Structured Abstract

Contents

• Preface
• Acknowledgments
• Technical Expert Panel
• Peer Reviewers
• Executive Summary
  • Main Points
  • Background and Purpose
  • Methods
  • Results
  • Strengths and Limitations
  • Implications and Conclusions
  • References
• Chapter 1. Introduction
  • 1.1. Background
  • 1.2. Terminology
  • 1.3. Purpose and Scope of the Systematic Review
• Chapter 2. Methods
  • 2.1. Review Approach
  • 2.2. Study Selection
  • 2.3. Data Extraction and Risk of Bias Assessment
  • 2.4. Data Synthesis
  • 2.5. Grading Strength of Evidence
  • 2.6. Author Statement
• Chapter 3. Search Results
• Chapter 4. Risk Factors for Pregnant People During the Prenatal Period
  • 4.1. Key Points
  • 4.2. Identity and Discrimination
  • 4.3. Socioeconomic Factors
  • 4.4. Violence, Trauma, and Psychosocial Stress Factors
  • 4.5. Structural/Institutional Factors
  • 4.6. Rural/Urban and Environment Factors
  • 4.7. Comorbidity Factors
  • 4.8. Hospital and Healthcare Use Factors
• Chapter 5. Risk Factors for Birthing People Immediately Before, During, or After Birth
  • 5.1. Key Points
  • 5.2. Identity and Discrimination
  • 5.3. Socioeconomic Factors
  • 5.4. Structural/Institutional Factors
  • 5.5. Rural/Urban and Environmental Factors
  • 5.6. Hospital and Healthcare Use Factors
  • 5.7. Comorbidity Factors
• Chapter 6. Discussion
  • 6.1. Overview
  • 6.2. Future Research
  • 6.3. Strengths and Limitations of the Review
  • 6.4. Conclusion
• References
• Appendixes
  • Appendix A. Methods – Search Strategy
  • Appendix B. Studies Excluded at Full Text
  • Appendix C. Evidence Tables

Suggested citation:

Slaughter-Acey J, Behrens K, Claussen AM, Usset T, Neerland C, Bilal-Roby S, Bashir H, Westby A, Wagner B, Dixon M, Xiao M, Butler M. Social and Structural Determinants of Maternal Morbidity and Mortality: An Evidence Map. Comparative Effectiveness Review No. 264. (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 75Q80120D00008.) AHRQ Publication No. 23(24)-EHC014. Rockville, MD: Agency for Healthcare Research and Quality; December 2023. DOI: https://doi.org/10.32970/AHRQEPCCER264. Posted final reports are located on the Effective Health Care Program search page.

This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 75Q80120D00008). The report was commissioned and funded by the National Institutes of Health (NIH) Office of Disease Prevention to inform a Pathways to Prevention Workshop. The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ or NIH. Therefore, no statement in this report should be construed as an official position of NIH, AHRQ, or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. Most AHRQ documents are publicly available to use for noncommercial purposes (research, clinical or patient education, quality improvement projects) in the United States, and do not need specific permission to be reprinted and used unless they contain material that is copyrighted by others. Specific written permission is needed for commercial use (reprinting for sale, incorporation into software, incorporation into for-profit training courses) or for use outside of the United States. If organizational policies require permission to adapt or use these materials, AHRQ will provide such permission in writing.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

A representative from AHRQ served as a Contracting Officer’s Representative and reviewed the contract deliverables for adherence to contract requirements and quality. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis, interpretation of data, or preparation or drafting of this report.

AHRQ appreciates appropriate acknowledgment and citation of its work. Suggested language for acknowledgment: This work was based on an evidence report, Social and Structural Determinants of Maternal Morbidity and Mortality: An Evidence Map, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ).