Data Shows Hidden AAPI Disparities in U.S. Maternal and Infant Mortality
记者/Reporter：Cory Clark
图片来源：NBC NewsPhotographed by NBC News
在过去30年里，美国孕产妇和婴儿死亡率一直在上升，比其他发达国家的上升幅度还要大。在多布斯判决之后（Dobbs decision，是美国最高法院于2022年6月发表的一项决定，该决定涉及堕胎的合法性和限制问题。最高法院以6票对3票的结果，裁定密西西比州的堕胎限制法律是合法的），这些数字呈指数级增长，而这其中绝大部分悲剧是完全可以避免的。在美国十大人口最多的城市中，费城的婴儿在出生后第一年的死亡率最高。
For the last 30 years maternal and infant mortality has been on the rise in the US, more so than in any other developed country. After the Dobbs decision, these numbers have grown exponentially, the vast majority of them completely preventable. Of the top ten most populated US cities, Philadelphia has the highest rate of infant mortality in the first year of life.“当我们强迫人们继续怀孕时，从统计学角度来看，由于罗伊诉韦德案已被推翻（罗伊诉韦德案是美国历史上最具影响力的最高法院判决之一。该判决于1973年由最高法院作出，认为堕胎是美国宪法规定的隐私权的一部分，因此将堕胎合法化）将会有更多的人在美国怀孕，这意味着越来越多的孕妇被迫处在危险之中，”明尼苏达大学公共卫生学院健康与种族平等蓝十字奖授教授、明尼苏达大学反种族主义健康平等研究中心创始主任瑞秋·哈德曼博士（Dr. Rachel Hardeman）说道。
“When we are forcing people to remain pregnant, that means statistically speaking, there are more people who will be pregnant in the United States because Roe has been overturned, which means there are more people in that risk pool for adverse outcomes,” said Dr. Rachel Hardeman, Blue Cross Endowed Professor of Health and Racial Equity at the University of Minnesota School of Public Health, and the founding director of the Center for Antiracism Research for Health Equity at the University of Minnesota.社会上大部分关注都集中在黑人和棕色社区的医疗卫生差异上。然而，这种过高的关注也掩盖了其他族裔社区面临的不平等问题，例如亚太裔社区。根据美国卫生和人类服务部（HHS）2019年的一份报告，亚裔产妇死于产后并发症的风险比非西班牙裔白人孕妇高出40%。
Most of the attention has been given to the health disparities in Black and Brown communities. However, this much-deserved attention is hiding disparities in other communities, like the AAPI community. According to a US Department of Health and Human Services (HHS) report in 2019, Asian American infants are 40 percent more likely to die from maternal complications as compared to non-Hispanic white mothers. 疾病控制和预防中心的《发病率和死亡率周报》列出了亚太裔孕产妇相关死亡率（PRMR）为每10万人中13.5例。这个数字与白人产妇每10万人中12.7例相接近，使得亚太裔与白人之间的不平等比率约仅为1.1。与其他种族/族裔群体的不平等比率相比，黑人与白人的比率为3.2，土著人与白人的比率为2.3。
The Center for Disease Control’s Morbidity and Mortality Weekly report listed the Pregnancy-Related Mortality Ratios (PRMR) of AAPI mothers at 13.5 pregnancy-related deaths per 100,000 live births. This sits near the same level as their White counterparts (12.7 per 100,000), making the disparity ratio between AAPIs to Whites about 1.1. Comparing the disparity ratio to other racial/ethnic groups, the Black to White ratio is at 3.2 and the Indigenous to White ratio is 2.3.
