Racial and Ethnic Disparities in Birth Outcomes and Labor and Delivery Charges Among Massachusetts Women With Intellectual and Developmental Disabilities.

Akobirshoev et al. (2020) looked at hospital records for women with intellectual or developmental disabilities in Massachusetts. They compared birth outcomes and delivery costs between Black and White women.

The team wanted to see if race changed the odds of early birth or high medical bills for mothers with IDD.

Black women with IDD had more preterm births than White women with IDD. Their hospital bills for labor and delivery were also higher.

The gap stayed even when other health issues were taken into account.

Schott et al. (2021) found that Black and Hispanic autistic adults on Medicaid waiver waitlists get fewer services than White peers. Both studies show the same pattern: people of color with IDD receive less or lower-quality care.

Kunze et al. (2025) report that most adults with IDD have tiny, family-only support networks. Small networks during pregnancy could help explain why Black mothers with IDD face worse birth outcomes.

Friedman (2018) shows that states allow participant direction in waivers but expect almost no one to use it. This policy gap may feed the cost and access disparities Ilhom found.

If you serve women with IDD, screen early for pregnancy and birth plans. Ask about travel, insurance, and support gaps. Link Black clients to prenatal care navigators and community doulas. Track due dates and flag high-cost hospitals that may add hidden fees. Small moves like these can shrink the disparity Ilhom et al. uncovered.