The Society for Maternal-Fetal Medicine (SMFM) recently published an SMFM Special Statement that urges a critical examination of how race is used in maternal-fetal medicine research (Wheeler et al., 2022). Although a full review of the statement is not possible here, several key points are summarized. Wheeler et al. (2022) challenge three commonly held myths as they propose a framework for conceptualizing race in research.
The first myth is that race is the same as genetics. Racial categorizations have been socially constructed and are arbitrary. Although race categories have been informed by physical characteristics like facial features, hair texture, and skin color, which may be genetically determined, racial identities are not a proxy for genetics. Wheeler et al. (2022) emphasize the importance of acknowledging that racism and its many adverse effects, not race, is the underlying cause of variations in outcomes presumably based on race.
Myth two is the assumption that racial disparities can be explained by economic disadvantages. Wheeler et al. (2022) stress the complexity of racial disparities in birth outcomes. These disparities may be partly linked to economic status and social determinants of health (SDOH) such as education, housing, and employment; however, disparate outcomes persist after controlling for economic status and SDOH. Racism and adverse outcomes may still be experienced in persons without economic disadvantage (Wheeler et al., 2022).
A third myth challenges the notion that data are colorblind. Many links between race and biology have been made in maternal-fetal literature based on very old studies rooted in racist ideology; however, these associations have informed clinical assessments and prediction models (Wheeler et al., 2022). These include race-based adjustments to pulmonary function tests, glomerular filtration results, and vaginal birth after cesarean prediction models. Responsive to calls to reevaluate tools that have interpreted race as a biologic variable, such tools have been or are being reevaluated (Wheeler et al., 2022).
Action Items for Approaching Race in Maternal-Fetal Medicine Research
When collecting race data, investigators should at a minimum use the five recommended National Institutes of Health (NIH, 2015) race categories with ethnicity reported separately. The NIH categories are American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, and White. Participants should self-report race data and be able to select as many race categories they see applicable (Wheeler et al., 2022).Researchers need to be deliberate in formulating antiracist research questions. This may include seeking consultation with an expert when planning a research study to ensure the development of a research question that is defined clearly and avoids using race as a proxy for genetics or other qualities that are inherent in individuals. Ancestry, which includes genetic markers, country of origin, and family history, is a better option than race for research questions focused on genetics and biology. However, when research is focused on lived experiences, there may be value in collecting data on race (Wheeler et al., 2022).
Investigators can ensure diverse research teams by engaging members of the community and including team members with different education backgrounds and experiences. All research team members should have basic instruction in bias, inclusivity, and antiracism (Wheeler et al., 2022). Research teams should include the communities that are affected by disparate outcomes. Teams must develop equitable partnerships with communities that include allocating financial resources, considering who rightfully owns research data, and including community members in the dissemination of research findings (Wheeler et al., 2022).
Perinatal nurses can support such efforts by following these guidelines when engaging in research and by critically appraising evidence sources that present race as a surrogate for genetics and biologic difference.
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