![]() In 2019, non-Hispanic Black women had an overall preterm birth rate of 14.39% compared to 9.26% in non-Hispanic White women the difference in early gestations was even starker, with a rate of 4.94% very preterm births in non-Hispanic Black women compared to 2.27% in White women 14. As the overall preterm birth rate has continued to increase, disparities in both overall preterm birth rates 11, 14, 15 and very low birthweight (VLBW) rates are widening, with VLBW disparities increasing for seven decades 12. For instance, disparities in preterm birth and neonatal mortality rates have shown a temporal evolution. Racial and ethnic neonatal disparities are impacted by temporal, local, and regional contexts. found higher rates of intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, and bronchopulmonary dysplasia in Black and Hispanic infants under 32 weeks in New York City 7. Furthermore, underserved newborns suffer an excess burden of neonatal morbidities. ![]() In 2018, the infant mortality rates in the United States for infants of non-Hispanic Black (10.75 per thousand live births), Native Hawaiian or Pacific Islander (9.39 per thousand live births), and American Indian or Alaska Native women (8.15 per thousand live births) were approximately double that of infants of non-Hispanic White (4.63 per thousand live births) and non-Hispanic Asian (3.63 per thousand live births) women 13. ![]() Infants of color are overrepresented within low birthweight rates, preterm birth rates 11, and neonatal mortality rates 12, 13. The largest body of literature describes disparities relating to parental (nearly universally maternal) race/ethnicity. Disparities may occur within any of the layers of the Socio-Ecological model demographic attributes, health system factors, and geographic location can all provide a fulcrum for inequities. The Socio-Ecological model, a framework that conceptualizes health status as stemming from multiple influences (including individual predisposition, health behaviors, relationships, community and societal factors), is a useful lens to elucidate intersectional sources of variation that may cumulatively and longitudinally contribute to inequities within neonatal care 9, 10. Disparities in neonatal outcomes are very well documented. Health disparities are “avoidable, systematic differences adversely affecting economically or socially disadvantaged groups” 8. Disparities in Perinatal and Neonatal Careĭisparities represent variation relating to disadvantage. EF-QI principles are applicable at every stage of project conception, execution, analysis, and dissemination, and may provide opportunities for reducing disparities in neonatal care. EF-QI initiatives purposely integrate equity throughout the fabric of the project and are inclusive, collaborative efforts that foreground and address the needs of disadvantaged populations. ![]() ![]() EF-QI differs from QI with an equity lens in that it is action-oriented and centered around equity. This article reviews disparities in perinatal and neonatal care, the impact of QI on health disparities, and the concept of “Equity-Focused Quality Improvement” (EF-QI). QI projects designed without an intentional focus on equity promotion may foster intervention-generated inequalities that further disadvantage vulnerable groups. QI work may mitigate, worsen, or perpetuate existing disparities. Although quality improvement (QI) methodology is often suggested as a tool to advance health equity, the impact of QI initiatives on disparities is variable. Evidence of health disparities affecting newborns abounds. ![]()
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