A new study from Boston Medical Center reveals that fewer than one in ten reproductive-aged women with opioid use disorder who test positive for hepatitis C receive treatment — and that Asian and Black women are significantly less likely to be tested at all. The virus, left unaddressed, passes quietly from mother to child during pregnancy or birth, setting in motion a lifetime of preventable harm. What the research exposes is not merely a gap in care, but a pattern of unequal access that transforms a curable condition into an inherited burden.
Study exposes racial disparities in hepatitis C testing and treatment for reproductive-aged women
Perinatal transmission of hepatitis C from untreated mothers to infants results in pediatric infection and long-term health complications including chronic liver disease and cancer.
If we aren't testing people, we can't connect them to care
Mark
Why does it matter so much whether a woman is tested during her reproductive years specifically?
Mimi
Because that's when transmission to a child is possible. If you treat hepatitis C before pregnancy or early in pregnancy, you prevent the virus from passing to the baby. After the window closes, the damage is done—the child is born infected. You've lost the chance to prevent it.
Mark
The study found that fewer than ten percent of women who tested positive got treatment. That's a staggering gap. What's blocking the other ninety percent?
Mimi
The research doesn't detail every barrier, but we can infer some of it. There's the testing gap itself—if you're not tested, you can't be treated. There's also stigma around opioid use disorder, which can make women reluctant to seek care or make providers reluctant to offer it. And there's the simple fact that treatment requires access to specialists, consistent appointments, and a healthcare system that prioritizes your care. For women already marginalized by race and addiction, those systems often don't show up.
Mark
The racial disparities are striking. Why would Black and Asian women be tested less?
Mimi
The study documents the disparity but doesn't fully explain the mechanism. It could be that providers have different screening practices based on race. It could be that these women have less access to prenatal care overall. It could be implicit bias—assumptions about who needs testing. The point is that the disparity exists, it's measurable, and it has real consequences.
Mark
Boston Medical Center's program doubled treatment rates. Why can't that scale nationally?
Mimi
Because it requires coordination, resources, and institutional commitment. You need obstetricians talking to infectious disease specialists. You need pharmacists involved. You need pediatric consultants at delivery. That's not the default anywhere. It's a deliberate choice to build that infrastructure. Most hospitals haven't made it yet.
The Pulse
- Fewer than 10% of women who test positive for hepatitis C actually receive treatment, leaving both mother and newborn exposed to a preventable chain of infection.
- Asian and Black women face a 25% lower likelihood of being tested compared to white women, meaning the crisis is invisible to the very system meant to address it.
- Every untreated pregnancy carries the risk of transmitting hepatitis C to the infant, where it can silently progress to chronic liver disease, failure, or cancer over decades.
- Boston Medical Center's Project RESPECT has more than doubled treatment initiation rates by embedding infectious disease care directly into obstetric and postpartum settings.
- The disparity is systemic, not incidental — until testing and treatment reach women equitably across race and geography, the cycle of perinatal transmission will continue.
A new study from Boston Medical Center reveals that fewer than one in ten reproductive-aged women with opioid use disorder who test positive for hepatitis C receive treatment — and that Asian and Black women are significantly less likely to be tested at all. The virus, left unaddressed, passes quietly from mother to child during pregnancy or birth, setting in motion a lifetime of preventable harm. What the research exposes is not merely a gap in care, but a pattern of unequal access that transforms a curable condition into an inherited burden.
Most infants born with hepatitis C contracted the virus from their mothers during pregnancy or birth. Left untreated, the infection can quietly progress to cirrhosis, liver failure, and cancer — damage that compounds across a lifetime. A new study from Boston Medical Center has traced where the system is failing these mothers and children, and the failure follows racial lines.
Analyzing national data on hepatitis C care for reproductive-aged women with opioid use disorder, researchers found that Asian and Black women were 25 percent less likely than white women to be tested for the virus. American Indian and Alaska Native women were tested most frequently of any group. Yet testing alone is insufficient: among women who tested positive, fewer than one in ten received treatment. The virus went unaddressed, pregnancies progressed, and the risk of transmission to the child remained.
