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Blackman KCA, Jefferson U, Cotton-Curtis W, Galloway D. Story Circles of Black Doulas, Cultural Brokers for Birthing People in Healthcare. QUALITATIVE HEALTH RESEARCH 2024:10497323241280828. [PMID: 39423359 DOI: 10.1177/10497323241280828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2024]
Abstract
Doula care services (in-person, hybrid, and virtual) during the COVID-19 pandemic may vary. The purpose of this study was to explore doulas' experiences as birthing professionals and epistemological resources assisting Black birthing families during the pandemic. Virtual qualitative story circles were conducted with 11 Black doulas who attended births as doulas from January 2020 to December 2021. Participants were recruited in California. The story circles were audio recorded and transcribed verbatim. Transcripts were analyzed using content analysis, with attention to the influence of epistemic injustice (types of injustices inflicted on marginalized groups) on service provision. Additionally, we employed Patricia Hill Collins' Black Feminist Theory which describes "Black women's ways of knowing" that disrupts and challenges existing epistemologies. Narrative data revealed (1) doulas are positioned as possessors of epistemic influence in birthing spaces with intersecting social identities, (2) a pervasive oppression of doulas' knowledge, (3) epistemological resilience and disruption, and (4) a commitment to Black indigenous practices. Despite these epistemic unfair structures, systems, and experiences, Black doulas reimagine and establish pathways for birthing families to navigate the healthcare system during intrapartum care.
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Affiliation(s)
- Kacie C A Blackman
- Department of Health Sciences, California State University Northridge, Northridge, CA, USA
| | - Urmeka Jefferson
- Department of Women, Children, and Family Nursing, Rush University, Chicago, IL, USA
| | | | - Detrich Galloway
- Department of Anthropology, University of California Riverside, Riverside, CA, USA
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2
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Scroggins JK, Harkins SE, Brown S, St Clair V, LeBron GK, Barcelona V. A systematic review of community-based interventions to address perinatal mental health. Semin Perinatol 2024; 48:151945. [PMID: 39033052 PMCID: PMC11377151 DOI: 10.1016/j.semperi.2024.151945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Little is known about the scope and effectiveness of community-based interventions to address maternal perinatal mental health in the US. We searched PubMed, CINAHL, and PsychINFO in January 2024 to conduct a systematic review of studies using community-based interventions for maternal mental health from pregnancy to 1 year postpartum in the US. We reviewed 22 quantitative studies, and assessed methodological quality and effectiveness of interventions. Most were randomized trials (n = 16) with strong or good methodological quality. The majority of the studies included racially and ethnically diverse participants (n = 14), delivered interventions through community health workers, nurses, midwives, and doulas (n = 18), and had mixed effectiveness of interventions (n = 14). Limitations included small sample sizes, interventions not specifically developed for mental health, limited community involvement in designing interventions, and focus on participants with no mental health issues. Community partners augment this review with lived experience and recommendations for research and clinical practice.
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Affiliation(s)
- Jihye Kim Scroggins
- Columbia University School of Nursing, 560W 168th St, New York, NY 10032, USA
| | - Sarah E Harkins
- Columbia University School of Nursing, 560W 168th St, New York, NY 10032, USA
| | - Sevonna Brown
- Black Women's Blueprint, PO Box 24713, Cadman Plaza Park , Brooklyn, NY 11202, USA
| | - Victoria St Clair
- Caribbean Women's Health Association, 3512 Church Avenue, Brooklyn, NY 11203, USA
| | | | - Veronica Barcelona
- Columbia University School of Nursing, 560W 168th St, New York, NY 10032, USA.
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Archer RE. Surviving in the midst of 'Nowhere': Disrupting the conceptualisation of a maternity care desert. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 39340760 DOI: 10.1111/1467-9566.13847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 07/26/2024] [Indexed: 09/30/2024]
Abstract
The conceptualisation of 'care deserts' has gained increased public attention in recent years. This paper engages a reproductive justice framework to investigate the (mis)alignment of a maternity care desert within a predominantly Black rural community in the United States. I draw on a case study of Gadsden County, Florida-a community that is perceived by its members to be a maternity care desert but that is not technically defined as one-to demonstrate how Black birthing people are cultivating a reproductive liberatory consciousness. Semi-structured interviews with birthing persons and reproductive health experts reveal three overarching processes-naming barriers to health equity, resisting health inequity and cultivating health equity-that characterise a reproductive liberatory consciousness, which I identify as an analytical tool to outline how local social actors are identifying structural constraints as well as developing strategies of communal care and resistance. This work contributes to sociological research on reproductive justice and health equity by exploring the limitations of 'desert' frameworks. Pointing to the need to carefully consider the mechanisms that actively disrupt and potentially transform spatial stratifications and inequities, this paper advances a new understanding of birthing space that captures the layered movements of those living within a perceived maternity care desert.