These numbers make it seem like there may not be as many racial disparities in PRMR in the AAPI community. Or at least that the disparities are not as important to recognize. And that feels clear given the way that the report framed the issue. But this exclusion of AAPIs may stem from an issue with data collection, one that is influenced by the infamous model minority myth.例如，在2021年的一项研究中，发现与非西班牙裔白人相比，菲律宾裔和越南裔母亲存在早产风险增加的情况。相比之下，中国，韩国和印度母亲的风险则降低了。
For example, in a 2021 study, it was found that Filipinas and Vietnamese mothers showed an increased risk for preterm birth when comparing Asian American subgroups to non-Hispanic White people. In contrast, Chinese, Korean, and Indian mothers showed decreased risk.另一项研究发现，产后孕妇可能面临的括约肌损伤、转入ICU、产后大出血、子宫破裂和非计划子宫切除等风险也因族裔而异。大多数亚洲族裔都比白人女性面临的风险要多，唯独日本女性的风险较低，而菲律宾和太平洋岛民女性的风险最高。
Another study found that the risk of composite adverse outcome obstetric anal sphincter injury, admission to the ICU, maternal blood transfusion, uterine rupture, and unplanned hysterectomy varied by ethnic group. Rates were higher for most Asian subgroups compared to White women, except for Japanese women who had a lower risk while the risk was highest for Filipina and Pacific Islander women.根据FertilityIQ的一份报告，与其他族裔的不孕患者相比，东亚血统的人患子宫内膜异位症的风险更高。例如，菲律宾族裔的患病可能性是白人的4.5倍，而韩国族裔的患病可能性是白人的5.5倍。
According to FertilityIQ, there is reason to believe that some people of East Asian descent may have an increased risk of endometriosis compared to fertility patients from other ethnicities and heritages. For example, Filipino patients are 4 and half times more likely compared to White patients, while Koreans are 5 and a half times more likely.
According to a recent report by the Children’s Hospital of Philadelphia (CHOP), Chinese and Japanese American populations have a higher risk of sudden infant death syndrome (SIDS) compared to their non-Hispanic white counterparts. Among US-born AAPI mothers Chinese Americans were least likely to receive the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), while Japanese and Korean women were least likely to receive this assistance among Asians born outside of the US.
Suicide is a leading cause of maternal mortality in the US. Asian women are nine times more likely to report suicidal ideations than their white counterparts in the immediate postpartum period. Nearly three-quarters of people with a pregnancy-related mental health cause of death had a history of depression, and more than two-thirds had past or current substance use.
More than 50 percent of Asian mothers showed a high risk for postpartum depression (PPD) during self-screening, yet clinical diagnosis rates for PPD were significantly lower. This suggests that there are barriers to Asian mothers being clinically diagnosed with PPD; which may include stigma, language, cultural issues, and insurance navigation or access.
A 2019 study found that many Chinese mothers experienced depressive symptoms but did not believe that depression applied to Chinese women, some did not believe that postpartum depression exists in their culture because people “did not talk about it.” Broadly speaking Asians are also the racial group least likely to seek help for mental health issues. When compared to Whites, Asian Americans are three times less likely to seek mental health services.
Asian Americans indicated that they are more comfortable reaching out to friends, peers, and their immediate social circle for mental health issues and support. An organization called 2020 Mom has been pushing for the use of peep-to-peep specialists to address mental health issues in the AAPI community and recently finished a pilot program for Black mothers that showed a lot of promise.
