Posted: April 24th, 2025

health policy

1. Read and review the article and provide a summary which includes, but is not limited to interpretation, validity, opinion etc. 

2. Topic: Increasing Rates of Diabetes among Youth in Florida

3. Topic: Increasing Rates of obesity among Adults in California

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Documentary Response Piece

Write a response piece to the documentary titled “Sick Around the World” from Frontline. Watch the documentary, Sick Around The World (produced by Frontline and PBS). There should be no fee or charge for watching the documentary. Below is a link to the documentary.

https://www.pbs.org/wgbh/frontline/film/sickaroundtheworld/

There are two parts to this assignment, Part A Research Part, Part B Response Part

Part A: Students are required to compare and contrast the health care financing and organization of the US health system with those of the other five capitalist societies profiled in the documentary. The research piece should address the following questions:

1. Identify main similarities and differences across the health systems profiled in the documentary.

2. What are the strengths and weaknesses of the US health system compared to those of the five developed countries profiled in the documentary?

3. Identify two changes the US has made to its healthcare system through the Affordable Care Act.

In Part Athe writing should be kept objective, this is the research portion- there is no opinion in this portion therefore there should also be no ‘I’, ‘We’, etc. Focus on the information from the documentary and your research.

Part B: Response

Based off of your research and the documentary, in your opinion, how do you think the US health system could be reformed in the future taking into consideration the evolution of the five documentaries profiled in the documentary?

What role do you think policy has in the health of a nation? How has health care policy in the US shaped the health of Americans.

Directions: The paper should be 5 pages, a minimum of 3 pages of content 1 reference page and 1 cover page. Students are required to use 2 sources (a minimum of 1 peer reviewed journal articles, and other quality sources- do NOT use your textbook, -) to support your statements as well the documentary. Using outside sources is recommended as well as referencing the documentary. Be sure to cite all sources correctly and in APA format.

W E L C O M E!!!!

Today we will:
•Define

Literature

Review
•Write Part 2 of the

Literature Review!

The Basic Structure of a RESEARCH PAPER

Which parts have you done?

Which parts have you done?

What comes NEXT?

What comes NEXT?

What IS a Literature Review???

Think about this…

Literature

Review

what could it be?

What IS a Literature Review???

Usually,

1. PART of a research paper

2. Contains several objective summaries of what
the research literature says about your topic or
question.

3. A demonstration of your familiarity with
pertinent work in the field.

4. A research history, upon which later
research can be built.

What IS a Literature Review???

Usually,

1. PART of a research paper

2. Contains several objective summaries of what
the research literature says about your topic or
question.

3. A demonstration of your familiarity with
pertinent work in the field.

4. A research history, upon which later
research can be built.

What IS a Literature Review???

Usually,

1. PART of a research paper

2. Contains several objective summaries of what
the research literature says about your topic or
question.

3. A demonstration of your familiarity with
pertinent work in the field.

4. A research history, upon which later
research can be built.

What IS a Literature Review???
Usually,

1. PART of a research paper

2. Contains several objective summaries of what
the research literature says about your topic or
question.

3. A demonstration of your familiarity with
pertinent work in the field.

4. A research history, upon which later
research can be built.

Let’s look at two samples:

1. Doctoral sample
2. Student sample

Open the Doctoral sample

in this week’s folder:

Treasure hunt!

1. Find each part of a basic
paper

in the Table of Contents

(When will you get YOUR doctorate??)

Please, open the student sample

in your Content Page.

Treasure hunt!

1. Find each part of a basic
paper

Now please find the
Literature Review
portion of the student
sample

As you see, a literature
review consists of 3 parts

3 parts

1. Introduction to the Literature Review

3 parts

1. Introduction to the Literature Review

2.

Review of Literature

3 parts

1. Introduction to the Literature Review

2. Review of Literature

3. Analysis of Literature

What part of the
literature review

have you started on?

What part of the
literature review

have you started on?

Without even realizing it!!

What part of the
literature review
have you started on?

1. Introduction Paragraph for the Literature Review

2. Review of Literature

3. Analysis of Literature

What part of the
literature review
have you started on?

1. Introduction Paragraph for the Literature Review

2. Review of Literature (Wait! What?? How??)

3. Analysis of Literature

YES!!! Your

GRADED and REVISED
Objective Summaries

will be copied
right into the

Review of Literature

BUT…

•Is that all?

BUT…

•Is that all?

ALMOST!

To make your literature review “flow,” you will
need to see what is the same and what is
different among your articles: (Remember the
student sample treasure hunt?)