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Affiliation(s)
- Rose E Archer
- Department of African American Studies, Emory University, Atlanta, Georgia, USA
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4
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Keefe-Oates B, Janiak E, Gottlieb B, Chen JT. Disparities in Postpartum Care Visits: The Dynamics of Parental Leave Duration and Postpartum Care Attendance. Matern Child Health J 2024; 28:1506-1516. [PMID: 38795280 PMCID: PMC11358175 DOI: 10.1007/s10995-024-03929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVES To understand differences in the relationship between parental leave duration and postpartum care across sociodemographic and income groups. METHODS We used data from six states participating in the Center for Disease Control and Prevention's yearly PRAMS study from 2016 to 2019 with a total sample of 12,442 people. Bivariable analyses assessed demographics among those who took more or less parental leave and estimated the prevalence of not accessing postpartum care by demographics, stratified by leave length. We used propensity score weighting to estimate the predicted risk and risk ratios of not accessing postpartum care with < 7 as compared to > = 7 weeks of leave, stratified by income. RESULTS There were significant differences in the prevalence of not accessing care stratified by leave duration, and disparities in utilization by race, ethnicity, and income. A shorter leave duration was associated with a higher risk of not accessing care (RR: 1.98 [CI 1.25-3.20] in higher income group, RR: 1.45 [CI 1.08, 1.99] in lower). The absolute risk of not accessing care was highest in the lower income group regardless of leave duration, though patterns of increased utilization with longer leave duration were consistent in both groups. CONCLUSIONS FOR PRACTICE While shorter leave durations increased the risk of not attending postpartum care, those with lower incomes had the highest absolute risk of not attending care. Policies to support paid leave and extended leave duration are necessary, along with additional supports to increase postpartum care utilization, particularly among low-income families.
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Affiliation(s)
- Brianna Keefe-Oates
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
| | - Elizabeth Janiak
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Barbara Gottlieb
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
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5
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McFarlane SJ, Wright KO, Acheampong B, Francis DB, Callands T, Swartzendruber A, Adesina O. Reframing the experience of childbirth: Black doula communication strategies and client responses during delivery hospitalization. Soc Sci Med 2024; 351:116981. [PMID: 38781745 DOI: 10.1016/j.socscimed.2024.116981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/09/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
Doulas, or birth coaches, are said to be "changing the world, one birth at a time." Black doulas have been suggested to mitigate against lack of representation in obstetric care, limited identity acknowledgement and accommodation, and obstetric racism. However, scientific inquiry into the specific communication strategies and messages used by Black doulas to advocate for clients was non-existent in extant literature. Guided by the Agency-Identity Model, we analyzed 20 diary-interviews of nine Black doulas who recently served Black clients. Specifically, we explored Black doulas' communication strategies and whether these strategies had an impact on client agency. We found that Black doulas prepare their clients for patient-provider interactions, including conversations about certain medical treatments and procedures and the risks for Black women and birthing people, the importance of informed consent, how to be heard, and how to resist neglect or abuse. We found that, in turn, most Black clients were able to enact agentic responses. We describe the specific doula messages, and contextualize our findings, considering how these collective interpersonal communication strategies of Black doulas, and their clients' agentic transformations, may index a sociopolitical movement to reframe the experience of childbirth in America.
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Affiliation(s)
- Soroya Julian McFarlane
- University of Georgia, Department of Communication Studies, 602 Caldwell Hall, GeorgiaAthens, GA, 30606, USA.
| | - Kallia O Wright
- University of Miami, School of Communication, 5100 Brunson Drive, Coral Gables, FL, 33146, USA.
| | - Beauty Acheampong
- University of Georgia, Department of Communication Studies, 602 Caldwell Hall, GeorgiaAthens, GA, 30606, USA.
| | - Diane B Francis
- Northeastern University, College of Arts, Media and Design, Ryder Hall, 11 Leon St #102, Boston, MA, 02115, USA.
| | - Tamora Callands
- University of Georgia, College of Public Health, 231 Wright Hall, Health Sciences Campus, 100 Foster Road, Athens, GA, 30602, USA.
| | - Andrea Swartzendruber
- University of Georgia, College of Public Health, 231 Wright Hall, Health Sciences Campus, 100 Foster Road, Athens, GA, 30602, USA.
| | - Oyinade Adesina
- University of Georgia, Department of Communication Studies, 602 Caldwell Hall, GeorgiaAthens, GA, 30606, USA.
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Post W, Thomas A, Sutton KM. "Black Women Should Not Die Giving Life": The lived experiences of Black women diagnosed with severe maternal morbidity in the United States. Birth 2024. [PMID: 38563087 DOI: 10.1111/birt.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE We sought to understand the lived experiences of Black women diagnosed with severe maternal morbidity (SMM) in communities with high maternal mortality to inform practices that reduce obstetric racism and improve patient outcomes. METHODS From August 2022 through December 2022, we conducted a phenomenological, qualitative study among Black women who experienced SMM. Participants were recruited via social media and met inclusion criteria if they self-identified as Black cisgender women, were 18-40 years old, had SMM diagnosed, and lived within zip codes in the United States that have the top-five highest maternal mortality rates. Family members participated on behalf of women who were deceased but otherwise met all other criteria. We conducted in-depth interviews (IDIs), and transcripts were analyzed using inductive and deductive methods to explore birth story experiences. RESULTS Overall, 12 participants completed IDIs; 10 were women who experienced SMM and 2 were mothers of women who died due to SMM. The mean age for women who experienced SMM was 31 years (range 26-36 years) at the time of the IDI or death. Most participants had graduate-level education, and the average annual household income was 123,750 USD. Women were especially interested in study participation because of their high-income status as they did not fit the stereotypical profile of Black women who experience racial discrimination. The average time since SMM diagnosis was 2 years. Participants highlighted concrete examples of communication failures, stereotyping by providers, differential treatment, and medical errors which patients experienced as manifestations of racism. Medical personnel dismissing and ignoring concerns during emergent situations, even when raised through strong self-advocacy, was a key factor in racism experienced during childbirth. CONCLUSIONS Future interventions to reduce racism and improve maternal health outcomes should center on the experiences of Black women and focus on improving patient-provider communication, as well as the quality and effectiveness of responses during emergent situations. Précis statement: This study underscores the need to center Black women's experiences, enhance patient-provider communication, and address emergent concerns to mitigate obstetric racism and enhance maternal health outcomes.
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Affiliation(s)
- Wendy Post
- Georgetown University, Washington, DC, USA
| | - Angela Thomas
- Medstar Research Institute, Hyattsville, Maryland, USA
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7
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Hernandez-Green N, Davis MV, Beshara MS, Hernandez-Spalding K, Francis S, Parker A, Farinu O, Chandler R. Examining the Perceptions of mHealth on Racial and Ethnic Disparities in Postpartum Health for Black Women: A Scoping Review. Health Promot Pract 2024:15248399241234636. [PMID: 38556711 DOI: 10.1177/15248399241234636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Background. Several disparities exist for Black mothers during the postpartum period, including but not limited to increased maternal mortality and morbidity rates, decreased access to care, and limited access to resources. Given the racial discrepancies in attention to postpartum care, coupled with the critical importance of the postpartum period for preventing adverse maternal health outcomes, research is warranted to explore how mobile health (mHealth) applications may help to alleviate maternal health disparities by optimizing postpartum care and addressing barriers to care for postpartum Black women. Thus, this review examines the perceptions of mHealth applications and their utility in health outcomes among postpartum Black women. Methods. We undertook a comprehensive literature search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included peer-reviewed articles published between 2010 and 2022 that were written in English, utilized mHealth as a primary intervention, and focused on postpartum health and access to resources, primarily among Black women in the United States. Results. A total of eight articles were included in our synthesis, encompassing mobile phone-based interventions for Black women. Cultural tailoring was included in five studies. Interventions that incorporated tailored content and fostered interactions reported high rates of follow-up. Conclusions. Tailored mHealth interventions can effectively promote behavior change and improve health care outcomes for Black women. However, there is a critical need for more research to assess user engagement and retention and whether these improvements indicate long-term sustainability.
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Johnson JD. Black Pregnancy-Related Mortality in the United States. Obstet Gynecol Clin North Am 2024; 51:1-16. [PMID: 38267121 DOI: 10.1016/j.ogc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
The maternal mortality rate for non-Hispanic Black birthing people is 69.9 deaths per 100,000 live births compared with 26.6 deaths per 100,000 live births for non-Hispanic White birthing people. Black pregnancy-related mortality has been underrepresented in research and the media; however, there is growing literature on the role of racism in health disparities. Those who provide care to Black patients should increase their understanding of racism's impact and take steps to center the experiences and needs of Black birthing people.
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Affiliation(s)
- Jasmine D Johnson
- Division of Maternal-Fetal Medicine, Indiana University School of Medicine, 550 North University Bloulevard, Suite 2440, Indianapolis, IN 46202, USA.
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9
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Lawal TK, Owen J, Brown AG, Effland KJ. The Birth Bundle Project: A Rainier Valley Midwifery-led Collaborative Care Initiative Offering Patients and Providers a Paradigm Shift to Impact Health Equity. J Midwifery Womens Health 2024; 69:287-293. [PMID: 37766388 DOI: 10.1111/jmwh.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/11/2023] [Indexed: 09/29/2023]
Abstract
Innovative midwifery-led collaborative care models have the potential to build on grassroots approaches to make transformative change within systems that work with families. Rainier Valley Midwives operates the Bundle Birth Project, a successful program that serves communities who are at higher risk for poor birth outcomes and face barriers to adequate medical, prenatal, and postpartum care, including Black, Indigenous, and persons of color. This project offers wraparound perinatal care services to provide a missing community of support to traditionally marginalized families before, during, and after birth while also bridging the gaps between midwives and physicians who attend births in different settings. By strengthening and formalizing the relationships between different types of perinatal providers including community-based doulas and lactation support professionals, this midwifery-led initiative improves the continuity and quality of care available to families including immigrant, refugee, and families of color in south Seattle, Washington.
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Affiliation(s)
| | | | - Andi Garcia Brown
- Rainier Valley Midwives, Seattle, Washington
- Seattle University, Seattle, Washington
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10
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Kenny KS, Wall-Wieler E, Frank K, Courchene L, Burton M, Dreaver C, Champagne M, Nickel NC, Brownell M, Rocke C, Bennett M, Urquia ML, Anderson M. Identifying newborn discharge to child protective services: Comparing discharge codes from birth hospitalization records and child protection case files. Ann Epidemiol 2024; 91:44-50. [PMID: 38184029 DOI: 10.1016/j.annepidem.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/08/2024]
Abstract
PURPOSE Newborn removal by North America's child protective services (CPS) disproportionately impacts Indigenous and Black families, yet its implications for population health inequities are not well understood. To guide this as a domain for future research, we measured validity of birth hospitalization discharge codes categorizing newborns discharged to CPS. METHODS Using data from 309,260 births in Manitoba, Canada, we compared data on newborns discharged to CPS from hospital discharge codes with the presumed gold standard of custody status from CPS case reports in overall population and separately by First Nations status (categorization used in Canada for Indigenous peoples who are members of a First Nation). RESULTS Of 309,260 newborns, 4562 (1.48%) were in CPS custody at hospital discharge according to CPS case reports and 2678 (0.87%) were coded by hospitals as discharged to CPS. Sensitivity of discharge codes was low (47.8%), however codes were highly specific (99.8%) with a positive predictive value (PPV) of 81.4%, and a negative predictive value (NPV) of 99.2%. Sensitivity, PPV and specificity were equal for all newborns but NPV was lower for First Nations newborns. CONCLUSIONS Canadian hospital discharge records underestimate newborn discharge to CPS, with no difference in misclassication based on First Nations status.
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Affiliation(s)
- Kathleen S Kenny
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada.
| | - Elizabeth Wall-Wieler
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada
| | - Kayla Frank
- First Nations Family Advocate Office, 200-286 Smith Street, Winnipeg, R3C 1K4, Manitoba, Canada
| | - Lindey Courchene
- First Nations Family Advocate Office, 200-286 Smith Street, Winnipeg, R3C 1K4, Manitoba, Canada
| | - Mary Burton
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada; Fearless R2W, PO Box 44095 Redwood Postal Outlet, Winnipeg, R2W 5M3, Manitoba, Canada
| | - Cheryle Dreaver
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada
| | - Micheal Champagne
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada; Fearless R2W, PO Box 44095 Redwood Postal Outlet, Winnipeg, R2W 5M3, Manitoba, Canada
| | - Nathan C Nickel
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada
| | - Cathy Rocke
- Faculty of Social Work, University of Regina, Education Building 456, Regina S4S 0A2, Saskatchewan, Canada
| | - Marlyn Bennett
- Faculty of Social Work, University of Calgary, 2500 University Dr NW MacKimmie Tower 301, Calgary T2N 1N4, Alberta, Canada
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada; Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, 155 College Street, Room 500, Toronto M5T 3M7, Ontario, Canada
| | - Marcia Anderson
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada; Ongomiizwin Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, P122 Pathology Building, 770 Bannatyne Ave, Winnipeg R3W 0W3, Manitoba, Canada
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Goh AH, Altman MR, Canty L, Edmonds JK. Communication Between Pregnant People of Color and Prenatal Care Providers in the United States: An Integrative Review. J Midwifery Womens Health 2024; 69:202-223. [PMID: 37961941 DOI: 10.1111/jmwh.13580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/16/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Racism and discrimination negatively affect patient-provider communication. Yet, pregnant people of color consistently report being discriminated against, disrespected, and ignored. The purpose of this integrated review was to identify studies that examined communication between pregnant people of color and their prenatal care providers and evaluate the factors and outcomes arising from communication. METHODS We searched the PubMed, Embase, CINAHL, and PsychINFO databases for studies published between 2001 and 2023. Articles were eligible for inclusion if they reported on primary research conducted in the United States, were written in English, and focused on patient-provider communication with a sample that included pregnant people of color, defined as those who self-identified as Black, African American, Hispanic, Latina/x/e, Indigenous, American Indian, Asian, Asian American, Native Hawaiian, and/or Pacific Islander American. Twenty-six articles were included in the review. Relevant data were extracted and compiled into an evidence table. We then applied the rating scale of the Johns Hopkins Evidence-Based Practice model to assess the level of evidence and quality of the studies. Themes were identified using a memoing technique and organized into 3 a priori categories: factors, outcomes, and recommendations. RESULTS Two overarching themes emerged from our analysis: racism/discrimination and unmet information needs. Subthemes were then identified as factors, outcomes, or recommendations. Factors included provider behaviors, language barriers, structural barriers, provider type, continuity of care, and fear. Outcome themes were disrespect, trust, decision-making power, missed appointments, and satisfaction with care. Lastly, culturally congruent care, provider training, and workforce development were categorized as recommendations. DISCUSSION Inadequate communication between prenatal care providers and pregnant people of color continues to exist. Improving access to midwifery education for people of color can contribute to delivering perinatal care that is culturally and linguistically aligned. Further research about digital prenatal health communication is necessary to ensure equitable prenatal care.
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Affiliation(s)
- Amy H Goh
- Boston College Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Molly R Altman
- School of Nursing, University of Washington, Seattle, Washington
| | - Lucinda Canty
- College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Joyce K Edmonds
- Boston College Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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12
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Nelson TJ, Butcher BDC, Delgado A, McLemore MR. Perspectives of Certified Nurse-Midwives and Physicians on the Structural and Institutional Barriers that Contribute to the Reproductive Inequities of Black Birthing People in the San Francisco Bay Area. J Midwifery Womens Health 2024. [PMID: 38369871 DOI: 10.1111/jmwh.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/31/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Black birthing people in the United States disproportionately endure inequitable experiences and outcomes during pregnancy and childbirth via structural, interpersonal, and obstetric racism. In this study, the researchers explore provider perspectives of how racism is perpetuated in institutional perinatal and reproductive health care. METHODS Critical Race Theory, Reproductive Justice, and midwifery theory were operationalized through secondary thematic analysis of existing qualitative data from the Community Racial Equity and Training Interventions and Evaluation of Current and Future Healthcare Clinicians Study. Twenty-four perinatal providers (certified nurse-midwives [n = 7] and physicians [n = 17]) voluntarily participated in interviews. A comparative approach was used to determine how professional identity and model of care influence physicians' and certified nurse-midwives' perceptions of equity. RESULTS Thematic analysis produced 5 themes: racism as a comorbidity, health care systems' inability to address the needs of Black birthing people, health care systems prioritizing providers over patients are failed systems, patients are the experts in the optimal health care model, and benefits of interprofessional teams grounded in Reproductive Justice. Additionally, both physicians and midwives expressed a need for a new care model. DISCUSSION With these findings, our team proposes a modification of the midwifery model for application by all provider types that could radically shift the experience and outcomes of perinatal and reproductive health care and reduce mortality. Using a human rights approach to care, a Reproductive Justice-Public Health Critical Race praxis-informed midwifery model may be operationalized by all perinatal and reproductive health care providers. This novel model reflects an iterative process that may offer institutions and providers methods to build on past research supporting midwifery-centered care for improving outcomes for all patients by specifically focusing on improving care of Black birthing people. The implications of this work offer broad application in current clinical practice, quality improvement, research, technology, and patient resources.