Earlier this year a bipartisan group of Representatives and Senators introduced 13 evidence-based bills that make up the Black Maternal Health Momnibus Act, a historic legislative package to address the United States’ urgent maternal health crisis in the US.“在地球上最富有的国家，产妇的死亡率却是发达国家中最高的。这是不可接受的，国会应该支持解决这个问题，”黑人孕产妇健康核心小组和众议院健康小组委员会成员布朗特·罗切斯特议员（Blunt Rochester）说。
“在两党合作之下，我很高兴能与众议员菲茨帕特里克（Fitzpatrick）一起提出了的《母亲问题法案》（Maternal Health Caucus），作为解决美国孕产妇高死亡率问题的一部分。我们的法案将对社区进行关键投资，这些项目将为产后患上精神问题和生活困难的母亲提供支持。”
“In the richest nation on the earth, moms are dying at the highest rate in the developed world. It’s unacceptable, and it’s up to Congress to support evidenced-based solutions to fix it,” said Congresswoman Blunt Rochester, a member of the Black Maternal Health Caucus and the House Health Subcommittee. “I was proud to introduce the bipartisan Moms Matter Act with Rep. Fitzpatrick as part of the Momnibus package to tackle the maternal mortality crisis in the United States. My bill will make critical investments in community-based programs that provide mental and behavioral health treatments and support to moms with maternal mental health conditions or substance use disorders. I am committed to working with my colleagues to get this bill to President Biden’s desk so we can combat this urgent health crisis, tackle racial and ethnic disparities in health outcomes, and ultimately, save Moms’ lives.”其他降低婴儿和产妇死亡率的举措包括一个名为费城乔伊银行（Philly Joy Bank）的试点项目，该项目由费城社区行动网络（CAN）运营，是一个利益相关者团体，专注于减少婴儿死亡率中暗含的种族差异。
Other initiatives to reduce infant and maternal mortality include a pilot program in Philadelphia called the Philly Joy Bank run by the Philadelphia Community Action Network (CAN) a collective impact stakeholder group focused on reducing racial disparities in infant mortality. The program will give a thousand dollars a month guaranteed income for approximately 250 pregnant Philadelphians to reduce racial disparities in birth outcomes. This income is no-strings-attached which respects the dignity and autonomy of participants and allows them the freedom to use the cash as they determine to best address their needs.卫生专员谢丽尔·贝蒂戈尔（Cheryl bettigoole）博士说：“费城婴儿高死亡率是一个可以解决的问题。我们知道，更好地支持孕妇和新父母有助于挽救婴儿的生命。作为美国最贫穷的大城市，要做到这一点并不容易，尤其是在世代贫困和被种族主义压垮的地区。”
“费城乔伊银行借鉴了其他无附加条件援助项目的成功经验，以帮助打破这些循环。我们非常高兴能有像威廉·佩恩基金会和Spring Point Partners这样慷慨的捐助者帮助启动这个万众期待的项目。”
“Infant mortality in Philadelphia is a solvable crisis,” said Health Commissioner Dr. Cheryl Bettigole. “We know that being able to better support pregnant people and new parents helps keep babies alive. As the poorest big city in the country, this is not always easy, especially in areas of the city that are being crushed by generational poverty and systemic racism. The Philly Joy Bank draws on the successes of other no-strings-attached guaranteed income projects to help break those cycles. We could not be more pleased to have generous donors like the William Penn Foundation and Spring Point Partners helping to kickstart this wonderful program.”
Hospitals across Philadelphia and the nation are collaborating to develop strategies to reduce persistent racial, ethnic, and geographic disparities and examine how care may be tailored to mothers with diverse needs. The end goal: Reduce risks for mothers and babies most susceptible to poor health outcomes.
其中一个战略是由杰弗逊医院和Keystone Connection to Wellness提供的“集中妊娠”项目，帮助孕妇接受教育，使准父母能够在孕期护理中扮演更积极和主动的角色。
One strategy is the Centering Pregnancy programs offered by Jefferson Hospital and Keystone Connection to Wellness to help educate pregnant women enabling expectant parents to take a more engaged and active role in their pregnancy care.另一个计划旨在全市增加专业助产士的配备。（在助产领域中接受了文化教育和培训的专业人士，他们能够更好地理解和尊重不同文化背景的孕妇和产妇的需求和价值观，并提供相应的支持和护理服务。这些助产士通常来自与孕妇和产妇相同或相似的文化背景，并能够使用相应的语言和传统知识来提供文化上敏感的产前、产后和育婴支持。）
“在我们疫苗公平项目取得成功的基础上，我们扩大了工作范围以解决其他健康差异，比如乙型肝炎，此外就是费城亚太裔社区产妇和婴儿过高的死亡率，”费城华埠发展会（Philadelphia Chinatown Development Corporation）的健康项目助理Kaizan Kollin说。
Another program seeks to increase the use of culturally competent Dulas throughout the city.
“Jumping off the successful impact of our vaccine equity projects, we are expanding our work to other health disparities such as Hepatitis B. and we are looking forward to including more health disparities that we can tackle, one of those being maternal and infant deaths disproportionately experienced by the Philadelphia AAPI community,” said Kaizan Kollin a Health Project Associate at Philadelphia Chinatown Development Corporation.