• like

• similar to

• also

• in the same way

• at the same time

• unlike

• in contrast

• contrasted with

• on the contrary

• while…

compare and contrast

Ready, Set, GO!

1. Pull up your Excel Research Tracker and read the
WHY column to determine what order to put your
articles in.

(You may find you have two with a similar purpose,
for example, and you put those together.)

Congratulations! You just completed the
necessary work to help you determine the order
of articles for your Review of Literature!

1. Introduction Paragraph for the Literature Review

2. Review of Literature

3. Analysis of Literature

This black box is a 3-minute video on how to split your
screen.

Please watch it now for an effective workshop time.

Please pull up the assignment in which you
had your title and references page (Week #6)

You will use this to start building your
final research paper

Called your Working Final Document

Please have this as half of your screen so you can
– watch the PowerPoint

– AND work at the same time

In your Working Final
Document,

Create appropriate level
headings to guide your

reader as in the next slide

(Title your headings
according to your research

question)

Level Headings

Student research question:

What have researchers learned about
racial disparities in outcomes among pregnant women
in the United States and ways to mitigate them?

Headings related to research question variables:

Adverse Pregnancy Outcome Factors

Approaches to Improving Pregnancy Outcomes

See next slide

for example

headings
in the
student
sample of
the paper

1

2

3

Approaches to Improving Pregnancy Outcomes 3

Please create yours now
Put an emoji in the chat bar when
ready to continue

Now please copy and paste your REVISED
objective summaries under the relevant Level 3
heading you just created.

See next slide

Like this!

A Note about your Review of the Literature!

In a FULL-length research paper, each level 3

heading would include at least three research articles.

But,

as this is a foundations course, you will provide

a total of 3 research articles,

under a minimum of two level 3 headers.

Check the Flow!

Is organized by findings, geography, methodology, or time?

Uses all three heading levels to help your readers find their way?

Uses transition words like compare/contrast words so the reader sees

the flow from article to article?

Sample comparison words Sample contrast words

…similar to… …different from…

…like… …however…

…also… …on the other hand…

Uses the student sample to help you check yourself?

Now…. Workshop! Write Part 2 of the Review of

Literature!!!

1st paragraph is the objective summary of the first research article

2nd paragraph starts with a citation and a transition phrase to

explain how this article is similar to, or different from, the 1st research

article. Then it continues with the objective summary of the second

research article ending with a citation

3rd paragraph starts with a citation and a transition phrase to

Explain how this article it is similar to, or different from, the 2nd

research article. Then it continues with the objective summary of the
third research article ending with a citation

• Slide 1: W E L C O M E!!!!
• Slide 2: The Basic Structure of a RESEARCH PAPER
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7: What IS a Literature Review???
• Slide 8: What IS a Literature Review???
• Slide 9: What IS a Literature Review???
• Slide 10: What IS a Literature Review???
• Slide 11: What IS a Literature Review???
• Slide 12: Let’s look at two samples:
• Slide 13: Open the Doctoral sample
• Slide 14
• Slide 15: (When will you get YOUR doctorate??)
• Slide 16
• Slide 17
• Slide 18
• Slide 19: As you see, a literature review consists of 3 parts
• Slide 20: 3 parts
• Slide 21: 3 parts
• Slide 22: 3 parts
• Slide 23
• Slide 24
• Slide 25: What part of the literature review have you started on?
• Slide 26: What part of the literature review have you started on?
• Slide 27
• Slide 28
• Slide 29
• Slide 30: To make your literature review “flow,” you will need to see what is the same and what is different among your articles: (Remember the student sample treasure hunt?)
• Slide 31: Ready, Set, GO!
• Slide 32: Congratulations! You just completed the necessary work to help you determine the order of articles for your Review of Literature!
• Slide 33: This black box is a 3-minute video on how to split your screen. Please watch it now for an effective workshop time.
• Slide 34: Please pull up the assignment in which you had your title and references page (Week #6)
• Slide 35: In your Working Final Document, Create appropriate level headings to guide your reader as in the next slide (Title your headings according to your research question)
• Slide 36: Level Headings
• Slide 37: Student research question:
• Slide 38: headings in the student sample of the paper
• Slide 39: Now please copy and paste your REVISED objective summaries under the relevant Level 3 heading you just created.
• Slide 40
• Slide 41: A Note about your Review of the Literature!
• Slide 42
• Slide 43

