health work, it is significant that they are performed effectively. In a nutshell, health needs assessments help make decisions and trigger some action. Hence, much emphasis should be placed on the actions that are proposed. These actions should be tailored to the specific needs of a given population targeted by the interventions.
Discussion
Despite being a developed country, the United States has one of the highest mortality rates in the world. According to the Centers for Disease Control and Prevention (CDC), about 700 American women die annually during childbirth or soon after (Centers for Disease Control and Prevention, n.d). The CDC continues to state that black women are more prone to die of pregnancy-related complications than their white counterparts. These national figures are replicated in most states, including Pennsylvania. A report produced by the Pennsylvania Department of Maternal Mortality Health in 2018 found that pregnancy-related deaths among black women increased by 23 percent between 2013 and 2018. This was against the national average of 21.4 percent during the same period. Surprisingly, births from black women in Pennsylvania only accounted for 14 percent. The statistics are grimmer in Philadelphia city where 73 percent of all pregnancy-associated deaths involved black women (Centers for Disease Control and Prevention, n.d). The increase in maternal mortality among this population is attributed to different factors such as distrust in providers of health care due to systematic racism issues as well as lack of access to good quality health care.
About 53 percent of deaths associated with pregnancy in Pennsylvania that had listed payment information were those of Medicaid. In addition, a report by the state’s Department of Health revealed that more than half of the deaths during the same period lacked prenatal care. Incidentally, lack of access to high-quality health care is not the only problem bedeviling Pennsylvania’s pregnant black women. Historically, healthcare providers have been known to abuse minority patients, causing them to distrust and shun them away from seeking their services.
Apart from the reported systematic racism issues against this population, Pennsylvania’s pregnant women are also prone to various pregnancy-related complications, which sometimes lead to fatalities. Specifically, these women are disposed to gestational diabetes, eclampsia and pre-eclampsia, high blood pressure, preterm labor, and postpartum hemorrhage (PPH). Gestational diabetes is a kind of diabetes that affects women who had no diabetes cases before they became pregnant. This condition interferes with a patient’s insulin, which refers to a hormone that the body utilizes sugar for energy. When blood sugar is not well controlled and allowed to rise to higher levels, serious health problems result, both for the mother and the unborn child. Thus, it is significant that the mother takes precautionary measures. Unfortunately, gestational diabetes does not come with any symptoms. A doctor must test the mother between the twenty-fourth and twenty-eighth weeks. However, those mothers with higher risks could be tested before then.
Pre-eclampsia and eclampsia can be dangerous complications that involve a sudden blood pressure spike. These conditions can be extremely serious and potentially cause death for both the mother and the baby. When the pre-eclampsia becomes severe, it can advance to eclampsia, where blood pressure causes coma or seizures. In many cases, pre-eclampsia does not have any symptoms, but in some instances, it can cause high blood pressure, severe headaches, vision problems, and sudden weight gain. Other symptoms include dark urine, frequent urination, and swelling of the feet, face, legs, and hands. However, racial prejudices in the country’s healthcare system have prevented pregnant black women from visiting healthcare facilities to check on their health.
Although high blood pressure is common during pregnancy, it does not pose a danger to either the mother or the child in most cases. However, it must be noted that cases of high blood pressure among the black population in the U.S. are rampant. High blood pressure before pregnancy is dangerous as it increases the risks of pre-eclampsia and preterm birth (Szpunar et al., 2020). Since high blood pressure does not have visible symptoms, it is important that the pregnant woman do regular blood pressure checks. Unfortunately, many pregnant black women in Pennsylvania do not attend prenatal clinics. Hence, they are more predisposed to the risks of high blood pressure.
Preterm labor happens when the contraction begins before the 37th week and after the 20th week of pregnancy. Babies who are prematurely born are at risk of developing more serious health problems in the long term. Again, preterm labor demands that the mother access medical help from her prenatal provider when she experiences any associated symptoms. These symptoms include abdominal cramps, pelvic pressure, changes in quantity or consistency of vaginal discharges, water breaking, painful or non-painful contractions, and persistent backache. Monitoring and treatment to delay premature birth are the only way to address the situation. Unfortunately, most pregnant black women in Pennsylvania do not have access to this treatment.
