Nicola Tavella, MPH, explains institution-wide elective induction and reduced perinatal disparities

A policy allowing elective inductions of labor (IOL) for all eligible patients at 39 weeks’ gestation or later was associated with reductions in cesarean delivery and neonatal intensive care unit (NICU) admission rates, according to findings presented at the 2026 Pregnancy Meeting of the Society for Maternal-Fetal Medicine. However, most disparities based on neighborhood-level social vulnerability persisted despite the policy change.

The retrospective study evaluated 21,854 nulliparous patients with term, singleton, vertex gestations who delivered at a large urban US hospital between January 2013 and December 2022. Patients with scheduled cesarean deliveries were excluded. Addresses were geocoded to 2020 US Census tracts and linked to Social Vulnerability Index (SVI) values ranging from 0 to 1, with high SVI defined as ≥ 0.75. Twenty-two percent of the cohort met criteria for high SVI.

“In this study, we were interested in seeing whether the fact that our institution had expanded the availability of elective inductions of labor at a specific time point could reduce perinatal health disparities,” said Nicola F. Tavella, MPH; Program director, Clinical Research for Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai.

“We wanted to see whether, in the pre-intervention period and the post-intervention period, there were differences not only in morbidity-related outcomes but also in the disparities within our patient population.”

Patients with high SVI disproportionately identified as non-White, lacked private insurance, and had higher rates of hypertension and NICU admission (P < .001). Induction rates did not differ by SVI group. Overall, IOL was more likely in the post-change period (9.0 [7.5,10.5]), while cesarean delivery (-3.8 [-5.2,-2.4]) and NICU admission (-1.5 [-2.4,-0.7]) were less likely after the policy change. The disparity in chorioamnionitis also decreased post-change (-0.5 [-0.9,-0.02]).

“Instead of looking at race and ethnicity as a proxy for sociostructural adversity, we used the Social Vulnerability Index as its own predictor variable to gauge disparity,” Tavella explained.

Although outcomes improved overall, SVI-based disparities were mostly unchanged. Tavella emphasized that universal policies may help reduce bias but are not sufficient on their own. “Something as simple as offering a service to anyone who wants it electively, versus it being provider-dependent, has the potential to improve care for everyone,” she said. “But to meaningfully close perinatal health disparities, we need to better understand and address the underlying sociostructural barriers.”

Reference:

Tavella NF, Ukoha EP, Edwards SE1, Stern T, Glazer KB,

Bianco AT. Addressing Perinatal Health Disparities through Institution-Wide Offering of Elective Inductions of Labor after 39 Weeks. Abstract. Presented at Society for Maternal-Fetal Medicine 2026 Pregnancy Meeting. February 8-13, 2026. Las Vegas, Nevada.