1

Racial Disparities in Healthcare Among Pregnant Women in the United States

Tamifer Lewis

Department of Public Health, Monroe College, King Graduate School

KG604-144: Graduate Research and Critical Analysis

Dr. Manya Bouteneff

December 4, 2022

2

Racial Disparities in Healthcare Among Pregnant Women in the United States

Introduction

African American, American Indian, and Alaska Native women are up to three times

more likely to die from adverse pregnancy related outcomes, a disparity that increases with age

(Centers for Disease Control and Prevention [CDC], 2019). In the United States, maternal

mortality and adverse health outcomes persist within the minority community, and as a result,

racial disparities in healthcare among pregnant women is a current and preventable public health

concern (CDC, 2019). It is therefore vital to understand the determinants of health that influence

negative pregnancy-related outcomes in minority women, and find ways to mitigate these

determinants’ effects. An intervention program in California, the Black Infant Health Program

(Nichols & Cohen, 2020), is a program that provided support to African American women

through group trainings, entailing stress reduction techniques, life skills development, and the

building of social support. This program enabled mitigation efforts to be focused and geared

around the factors that influence and contributed to adverse pregnancy outcomes among the

minority women within the community, thus reducing and preventing negative pregnancy

outcomes in women of color.

Literature Review

Introduction to the Literature Review

Research suggests that racial disparities in healthcare among pregnant women persists in

the United States (Zhang et al., 2013). Due to this continuous occurrence, it is vital to examine

the factors that contribute to the adverse outcomes in maternal health. The literature review

contained only research articles about factors that impacted and influenced disparities in

pregnancy outcomes. Factors that were reviewed were socioeconomic status, public health

3

insurance, race/ethnicity, and poverty status. The literature review was conducted using EBSCO

Host and ProQuest databases from the Monroe College Library, as well as through Google

Scholar. To ensure only high-quality, secondary research, the present researcher applied the

following search parameters: research needed to have been published between 2012-2022, the

full article had to have been accessible, and each research article had to have been published in

an academic journal. The search terms used to compile pertinent articles were ‘racial disparities’,

‘maternal health’, ‘adverse pregnancy outcomes’, and ‘maternal health outcomes’.

Review of the Literature

Adverse Pregnancy Outcome Factors

Darling et al. (2021) conducted a study between 2001 and 2018 to examine the efficiency

of qualified interventions in preterm birth, small for gestational age, low birth weight, neonatal

death, cesarean deliveries, maternal care satisfaction, and coast effectiveness programs. A

systematic review was used to collect data from the United States, France, Spain, and the

Netherlands. The studies consisted of mostly non- Caucasian women from low-income

population ranging from 12 to 46 years of age and being between 20 to 32 weeks’ gestation.

Interventional programs were implemented into three categories: group prenatal care, augmented

prenatal care, or a combination of both group and augmented prenatal care (Darling et

al., 2021).

The researchers found that certain interventions, such as prenatal care and augmented care, or a

combination of both, may decrease adverse outcomes in small-for-gestational-age and preterm

birth, and could aid in increasing maternal care satisfaction. Interventions that worked on

enhancing coordination of care were found to result in providing more effective cost savings.

The researchers also found disparities in the quality of access to care in the vulnerable

population. There was insufficient evidence of suitable quality to confirm that the interventions

4

were successful at enhancing clinical outcomes in prenatal care for at risk populations (Darling et

al., 2021).

Similar observations were made in a study conducted by Nichols and Cohen (2020),

between 2006 and 2018 to examine the methods used to improve the results of maternal

mortality in California. The study was conducted using a scoping review to evaluate research on

women and maternal health in the United States. The researchers used information from the US

Maternal Fetal Medicine Network to measure the percentage of studies where pregnant women,

women, and children were the main focus. The researchers also reviewed documentation on

healthcare policies and practices from California’s public health department, healthcare

foundation, and Maternal Quality Care Collaborative. Nichols and Cohen (2020) found that

although the health of fetus and children could be adversely affected by the health of the mother,

the majority of maternal programs in the United States places emphasis on the child. The

researchers also found four areas of concern in women health experiences, both in pre and

postnatal care. The problem areas entailed inadequate investment in women’s health, inefficient

quality of care and avoidable caesarean delivers, expanding disparities in minority women and

women living in rural areas, and contradictory collection and distribution of data (Nichols &

Cohen, 2020).