Postpartum hemorrhage (PPH) refers to excessive bleeding after the birth of a child. The resultant loss of blood can be life-threatening to the mother. Although PPH usually takes place within one day after delivering a baby, in some cases, it can last up to 12 weeks (Yearby, 2018). Although it is normal to bleed after giving birth, most pregnant black mothers do not understand that PPH is a medical emergency that requires urgent attention. Hence, they tend to ignore such warning signs as blurred vision, rapid heartbeat, confusion or dizziness, heavy vaginal bleeding, clammy skin or chills, body weakness, as well as vomiting and nausea.
Studies have shown that postpartum-related deaths among black women in Pennsylvania are 3.5 times more than their white counterparts. Whereas postpartum cardiomyopathy has been identified as a leading cause of fatalities in women across all races, it is six times higher among black women as compared to white women (Ryan et al., 2021). In addition, pre-eclampsia and eclampsia are cardiovascular conditions that are more prominent among black women in Pennsylvania than their white counterparts. This reiterates the significance of increasing vigilance among this population to hasten early diagnosis and treatment of the conditions.
The disparities that characterize maternal mortality among pregnant black women in Pennsylvania mirror the implications of structural racism on health care and health in general. It clearly shows that the healthcare systems that are currently available in place are skewed against the plight of this population. However, there could be a silver lining to this, as the experiences of pregnant black women can be used to inform appropriate healthcare systems that will ultimately improve their experiences of giving birth. These experiences can help design specific healthcare needs to be tailored toward modeling health care before, during, and after delivery. Hence, carrying out health care needs assessments for pregnant black women in Pennsylvania will go a long way in addressing the blunt racial disparities that characterize the state’s health care system.
Implications
Considering these disturbing trends, the most important priority for action would be to improve access to maternal health care, including health insurance for pregnant black women in Pennsylvania and the United States. Often, the first step towards achieving affordable and quality health care is to access health insurance. The incredible progress made by the Affordable Care Act, where 20 million more people were added to the country’s health care insurance scheme, is a demonstration that a lot can be achieved. Although access to health insurance cannot eliminate maternal and infant mortality disparities, there is no denying that it plays a huge role in ensuring healthier births and pregnancies. Indeed, the rates of infant mortality in states that had expanded their Medicaid coverage fell as compared to those that did not exist between 2014 and 2016. Expansion of Medicaid ensures that even the disenfranchised within the community can access health care services, including prenatal and antenatal, which ultimately lead to a decrease in infant mortality rates. States that expanded their Medicaid witnessed increased access to health care services among pregnant black women.
Moreover, health insurance schemes should be reformed to ensure that young adults are allowed to stay on the health insurance plans of their parents until the age of 27, for instance. This way, they will benefit from increased early prenatal care, a decreased preterm birth rate, and appropriate prenatal care (Kelly et al., 2022). This ensures that the gains brought about by health insurance coverage remain in place for an extended duration of time.
However, it must be noted that even with health insurance, it is still difficult to access quality, culturally appropriate, and timely health care. Most pregnant black women in Pennsylvania lived in underserved districts where hospital maternity wards and doctors are far away. The situation worsens if the woman needs additional services such as reproductive health care and mental health care (Brown et al., 2021). Even in situations where physical access to the required facilities providers is available, many pregnant black women must still confront the issue of the cost of health care.
The scarcity in accessing to medical professionals and maternity wards makes it difficult for pregnant black women to receive timely prenatal care in Pennsylvania. Across the state, several maternity wards, particularly those serving low-income neighborhoods, have been recently closed. The United Medical Center and the Providence Hospital are examples of such maternity care facilities whose closures have left many pregnant black women without alternatives when it comes to accessing quality care for giving birth. Furthermore, it jeopardizes healthcare continuity, which is critical for child delivery. It is significant that a pregnant woman sees the same physician throughout her pregnancy to allow for better monitoring and management of any health-related complications. This is critical in ensuring that the pregnant woman receives the highest quality health care. When hospitals serving minority women are unceremoniously closed without any notice, many black women are generally left without options for quality prenatal care and professionals.
