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J Natl Med Assoc. 2018 Nov 29. pii: S0027-9684(18)30290-6. doi: 10.1016/j.jnma.2018.10.016. [Epub ahead of print]

Strengthening the postpartum transition of care to address racial disparities in maternal health.

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Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address:
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Section of General Internal Medicine, Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, MA, USA.


Maternal morbidity and mortality, important indicators of healthcare quality both nationally and internationally, have gained increasing public attention in the United States (U.S.). The U.S. has the highest rate of maternal mortality among high-income countries; notably, this rate has more than doubled since 1990. Black women in the U.S. die at three to four times the rate of white women from pregnancy-related complications, one of the widest of all racial disparities in women's health. Medical complications, including cardiovascular disease and hypertensive disorders in pregnancy, remain leading contributors to disparities in maternal outcomes including pregnancy-related deaths. However, an under-explored opportunity for improvement is the failure to transition from obstetrical to primary care, which limits optimizing postpartum health. Health system approaches, community-based interventions, and policy solutions that facilitate transitions of care may be critical to eliminating persistent disparities in maternal outcomes.


Maternal health; Primary care; Racial and ethnic disparities; Transition of care


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