Approaches to Improving Pregnancy Outcomes

In contrast to the preceding studies, Zhang et al. (2013) conducted a study between 2005

and 2007 to calculate the excessive rate of unfavorable outcomes in pregnancy within racial and

ethnic groups. The study also aimed to measure the possibility of Medicaid savings that are

linked to paid maternal care claims resulting from the inequalities that contribute to unfavorable

maternal outcomes. A cross-sectional study using Medicaid Analytic eXtract (MAX) data was

5

used to gather pregnancy outcome information from inpatient hospitals from 14 states (Florida,

Alabama, Arkansas, North Carolina, Georgia, Louisiana, Kentucky, Mississippi, Maryland,

Missouri, Tennessee, South Carolina, Virginia, and Texas). The study consisted of a little over 2

million patients who were insured with Medicaid and had a delivery code of maternal delivery

stay. Zhang et al. (2013) found that, with the exception of gestational diabetes, African American

women showed the worst outcomes out of all unfavorable pregnancy outcomes. These disparities

are postulated as being multi-factorial, having causes stemming from complicated experiences

with racism, poverty, and complex healthcare interactions. It was also found that women covered

under Medicaid health insurance were more likely to have consistency in care from prenatal care

through delivery compared to their counterparts. However, due to participation in Medicaid

programs being influenced by reimbursement rates, some providers may choose to stop

accepting Medicaid patients because of reimbursement delays and low payment rates, which

could contribute to negative birth outcomes (Zhang et al., 2013).

Analysis of the Literature

In the United States, the persistence of maternal mortality continues to be a problem area

in public health. The contributing factors that impact pregnancy outcomes persist in burdening

the U.S., leading to poor healthcare quality, and increasing health disparities. The studies used in

the literature review each used a different form of research methodology to collect data,

including systematic and scoping reviews and cross-sectional studies. Similarly, Darling et al.

(2021), Nichols and Cohen (2020), and Zhang et al. (2013) have emphasized the correlation

between race/ethnicity and financial status playing a part in influencing quality of care, access of

care, and pregnancy outcomes in pregnant minority women. To mitigate the disparities in

maternal health, Darling et al. (2021) and Zhang et al. (2013) suggested that interventions should

6

be inspected and geared towards determining and eradicating the racial and ethnic disparities that

affect pregnancy-related outcomes. Whereas Nichols and Cohen (2020) suggested focusing on

exploring the distinctive experiences of particular at-risk subgroups of women, such as women in

prison, who are of childbearing age, and the pregnant women who are less likely to pursue

prenatal care, such as undocumented women.

Discussion

Introduction to Discussion

There is current evidence that racial disparities in healthcare among pregnant women

continues to be a problem in the United States. African American mothers experience higher

adverse pregnancy outcomes and are less likely to obtain sufficient prenatal care when compared

to Caucasian women (Zhang et al., 2013). According to an article published by The New York

Times (Rabin, 2019), there has been a persistence and growth in racial disparity throughout the

years despite calls to take action to improve medical care access for women of color. Similarly,

in a study conducted by Nichols and Cohen (2020) mounting disparities continue amid women’s

health outcomes in the United States, primarily along lines of race and ethnicity in residents

living in urban and rural areas. These disparities directly affect African American, Alaska

Native, and Native American Women (Rabin, 2019). While the rate of maternal mortality has

dropped across the world, America’s maternal health outcomes have worsened (Rabin, 2019).

Evidence-Based Recommendations

Recommendations from the Literature

To reduce the disparities among minority women different interventions have been tried.

Federal law enacted the Preventing Maternal Death Act (as cited in Rabin, 2019) providing states

with grants to explore, examine and investigate pregnancy related deaths for up to one year after

7

the birth of a child. Also, The American College of Obstetrics and Gynecologists created new

guidelines in treating cardiovascular disease in pregnant women (as cited in Rabin, 2019). In

2014, the Alliance for Innovation on Maternal Health (AIM) was developed by the American

College of Obstetrics and Gynecology to collaborate with partners of states and hospitals to

gather information on safety measures being taken to improve maternal health outcomes,

allowing partners to assess and track program progress (as cited in Nichols & Cohen, 2020). In

the study conducted by Nichols and Cohen (2020), two out of the various initiatives that

California implemented were the Black Infant Health Program (BIH) and increasing the states

income eligibility for pregnant women to 200% of the federal poverty level. With the

implementation of these programs, mortality rates decreased from 22.1% to 8.3%. Altogether,

California’s maternal mortality rate decreased by over 50% between 2006 and 2018 (Nichols &

Cohen, 2020). To prevent negative pregnancy outcomes in women of color, California used

federal funds to develop programs that focused on African American mothers and the health

determinants that are influenced by social and structural factors. The Black Infant Health

Program has provided support to African American women through group trainings, entailing

stress reduction, life skills development, and building social support (Nichols & Cohen, 2020).

