Racial inequities in treatment for pain after cesarean birth

photo by Steve Babuljak 2018, pregnant woman in hospital bed
Racial disparities in maternal and infant health are well documented. These differences persist even when accounting for factors like insurance coverage, income and education. In addition to societal racism, this also points to institutional racism—differences in delivery of health care by race that contribute to disparate outcomes. This has been reported in pain management for Black and White patients, such as Black patients with migraines or back pain being less likely than White patients to receive narcotic pain medications in emergency rooms. Using information from North Carolina Women’s Hospital, Bixby member Dr. Ifeyinwa Asiodu and colleagues at the University of North Carolina, led by Dr. Jasmine Johnson, published the first study to explore whether a similar health inequity exists for pain treatment after cesarean birth.

They found that White women were asked to assess their pain more often than women in any other racial or ethnic group. Black and Hispanic women were evaluated for pain less frequently, had higher pain scores and received less pain medication than White women. Those differences didn’t go away when considering other clinical factors, suggesting that these racial inequities are the result of different delivery of care. This builds on prior work showing the undertreatment of pain with medicine among Black patients.

Although there may be overt racism at play, the issue is complex. The researchers were unable to assess the role of patient beliefs and preferences around pain or potential biases among healthcare providers. An earlier University of Virginia study showed that many laypeople and medical trainees endorsed at least one false belief about Black patients that could affect their clinical assessments of pain. Those beliefs are encoded within implicit biases and can manifest in different treatment. Negative biases have been shown to be more pronounced in stressful contexts, pointing to the importance of staffing and management of clinician burnout.

These findings suggest that electronic medical records could be used for other institutions to identify racial and ethnic disparities and track progress toward ameliorating them. It also calls for standardizing pain management procedures to avoid this disparate treatment.