Dr. Rachel Epstein, the study's senior author, frames the stakes directly — identifying and treating hepatitis C in women of reproductive age breaks the cycle. It protects the mother from severe disease and prevents transmission to the child. Both outcomes are achievable. The gap between what is medically possible and what is actually happening is precisely what the research exposes.
First author Breanne Biondi underscores a foundational problem: women who are never tested cannot be connected to care. The solution demands systems that actively reach people, that treat hepatitis C as a routine part of reproductive health, and that offer treatment during and after pregnancy with full transparency about risks and benefits.
Boston Medical Center has begun constructing such a system through Project RESPECT, which integrates obstetricians, family medicine physicians, and pharmacists into coordinated hepatitis C care during the postpartum period. Pediatric infectious disease specialists consult on every birthing parent with hepatitis C during their hospital stay. The results are measurable: treatment initiation rates have more than doubled since the program launched.
But one hospital's progress does not resolve a national inequity. Some women are screened; others are not. Some access effective antivirals; others encounter indifference or structural barriers. Until testing and treatment reach every reproductive-aged woman regardless of race or ethnicity, the virus will continue its passage from mother to child — preventable infection becoming preventable tragedy.
Most babies born with hepatitis C got the virus from their mothers during pregnancy or birth. If no one treats the infection, it can quietly become cirrhosis, liver failure, cancer—the kind of slow damage that compounds across a lifetime. A new study from Boston Medical Center has mapped out where the system is failing these mothers and their children, and the answer is written along racial lines.
Researchers analyzing national data on hepatitis C care for reproductive-aged women with opioid use disorder found a stark pattern: Asian and Black women were 25 percent less likely than white women to be tested for the virus in the first place. American Indian and Alaska Native women, by contrast, were tested more frequently than any other group. But testing is only the beginning. Among women who actually tested positive, fewer than one in ten received treatment. The virus went untreated, the pregnancy progressed, and the risk of transmission to the child remained.
The implications are severe and preventable. Hepatitis C is not a death sentence if caught and treated early. The virus can be cleared. But you have to know you have it. You have to have access to treatment. You have to be in a system that prioritizes your care. For many reproductive-aged women struggling with opioid use disorder, those conditions are not met equally.
Dr. Rachel Epstein, an infectious disease clinician-scientist at Boston Medical Center and senior author of the study published in Clinical Infectious Diseases, frames the stakes plainly: identifying and treating hepatitis C in women of reproductive age is a way to break the cycle. It protects the mother from severe disease later. It prevents transmission to the child. Both outcomes matter. Both are achievable. The gap between what is possible and what is actually happening is the problem the research exposes.
Breanne Biondi, the study's first author and a PhD candidate at Boston University School of Public Health, points to a fundamental truth: if women are not tested, they cannot be connected to care. Without that connection, complications follow—including the transmission of virus to the next generation. The solution requires more than good intentions. It requires systems that actively reach people, that offer treatment during pregnancy and after birth with full discussion of risks and benefits, that treat hepatitis C as a routine part of reproductive health rather than an afterthought.
Boston Medical Center has begun building such a system. A program called Project RESPECT brings obstetricians, family medicine doctors, and pharmacists into the same room to integrate hepatitis C treatment into postpartum care. Pediatric infectious disease specialists consult on every birthing parent with hepatitis C during their hospital stay and help connect both parent and infant to ongoing care. The results are measurable: women are now initiating treatment at more than double the rate they were before the program started.
But one hospital's success does not fix a national problem. The disparities documented in this study persist because testing and treatment are not equitably distributed. Some women are screened; others are not. Some have access to effective antivirals; others do not. Some have clinicians who understand the urgency; others encounter indifference or systemic barriers. Until those gaps close—until every reproductive-aged woman, regardless of race or ethnicity, has equal access to testing and treatment—the virus will continue to pass from mother to child, preventable infection becoming preventable tragedy.
Notable Quotes
By identifying and treating hepatitis C early, we can significantly reduce the risk of severe disease and prevent transmission to children, ultimately improving both maternal and infant health outcomes.— Dr. Rachel Epstein, infectious disease clinician-scientist at Boston Medical Center
If we aren't testing people, we can't connect them to care and that can lead to significant complications, including transmitting the virus.— Breanne Biondi, first author of the study and PhD candidate at Boston University School of Public Health
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