Recommendations for Future Mitigation

The present research suggests that other states model their interventions on the programs

that research has shown to be effective in California (Nichols & Cohen, 2020). However, a

barrier to implementation is funding for many states, which will require leaders to fight for the

needed financial backing. Funding should then be used to address the social factors that

influence maternal health in order to reduce the psychosocial risks in those women who may be

more vulnerable to adverse pregnancy outcomes (Nichols & Cohen, 2020). With increased

8

federal funding, programs can be geared towards providing quality care to women of color, as

was done in the Black Infant Health Program (Nichols & Cohen, 2020). This could be

implemented by utilizing methods of care that are relatable to those receiving services in the

community, providing them with medical professionals that are culturally competent and

adequately trained in serving underserved communities. This would foster a mutually trusting

provider-patient relationship, as pregnancy-related risks of a mother do not end after her child’s

birth.

Since increased funding has proven effective in the state of California to prevent negative

outcomes (Nichols & Cohen, 2020), it is therefore recommended by the present researcher to

utilize Medicaid to expand access and coverage to mothers without the means of receiving

adequate care during all stages of pregnancy, and during the postpartum period, when they can

still be adversely affected by her pregnancy. Leaders in positions of power must advocate for the

federal government to enact policies requiring states to provide medical coverage to women for

at least one year after the birth of their child, and state programs should expand Medicaid

coverage for women focusing on their healthcare needs before, during, and after pregnancy.

Especially close attention is needed for those women who have or had high risk pregnancies

(Nichols & Cohen, 2020). If provided with the pertinent funding, healthcare facilities will be

better able to adopt a similar program to California’s Black Infant Health Program (Nichols &

Cohen, 2020). Providing coverage for various stages, before, during, and after pregnancy would

also ensure that mothers have efficient access to care, should adverse symptoms develop.

Implementing these programs would develop a foundation in the quality of racial maternal care

across all states and provide cohesion and uniformity in the delivery of care, therefore reducing

the current disparity rates.

9

Conclusion

As seen in the Black Infant Health Program (Nichols & Cohen, 2020), which provided

support to African American women through group trainings, medical facilities can use a similar

model to create services related to stress reduction techniques, life skills development, and the

building of social support. These strategies can enable mitigation efforts to be focused and

geared around the influencing factors that contributed to adverse pregnancy outcomes among the

minority women within the community, thus reducing and preventing negative pregnancy

outcomes in women of color. Since African American, American Indian, and Alaska Native

women are up to three times more likely to die from adverse pregnancy related outcomes, a

disparity that increases with age (CDC, 2019), leaders must act to address this issue. In the

United States, maternal mortality and adverse health outcomes persist within the minority

community and, as a result, racial disparities in healthcare among pregnant women is a current

preventable public health concern; therefore, it is vital to understand the determinants of health

that influences negative pregnancy related outcomes in minority women and to gain access to

funding in order to increase services dedicated reduction of adverse outcomes.

10

References

Darling, E. K., Cody, K., Tubman-Broeren, M., & Marquez, O. (2021). The effect of prenatal

care delivery models targeting populations with low rates of PNC attendance: A

systematic review. Journal of Health Care for the Poor and Underserved, 32(1), 119-

136. https://www.proquest.com/scholarly-journals/effect-prenatal-care-delivery-models-

targeting/docview/2507722229/se-2

Nichols, C. R., & Cohen, A. K. (2020). Preventing maternal mortality in the United States:

Lessons from California and policy recommendations. Journal of Public Health Policy,

42(1), 127-144. https://doi.org/10.1057/s41271-020-00264-9

Rabin, R. C. (2019, May 8). Huge racial disparities persist in pregnancy-related deaths, and are

growing. New York Times, A20(L).

https://link.gale.com/apps/doc/A584694288/ITOF?u=nysl_me_moncol&sid=bookmark-

ITOF&xid=b9422ff9

Zhang, S., Cardarelli, K., Shim, R., Ye, J., Booker, K. L., & Rust, G. (2013). Racial disparities in

economic and clinical outcomes of pregnancy among Medicaid recipients. Maternal and

Child Health Journal, 17(8), 1518+.

https://link.gale.com/apps/doc/A344827866/PPNU?u=nysl_me_moncol&sid=bookmark-

PPNU&xid=51747d52