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Affiliation(s)
- Tamara J Nelson
- Department of Family Health Care Nursing School of Nursing, University of California San Francisco, San Francisco, California
| | - Brittany D Chambers Butcher
- Department of Human Ecology, Human Development and Family Studies, University of California Davis, Davis, California
| | - Ana Delgado
- Department of Family Health Care Nursing School of Nursing, University of California San Francisco, San Francisco, California
| | - Monica R McLemore
- Department of Family Health Care Nursing School of Nursing, University of California San Francisco, San Francisco, California
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13
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Sharps P, Mahoney D. Maternal health disparities: Challenges and recommendations to achieving equity and justice. J Adv Nurs 2024. [PMID: 38361425 DOI: 10.1111/jan.16098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Phyllis Sharps
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Diane Mahoney
- University of Kansas School of Nursing, Kansas City, Kansas, USA
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14
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Lenze SN, McKay-Gist K, Paul R, Tepe M, Mathews K, Kornfield S, Phillips C, Smith R, Stoermer A, Carter EB. Elevating Voices, Addressing Depression, Toxic Stress, and Equity Through Group Prenatal Care: A Pilot Study. Health Equity 2024; 8:87-95. [PMID: 38287981 PMCID: PMC10823176 DOI: 10.1089/heq.2023.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction Elevating Voices, Addressing Depression, Toxic Stress and Equity (EleVATE) is a group prenatal care (GC) model designed to improve pregnancy outcomes and promote health equity for Black birthing people. This article outlines the foundational community-engaged process to develop EleVATE GC and pilot study results. Methods We used community-based participatory research principles and the Ferguson Commission Report to guide creation of EleVATE GC. The intervention, designed by and for Black birthing people, centers trauma-informed care, antiracism, and integrates behavioral health strategies into group prenatal care to address unmet mental health needs. Using a convenience sample of patients seeking care at one of three safety-net health care sites, we compared preterm birth, small for gestational age, depression scores, and other pregnancy outcomes between patients in individual care (IC), CenteringPregnancy™ (CP), and EleVATE GC. Results Forty-eight patients enrolled in the study (n=11 IC; n=14 CP; n=23 EleVATE GC) and 86% self-identified as Black. Patients participating in group prenatal care (EleVATE GC or CP) were significantly less likely to experience a preterm birth <34 weeks. Rates of small for gestational age, preterm birth <37 weeks, depression scores, and other pregnancy outcomes were similar across groups. Participants in CP and EleVATE GC were more likely to attend their postpartum visit and breastfeed at hospital discharge than those in IC. Discussion Our findings model a systematic approach to design a feasible, patient-centered, community-based, trauma-informed, antiracist intervention. Further study is needed to determine whether EleVATE GC improves perinatal outcomes and promotes health equity.
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Affiliation(s)
- Shannon N. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Rachel Paul
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Katherine Mathews
- SSM Health St. Mary's and Department of Obstetrics, Gynecology, and Women's Health, St. Louis University, St. Louis, Missouri, USA
| | - Sara Kornfield
- Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cheron Phillips
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Richelle Smith
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Amanda Stoermer
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
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Taiwo TK, Goode K, Niles PM, Stoll K, Malhotra N, Vedam S. Perinatal Mood and Anxiety Disorder and Reproductive Justice: Examining Unmet Needs for Mental Health and Social Services in a National Cohort. Health Equity 2024; 8:3-13. [PMID: 38250299 PMCID: PMC10797170 DOI: 10.1089/heq.2022.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Perinatal Mood and Anxiety Disorders (PMADs) are the most common complications during the perinatal period. There is limited understanding of the gaps between need and provision of comprehensive health services for childbearing people, especially among racialized populations. Methods The Giving Voice to Mothers Study (GVtM; n=2700), led by a multistakeholder, Steering Council, captured experiences of engaging with perinatal services, including access, respectful care, and health systems' responsiveness across the United States. A patient-designed survey included variables to assess relationships between race, care provider type (midwife or doctor), and needs for psychosocial health services. We calculated summary statistics and tested for significant differences across racialized groups, subsequently reporting odds ratios (ORs) for each group. Results Among all respondents, 11% (n=274) reported unmet needs for social and mental health services. Indigenous women were three times as likely to have unmet needs for treatment for depression (OR [95% confidence interval, CI]: 3.1 [1.5-6.5]) or mental health counseling (OR [95% CI]: 2.8 [1.5-5.4]), followed by Black women (OR [95% CI]: 1.8 [1.2-2.8] and 2.4 [1.7-3.4]). Odds of postpartum screening for PMAD were significantly lower for Latina women (OR [95% CI]=0.6 [0.4-0.8]). Those with midwife providers were significantly more likely to report screening for anxiety or depression (OR [95% CI]=1.81 [1.45-2.23]) than those with physician providers. Discussion We found significant unmet need for mental health screening and treatment in the United States. Our results confirm racial disparities in referrals to social services and highlight differences across provider types. We discuss barriers to the integration of assessments and interventions for PMAD into routine perinatal services. Implications We propose incentivizing reimbursement schema for screening and treatment programs; for community-based organizations that provide mental health and social services; and for culture-centered midwife-led perinatal and birth centers. Addressing these gaps is essential to reproductive justice.
