[Unless otherwise noted, the following section is from Rattermann et al., 2021].

Health equity is a major concern for pediatric and adolescent children. Despite the great gains made in access to healthcare since the passage of the Affordable Care Act, children from poor communities often lag behind their peers in more affluent communities in access to quality healthcare.

Over one quarter of poor children under 18 years of age in the U.S. have gone more than 6 months without having contact with a doctor or other healthcare professional, with 4.2% of those children having no contact with a doctor or healthcare professional in over five years.

Many schools are addressing the lack of access to healthcare through school nurse programs and school-based health centers. School-based healthcare provides access to primary and preventive healthcare services for students who are at risk for negative medical, social, and academic outcomes. For children from low-income families, the school nurse and the school-based health center are often the only medical care that is available to them.

Training pediatricians to deliver culturally appropriate care and promote health equity is a priority, especially in the context of COVID-19-related racial and ethnic disparities and the increased recognition of racism as a public health crisis. Funding agencies are focusing on defining key terms, including introducing a definition of pediatric health equity (Hernandez et al., 2022). This includes:

• Ensuring every child has the opportunity to be as healthy as possible.
• Removing obstacles such as poverty, discrimination, and lack of access to good jobs.
• Providing fair pay, quality education and housing, safe environments, and good healthcare.
• Developing curricula that are accountable to community needs and that more comprehensively address health inequities.
• Creating competency among pediatricians that address racism, discrimination, and other contributors to inequities.

7.1 Health Inequities in Perinatal Care

[Unless otherwise noted, this section is from Ibrahim et al., 2022]

The World Health Organization has incorporated “respectful maternity care” as a central tenet of high-quality care. Person-centered maternity care is “care that is respectful of and responsive to women’s preferences, needs, and values and is a core component of quality maternity care”.

Inequities in the quality of preconception, prenatal, intrapartum, and postpartum care contribute to racial disparities in maternal health outcomes. Notably, when mode of delivery is disaggregated by race, Black women in the U.S. have the highest rates of cesarean birth, despite similar predisposing factors. Black and Indigenous women in the U.S. are significantly more likely to die within a year of giving birth than white women.

Improving maternal health and health equity is a key priority. Racism and racial discrimination are linked to poor health, and specifically, negative birth outcomes for women of color and their infants. Mistreatment during pregnancy and childbirth has been associated with both short- and long-term adverse mental health outcomes that include pain and suffering, postpartum depression and post-traumatic stress disorder, fear of birth, negative body image, and feelings of dehumanization.

7.2 Reproductive Justice

At United Nations conferences in 1994 (Cairo) and in 1995 (Beijing), participants considered the status of women, population, and development. They adopted the principle of reproductive justice, the fundamental right to control the number and timing of childbearing. This requires access to family planning information, contraceptive services, and abortion. Reproductive justice calls for the right to live in supportive environments that provide reproductive rights, equal opportunities for women, education, fair wages, housing, and healthcare (Speidel and Sullivan, 2023).

The concept of reproductive justice represents a significant shift from traditional notions of reproductive rights. As described by Ross and colleagues, “The ability of any woman to determine her own reproductive destiny is directly linked to the conditions in her community and these conditions are not just a matter of individual choice and access. For example, a woman cannot make an individual decision about her body if she is part of a community whose human rights as a group are violated, such as through environmental dangers or insufficient quality healthcare” (Fleming et al, 2019).

The recent Supreme Court ruling overturning Roe v. Wade has already affected pregnancy-related healthcare for many women. It has also impacted OB/GYN training in the states that have restricted abortion services. This means some hospitals will no longer offer vital training used to manage miscarriages and other pregnancy-related complications.