Abstract
Introduction
Health disparities exposed by the Covid-19 pandemic have prompted healthcare professionals
to investigate disparities within their own specialty. Racial and ethnic disparities
in obstetrics are well documented but inequities in gynaecology are less well known.
Our aim is to review the literature on two commonly performed procedures, hysterectomy
and myomectomy, and one condition, ectopic pregnancy, to evaluate the prevalence of
racial, ethnic and socioeconomic disparities in benign gynaecology and minimal access
surgery.
Methods
A narrative review of 33 articles identified from a Pubmed using the following search
criteria; “race”; “ethnicity”; “socioeconomic status”; “disparity”; “inequity”; and
“inequality”. Case reports and papers assessing gynaecological malignancy were excluded.
Results
Despite minimal access surgery having fewer complications and faster recovery than
open surgery, US studies have shown that black and ethnic minority women are less
likely than white women to have minimally invasive hysterectomies and myomectomies.
Uninsured women and patients on Medicaid are also less likely to receive minimally
invasive procedures. Contributing factors include fibroid size, geographic location
and access to hospitals performing minimal access surgery, and the discontinuation
of power morcellation. Ethnic minority women who receive minimally invasive myomectomy
have been shown to have a higher risk of complications and prolonged recovery. Black
and ethnic minority women also have a higher risk of morbidity and mortality from
ectopic pregnancy and are more likely to receive surgical than medical management.
Conclusion
Extensive study from the US has demonstrated disparities in access to minimally invasive
gynaecological surgery, whereas in the UK the data is infrequent, inconsistent and
incomplete. Little is known about the influence of patient preference and counselling
as well as institutional bias on health equity in gynaecology. Further research is
necessary to identify interventions that mitigate these disparities in access and
outcomes.
Abbreviations:
BAME (Black, Asian and Minority Ethnic), MBRACCE-UK (Mothers and Babies: Reducing Risk Through Audits and Confidential Enquiries Audits and Confidential Enquiries across the UK), HMB (Heavy menstrual bleeding), MIH (Minimally invasive hysterectomy), BMI (Body mass index), MIM (Minimally invasive myomectomy), FDA (Food and Drug Administration EP – ectopic pregnancy)Keywords
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Article info
Publication history
Published online: August 25, 2021
Accepted:
August 23,
2021
Received in revised form:
August 11,
2021
Received:
April 15,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
