Health disparities are differences in disease prevalence, mortality rates, and adverse health outcomes across social demographics. The prevalence of health disparities stems from sociopolitical inequities that contribute to the ongoing marginalization of different communities, the majority of which occur along racial and ethnic lines in the United States. As moral wrongs in need of moral repair, health disparities can be addressed in one of six ways, articulated in the scholarship of Margaret Urban Walker: (1) holding wrongdoers responsible; (2) addressing the harms imposed on victims; (3) instating moral terms and standards into harmed communities to regain their trust in social mechanisms meant to protect them; (4) recreating trust among harmed communities rooted in new norms; (5) nourishing hope; and (6) bringing together victims and wrongdoers. This dissertation engages the aforementioned morally reparative steps to redress the moral wrong of health disparities in the United States through proposed policy, educational, and clinical interventions. This dissertation examines health disparities from four perspectives. First, it employs a sociohistorical lens to chart the history of health disparities in the United States and the complex social factors contributing to their prevalence. Second, it uses international rights rhetoric of the United Nations and its supporting committees to examine methods of accountability from the United States aimed at reducing disparities and inequities. Third, the dissertation applies the lens of Jacques Maritain’s ontologically informed personalism to reclaim personhood as a viable concept that attends to the sacrality of humanity and our status as social and political beings. Fourth, the dissertation applies the historical, rights, and personalist perspectives in a case study centering black birthing people as an exemplary demographic plagued by racially impacted health disparities and in need of moral repair. This dissertation uses the four-perspective approach to conclude with a morally reparative framework aimed at eliminating health disparities through constructive healthcare policy, practice, and educational measures affirming personhood, human dignity, universal human rights, and health for all people.

BACKGROUND: Nearly all birthing people in the Dominican Republic (DR) deliver in a hospital, yet maternal and newborn mortality remain high. Respectful maternity care challenges have been reported but not systematically documented. This observational, mixed-methods study assessed birthing people’s and providers’ experiences at a public hospital in the DR, during the COVID-19 pandemic. METHODS: In May-July 2022, we surveyed postpartum people and providers to adapt the Person-Centered Maternity Care (PCMC) survey. In July-August 2022 we applied the contextually-modified PCMC survey with postpartum people and providers. Possible scores ranged from 0 (poor) to 93 (exceptional). We calculated mean scores and examined associations with socio-demographic factors. A concordance/discordance analysis examined postpartum people’s and providers’ responses. Content analysis of open-ended questions explored PCMC and opportunities for improvement. Results were stratified by nationality (Dominican or Haitian). RESULTS: Respondents felt the PCMC survey was appropriate for the context but recommended adding questions around contraception, maternal-newborn separation, differential treatment, and c-section decision-making. The mean PCMC score was 60.1 for postpartum people and 62.0 for providers. Being of Haitian origin, speaking Creole at home, being older, and living further from the facility were associated with lower scores (p<.001). Nearly 70% of providers reported birthing people were spoken to in understandable language/terms compared to 29.8% of birthing people. Most providers (91.7%) reported that consent was sought before procedures, compared to 58.1% of birthing people. Fewer Haitians, compared to Dominicans, reported favorably regarding friendly treatment (42% v 83%); ability to ask questions (34% v 66%); consent being sought before procedures (52% v 71%); and being spoken to in understandable language/terms (14% v 63%). Sixty-one percent of Haitians and 44% of Dominicans reported maternal-newborn separation for more than 6 hours. Qualitative responses revealed verbal abuse and the emotional toll of maternal-newborn separation, among other issues. Birthing people suggested improvements relating to family connectedness: companions, providers communicating with families, and keeping the mother-baby dyad together. Providers focused on infrastructure, equipment/supplies, training, and policy. CONCLUSION: As the first study to apply the PCMC survey in the DR, this study systematically documented challenges and opportunities to improve birth experiences from the perspectives of postpartum people and obstetric providers. Stakeholder-generated and evidence-based recommendations should be prioritized at Hospital Presidente Estrella Ureña. / 2025-01-04T00:00:00Z

This thesis seeks to investigate the 2014 Medicaid expansion’s effect on maternal mortality rates for New York and California. The CDC reported in 2019 that maternal mortality rates have been increasing. These findings are concerning for mothers and are a problem for developed nations like the United States with improved healthcare. Furthermore, women of color are disproportionately affected relative to white women. Previous research has indicated that healthcare expansions positively affect decreasing death rates among pregnant women. In this study, I investigate how increased access to healthcare through the 2014 Medicaid expansion under the Affordable Care Act affects maternal mortality for New York and California. I utilize the publicly available CDC Wonder Underlying Cause of Death 1999-2020 data to conduct my research for this analysis. For my analysis, I chose to observe the years 2006-2016. I plotted each state’s mortality rates by year to observe any visual trends or changes in reported data and then after ran regressions of each race on deaths. The results exhibited that women of color tend to experience higher maternal mortality ratios. When observing how deaths have changed post-expansion, the coefficients were not statically significant to a degree that would allow me to make confident conclusions that mortality rates had improved. This study contributes to the literature that women of color are more likely to suffer worse maternal health outcomes than white women. It brings to light the importance of attaining a solution to this issue.

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