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Affiliation(s)
- Tanya Khemet Taiwo
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Bastyr University Department of Midwifery, Kenmore, Washington, USA
| | - Keisha Goode
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- SUNY Old Westbury, Old Westbury, New York, USA
- National Association of Certified Professional Midwives, Keene, New Hampshire, USA
| | - P. Mimi Niles
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rtory Meyers College of Nursing, New York University, New York, New York, USA
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nisha Malhotra
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Walter JR, Xu S, Rogers JA. From lab to life: how wearable devices can improve health equity. Nat Commun 2024; 15:123. [PMID: 38167483 PMCID: PMC10761710 DOI: 10.1038/s41467-023-44634-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
Wearable devices can provide personalised medicine at the point of need, potentially increasing access to health services and therefore improving health equity. Here the authors discuss their experiences developing wearable devices for vulnerable patient populations, including neonates and pregnant individuals.
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Affiliation(s)
- Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, 60611, USA
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60611, USA
- Sibel Health, Chicago, IL, 60614, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60611, USA.
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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17
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Schott SL, Adams A, Dougherty RJ, Montgomery T, Lapite FC, Fletcher FE. Renewed calls for abortion-related research in the post-Roe era. Front Public Health 2023; 11:1322299. [PMID: 38179559 PMCID: PMC10765585 DOI: 10.3389/fpubh.2023.1322299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
Nearly 50 years after Roe versus Wade, the United States Supreme Court's decision in Dobbs versus Jackson Women's Health Organization unraveled the constitutional right to abortion, allowing individual states to severely restrict or ban the procedure. In response, leading medical, public health, and community organizations have renewed calls for research to elucidate and address the burgeoning social and medical consequences of new abortion restrictions. Abortion research not only includes studies that establish the safety, quality, and efficacy of evidence-based abortion care protocols, but also encompasses studies on the availability of abortion care, the consequences of being denied an abortion, and the legal and social burdens surrounding abortion. The urgency of these calls for new evidence underscores the importance of ensuring that research in this area is conducted in an ethical and respectful manner, cognizant of the social, political, and structural conditions that shape reproductive health inequities and impact each stage of research-from protocol design to dissemination of findings. Research ethics relates to the moral principles undergirding the design and execution of research projects, and concerns itself with the technicalities of ethical questions related to the research process, such as informed consent, power relations, and confidentiality. Critical insights and reflections from reproductive justice, community engagement, and applied ethics frameworks have bolstered existing research ethics scholarship and discourse by underscoring the importance of meaningful engagement with community stakeholders-bringing attention to overlapping structures of oppression, including racism, sexism, and ways that these structures are perpetuated in the research process.
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Affiliation(s)
- Sophie L. Schott
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - April Adams
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Ryan J. Dougherty
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Taylor Montgomery
- Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, United States
- Department of Population Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Faith E. Fletcher
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
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Wingo EE, Newmann SJ, Borne DE, Shapiro BJ, Seidman DL. Improving Reproductive Health Communication Between Providers and Women Affected by Homelessness and Substance Use in San Francisco: Results from a Community-Informed Workshop. Matern Child Health J 2023; 27:143-152. [PMID: 37204587 PMCID: PMC10691983 DOI: 10.1007/s10995-023-03671-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Many cisgender women affected by homelessness and substance use desire pregnancy and parenthood. Provider discomfort with patient-centered counseling about reproductive choices and supporting reproductive decisions of these women poses barriers to reproductive healthcare access. METHODS We used participatory research methods to develop a half-day workshop for San Francisco-based medical and social service providers to improve reproductive counseling of women experiencing homelessness and/or who use substances. Guided by a stakeholder group comprising cisgender women with lived experience and providers, goals of the workshop included increasing provider empathy, advancing patient-centered reproductive health communication, and eliminating extraneous questions in care settings that perpetuate stigma. We used pre/post surveys to evaluate acceptability and effects of the workshop on participants' attitudes and confidence in providing reproductive health counseling. We repeated surveys one month post-event to investigate lasting effects. RESULTS Forty-two San Francisco-based medical and social service providers participated in the workshop. Compared to pre-test, post-test scores indicated reduced biases about: childbearing among unhoused women (p < 0.01), parenting intentions of pregnant women using substances (p = 0.03), and women not using contraception while using substances (p < 0.01). Participants also expressed increased confidence in how and when to discuss reproductive aspirations (p < 0.01) with clients. At one month, 90% of respondents reported the workshop was somewhat or very beneficial to their work, and 65% reported increased awareness of personal biases when working with this patient population. CONCLUSIONS FOR PRACTICE A half-day workshop increased provider empathy and improved provider confidence in reproductive health counseling of women affected by homelessness and substance use.
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Affiliation(s)
- Erin E Wingo
- Person-Centered Reproductive Health Program (PCRHP), Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Sara J Newmann
- Department of Obstetrics, Gynecology & Reproductive Services, University of California, San Francisco, San Francisco, CA, USA
| | - Deborah E Borne
- Transitions Division, San Francisco Health Network, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Brad J Shapiro
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Dominika L Seidman
- Department of Obstetrics, Gynecology & Reproductive Services, University of California, San Francisco, San Francisco, CA, USA
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Richardson MB, Toluhi AA, Baskin ML, Budhwani H, Julian ZI, Knight CC, Sinkey R, Szychowski JM, Tita AT, Wingate MS, Turan JM. Community and Systems Contributors and Strategies to Reduce Racial Inequities in Maternal Health in the Deep South: Provider Perspectives. Health Equity 2023; 7:581-591. [PMID: 37736520 PMCID: PMC10510686 DOI: 10.1089/heq.2023.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 09/23/2023] Open
Abstract
Purpose Black pregnant individuals in Alabama are disproportionately affected by severe maternal morbidity and mortality (SMM). To understand why racial disparities in maternal health outcomes persist and identify potential strategies to reduce these inequities, we sought perspectives from obstetric health care providers, health administrators, and members of local organizations who provide pregnancy, delivery, and postpartum care services in Alabama. Methods We conducted qualitative in-depth interviews with stakeholders (n=20), purposively recruited from community-based organizations, clinical settings, government organizations, and academic institutions. Interview guides were based on Howell's conceptual model of pathways to racial disparities in maternal mortality. Data were coded using a modified framework theory approach and analyzed thematically. Results Racism, unjust laws and policies, and poverty/lack of infrastructure in communities emerged as major themes contributing to racial disparities in maternal health at the community and systems levels. Inadequate health insurance coverage was described as a strong driver of the disparities. Service providers suggested strategies for Alabama should be community focused, evidence based, and culturally sensitive. These should include Medicaid expansion, expanded parental leave, and removal of laws restricting choice. Community- and systems-level interventions should include community infrastructure improvements, choice in maternity services, and provision of digital communication options. Conclusions Providers shared perspectives on community and structural areas of intervention to reduce racial inequities in SMM. These results can inform discussions with health system and community partners about Alabama and other Deep South initiatives to improve maternal health outcomes in black communities.
