Racial and ethnic disparities in birth outcomes and labour and delivery-related charges among women with intellectual and developmental disabilities.
Black and Hispanic women with IDD face doubled stillbirth odds and thousands of dollars more in delivery charges—screen these clients for enhanced perinatal supports.
01Research in Context
What this study did
The team looked at hospital records for women with intellectual or developmental disabilities. They compared birth outcomes and hospital bills across Black, Hispanic, and White women.
They used existing discharge data, so no one was asked to join a new study. The goal was to see if race changed risks and costs for the same disability group.
What they found
Black and Hispanic mothers with IDD had twice the chance of stillbirth compared with White mothers with IDD. Their hospital bills were also 6–9 percent higher.
The gap stayed even when other health issues were taken into account.
How this fits with other research
Ohan et al. (2015) first showed that women with IDD in general have longer stays and more C-sections. Baixauli et al. (2019) zooms in to show those harms hit Black and Hispanic women hardest.
Udhnani et al. (2025) later interviewed 16 mothers with IDD and heard the same story: care is hard to reach and often disrespectful. The numbers and the voices line up.
Friedman et al. (2021) found that better quality scores can lower long-term costs for IDD services. Together the papers say: fix care quality early, especially for minority mothers, and you may save money later.
Why it matters
If you serve women with IDD, flag Black and Hispanic clients for extra prenatal check-ins. Ask about transportation, language, and pain concerns at every visit. A simple screening sheet can trigger earlier ultrasounds, high-risk consults, or social-work referrals. Better monitoring may cut stillbirth risk and keep families out of the NICU.
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02At a glance
03Original abstract
BACKGROUND: Women with intellectual and developmental disabilities (IDD) in the USA are bearing children at increasing rates. However, very little is known whether racial and ethnic disparities in birth outcomes and labour and delivery-related charges exist in this population. This study investigated racial and ethnic disparities in birth outcomes and labour and delivery-related charges among women with IDD. METHODS: The study employed secondary analysis of the 2004-2011 Healthcare Cost and Utilization Project National Inpatient Sample, the largest all-payer, publicly available US inpatient healthcare database. Hierarchical mixed-effect logistic and linear regression models were used to compare the study outcomes. RESULTS: We identified 2110 delivery-associated hospitalisations among women with IDD including 1275 among non-Hispanic White women, 527 among non-Hispanic Black women and 308 among Hispanic women. We found significant disparities in stillbirth among non-Hispanic Black and Hispanic women with IDD compared with their non-Hispanic White peers [odds ratio = 2.50, 95% confidence interval (CI): 1.16-5.28, P < 0.01 and odds ratio = 2.53, 95% CI: 1.08-5.92, P < 0.01, respectively]. There were no racial and ethnic disparities in caesarean delivery, preterm birth and small-for-gestational-age neonates among women with IDD. The average labour and delivery-related charges for non-Hispanic Black and Hispanic Women with IDD ($18 889 and $22 481, respectively) exceeded those for non-Hispanic White women with IDD ($14 886) by $4003 and $7595 or by 27% and 51%, respectively. The significant racial and ethnic differences in charges persisted even after controlling for a range of individual-level and institutional-level characteristics and were 6% (ln(β) = 0.06, 95% CI: 0.01-0.11, P < 0.05) and 9% (ln(β) = 0.09, 95% CI: 0.03-0.14, P < 0.01) higher for non-Hispanic Black and Hispanic Women with IDD compared with non-Hispanic White women with IDD. CONCLUSIONS: Our findings highlight the need for an integrated approach to the delivery of comprehensive perinatal services for racial and ethnic minority women with IDD to reduce their risk of having a stillbirth. Additionally, further research is needed to examine the causes of racial and ethnic disparities in hospital charges for labour and delivery admission among women with IDD and ascertain whether price discrimination exists based on patients' racial or ethnic identities.
Journal of intellectual disability research : JIDR, 2019 · doi:10.1111/jir.12577