Another significant factor in addressing disparities in maternal health is access to reproductive health. Although Medicaid and ACA expansions led to an increase in reproductive health services, there are still too many black women who cannot access the same. There still exist funding various funding shortfalls and too many restrictions that inhibit these women from accessing contraception, reproductive cancer screenings, abortion, and STI screenings. This leaves the women susceptible to various pregnancy-related risks. Contraceptives are significant reproductive tools that allow women to adequately plan their pregnancies around their specific circumstances and personal health. Planned pregnancies have direct correlations with better health results when compared to unplanned pregnancies. The uptake of contraceptives among the black community is very low. This deprives them of the power to plan their pregnancies. Indeed, women who plan their pregnancies are most likely to refrain from some lifestyle behaviors such as alcohol consumption and smoking. Moreover, pregnancy planning also helps women with underlying health conditions to manage their conditions before conception. This way, they are able to reduce the risks associated with pregnancy complications.
Ordinarily, women seeking postpartum contraception for immediate use should be given long-acting reversible contraception (LARC). Unfortunately, black women face structural financial barriers that prevent them from accessing LARC. Worse still, immediate LARC postpartum reimbursement from Medicaid is limited. In addition, contraceptive counseling sessions are not tailored to address the specific health care needs of black women. They are not offered in alignment with black women-centered approaches in a way that takes into account their circumstances and experiences. This should be reversed to ensure that the specific needs of individual pregnant black women are considered.
A good number of Pennsylvania’s health care workforce do not appreciate the underlying disparities that hinder maternal health care for women of color. In many cases where pregnant black women have died or experienced complications during pregnancies, medical professionals have been reported not to have paid due diligence on the women’s specific medical needs and experiences. Overall, they do not diligently assess the health care needs of their pregnant black women patients. Given the above scenarios, the most appropriate intervention for pregnant black women is to first assess their specific health care needs and then address them based on the circumstances and experiences of each individual woman.
Conclusion
The provision of health care is a fundamental human right that all citizens should enjoy. However, this is not often the case, as health care costs have continued to soar over the past thirty years. Although there has been an upscale of health insurance schemes intended to improve access to health care in the country, many people cannot access quality health care still. The most affected group is the minorities, especially African Americans. Pregnant black women particularly have unique healthcare needs that cannot be addressed through the generalization of healthcare. Health needs assessment helps identify the unique individual health problems for specific groups. In assessing the health care needs of pregnant American black women, it is significant to specifically explore the disparities that characterize health care provision across many states. Women of color are victims of systematic racial discrimination in the provision of health care. The U.S. healthcare workers do not appreciate the unique healthcare needs of pregnant black women either. This, in addition to the high cost of health care, cause them to shun healthcare facilities, thus, increasing the risks of maternal deaths or complications. The most appropriate intervention is to embrace a health needs assessment that ultimately identifies an individual’s health needs.
References
Ake, T. et al., (2018) ‘Needs assessment for creating a patient-centered, community-engaged health program for homeless pregnant women’, Journal of Patient-Centered Research and Reviews, 5(1), pp. 36-44.
Brown, H. L., Small, M. J., Clare, C.. A. & Hill, W.. C., (2021) ‘Black women health inequity: The origin of perinatal health disparity’ Journal of the National Medical Association, 113(1), pp. 105-113 Web.
Centers for Disease Control and Prevention, n.d. Working Together to Reduce Black Maternal Mortality. Web.
Kelly, T. et al., (2022) ‘Racism and the reproductive health experiences of u.s.-born black women’, Obstetrics & Gynecology, 139(3), pp. 407-416.
Ryan, G. et al., (2021) ‘Using needs assessment surveys to understand priorities for pregnant and parenting community college students: Comparing US and foreign-born parents’ Journal of Americal College Health, p. Web.
Szpunar, M. J., Crawford, J. N., Baca, S. A. & Lang, A. J., (2020) ‘Suicidal Ideation in Pregnant and Postpartum Women Veterans: An Initial Clinical Needs Assessment’, Military Medicine, 185(1-2), p. e105–e111. Web.
Yearby, R., (2018) ‘Racial disparities in health status and access to healthcare: The continuation of inequality in the United States due to structural racism’, The American Journal of Economics and Sociology, 77(3.4), pp. 1113-1152. Web.