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Affiliation(s)
- Molly B. Richardson
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Angelina A. Toluhi
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Monica L. Baskin
- Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
| | - Henna Budhwani
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University (FSU), Tallahassee, Florida, USA
| | - Zoë I. Julian
- Department of Obstetrics and Gynecology, WellStar Kennestone Regional Medical Center, Marietta, Georgia, USA
| | - Candace C. Knight
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- School of Nursing, UAB, Birmingham, Alabama, USA
| | - Rachel Sinkey
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, UAB, Birmingham, Alabama, USA
| | - Jeff M. Szychowski
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- Department of Biostatistics, UAB, Birmingham, Alabama, USA
| | - Alan T.N. Tita
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, UAB, Birmingham, Alabama, USA
| | - Martha S. Wingate
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
| | - Janet M. Turan
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
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20
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Garrett SB, Jones L, Montague A, Fa-Yusuf H, Harris-Taylor J, Powell B, Chan E, Zamarripa S, Hooper S, Chambers Butcher BD. Challenges and Opportunities for Clinician Implicit Bias Training: Insights from Perinatal Care Stakeholders. Health Equity 2023; 7:506-519. [PMID: 37731787 PMCID: PMC10507933 DOI: 10.1089/heq.2023.0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction In an attempt to address health inequities, many U.S. states have considered or enacted legislation requiring antibias or implicit bias training (IBT) for health care providers. California's "Dignity in Pregnancy and Childbirth Act" requires that hospitals and alternative birthing centers provide IBT to perinatal clinicians with the goal of improving clinical outcomes for Black women and birthing people. However, there is as yet insufficient evidence to identify what IBT approaches, if any, achieve this goal. Engaging the experiences and insights of IBT stakeholders is a foundational step in informing nascent IBT policy, curricula, and implementation. Methods We conducted a multimethod community-based participatory research study with key stakeholders of California's IBT policy to identify key challenges and recommendations for effective clinician IBT. We used focus groups, in-depth interviews, combined inductive/deductive thematic analysis, and multiple techniques to promote rigor and validity. Participants were San Francisco Bay Area-based individuals who identified as Black or African American women with a recent hospital birth (n=20), and hospital-based perinatal clinicians (n=20). Results We identified numerous actionable challenges and recommendations regarding aspects of (1) state law; (2) IBT content and format; (3) health care facility IBT implementation; (4) health care facility environment; and (5) provider commitment and behaviors. Patient and clinician insights overlapped substantially. Many respondents felt IBT would improve outcomes only in combination with other antiracism interventions. Health Equity Implications These stakeholder insights offer policy-makers, health system leaders, and curriculum developers crucial guidance for the future development and implementation of clinician antibias interventions.
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Affiliation(s)
- Sarah B. Garrett
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Linda Jones
- California Preterm Birth Initiative, University of California, San Francisco, California, USA
| | - Alexandra Montague
- UCSF-UC Law Consortium on Law, Science & Health Policy, University of California College of the Law, San Francisco, California, USA
| | - Haleemat Fa-Yusuf
- Independent Researcher and Community Advisor, San Francisco, California, USA
| | - Julie Harris-Taylor
- California Preterm Birth Initiative, University of California, San Francisco, California, USA
| | - Breezy Powell
- California Preterm Birth Initiative, University of California, San Francisco, California, USA
| | - Erica Chan
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stephen Zamarripa
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Sarah Hooper
- UCSF-UC Law Consortium on Law, Science & Health Policy, University of California College of the Law, San Francisco, California, USA
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21
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Lathan EC, Britt A, Ravi M, Ash MJ, McAfee E, Wallace S, Johnson CB, Woods-Jaeger B, Powers A, Michopoulos V. WHEN REPRODUCTION IS NO LONGER AUTONOMOUS: FEELING RESPECTED BY MATERNITY CARE PROVIDERS MODERATES THE ASSOCIATION BETWEEN AUTONOMY IN DECISION MAKING AND BIRTH-RELATED PTSD SYMPTOMS IN A COMMUNITY SAMPLE OF POSTPARTUM BLACK WOMEN. J Trauma Dissociation 2023; 24:520-537. [PMID: 37233983 PMCID: PMC10330569 DOI: 10.1080/15299732.2023.2212406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023]
Abstract
Black individuals are at particularly high risk for birth-related posttraumatic stress disorder (PTSD) symptoms, in part due to a lack of opportunity to lead maternity care decisions. Maternal care providers need evidence-based ways to reduce pregnant persons' risk for birth-related PTSD symptoms despite reduced autonomy in decision making resulting from heightened restrictions on reproductive rights. We investigated whether a potential relation between autonomy in decision making and birth-related PTSD symptoms would be moderated by being mistreated or feeling respected by maternity care providers in a community sample of Black women (N = 52; Mage = 28.2 years, SDage = 5.7 years) seeking maternity care at a public hospital in the southeastern United States. At six weeks postpartum, participants completed measures assessing autonomy in decision making, current birth-related PTSD symptoms, number of mistreatment events, and feelings of respect from providers during pregnancy, childbirth, and the postpartum period. Autonomy in decision making was negatively correlated with birth-related PTSD symptoms, r=-.43, p < .01. An interaction between autonomy in decision making and mistreatment by providers was trending toward significance, B=-.23, SE=.14, p = .10. Autonomy in decision making and feeling respected by maternity care provider interacted to predict birth-related PTSD symptoms, B = .05, SE=.01, p < .01. Feeling respected by providers may buffer against the negative effects of lack of autonomy in decision making on birth-related PTSD symptoms, highlighting the importance of providers' ability to convey respect to pregnant patients when they cannot lead care decisions.
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Affiliation(s)
- Emma C. Lathan
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Abby Britt
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Meghna Ravi
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Marcia J. Ash
- Dept of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Elizabeth McAfee
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Shimarith Wallace
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Colin B. Johnson
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Briana Woods-Jaeger
- Dept of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Abigail Powers
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasiliki Michopoulos
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
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22
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Katon JG, Bossick AS, Tartaglione EV, Enquobahrie DA, Haeger KO, Johnson AM, Ma EW, Savitz D, Shaw JG, Todd-Stenberg J, Yano EM, Washington DL, Christy AY. Assessing Racial Disparities in Access, Use, and Outcomes for Pregnant and Postpartum Veterans and Their Infants in Veterans Health Administration. J Womens Health (Larchmt) 2023; 32:757-766. [PMID: 37186805 DOI: 10.1089/jwh.2022.0507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Objective: Limited population-based data examines racial disparities among pregnant and postpartum Veterans. Our objective was to determine whether Black/white racial disparities in health care access, use, and Veteran and infant outcomes are present among pregnant and postpartum Veterans and their infants using Veterans Health Administration (VA) care. Methods: The VA National Veteran Pregnancy and Maternity Care Survey included all Veterans with a VA paid live birth between June 2018 and December 2019. Participants could complete the survey online or by telephone. The independent variable was self-reported race. Outcomes included timely initiation of prenatal care, perceived access to timely prenatal care, attendance at a postpartum check-up, receipt of needed mental health care, cesarean section, postpartum rehospitalization, low birthweight, preterm birth, admission to a neonatal intensive care unit, and breastfeeding. Nonresponse weighted general linear models with a log-link were used to examine associations of race with outcomes. Cox regression was used to examine the association of race with duration of breastfeeding. Models adjusted for age, ethnicity, urban versus rural residence, and parity. Results: The analytic sample consisted of 1,220 Veterans (Black n = 916; white n = 304) representing 3,439 weighted responses (Black n = 1,027; white n = 2,412). No racial disparities were detected for health care access or use. Black Veterans were more likely than white Veterans to have a postpartum rehospitalization (RR 1.67, 95% CI: 1.04-2.68) and a low-birthweight infant (RR 1.67, 95% CI: 1.20-2.33). Conclusion: While no racial disparities were detected for health care access and use, we identified disparities in postpartum rehospitalization and low birthweight, underscoring that access is not sufficient for ensuring health equity.
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Affiliation(s)
- Jodie G Katon
- Health Services Research and Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Andrew S Bossick
- Department of Public Health Sciences, Henry Ford Healthcare System, Detroit, Michigan, USA
| | - Erica V Tartaglione
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, HSR&D, Seattle, Washington, USA
| | | | - Kristin O Haeger
- Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Amanda M Johnson
- Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Erica W Ma
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, HSR&D, Seattle, Washington, USA
| | - David Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jonathan G Shaw
- VA Palo Alto Healthcare System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Jeffery Todd-Stenberg
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, HSR&D, Seattle, Washington, USA
| | - Elizabeth M Yano
- Health Services Research and Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Jonathan and Karen Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Donna L Washington
- Health Services Research and Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Alicia Y Christy
- Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
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Sayyad A, Lindsey A, Narasimhan S, Turner D, Shah P, Lindberg K, Mosley EA. "We really are seeing racism in the hospitals": Racial identity, racism, and doula care for diverse populations in Georgia. PLoS One 2023; 18:e0286663. [PMID: 37285338 DOI: 10.1371/journal.pone.0286663] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Poor birth outcomes are more prevalent for Black communities, but strong evidence shows that doula care can improve those outcomes. More evidence is needed to understand racial differences, discrimination, and equity in doula care. METHODS The current study's objective was to describe the experiences of Black doulas as well as the challenges and facilitators of providing doula care to communities of color in Georgia. From Fall 2020-Fall 2021, 20 surveys and in-depth interviews were conducted with doulas as part of a community-based participatory study co-led by Healthy Mothers, Healthy Babies Coalition of Georgia and academic researchers. RESULTS Doula participants were diverse in age (5% under 25, 40% 25-35, 35% 36-45, and 20% 46+) and race/ethnicity (45% white, 50% Black, 5% Latinx). Most (70%) Black doulas reported that more than 75% of their clientele is Black, while most (78%) white doulas reported that less than 25% of their clientele is Black. Doulas noted the alarming Black maternal mortality rate and how mistreatment causes Black clients to lose trust in medical staff, leaving them in need of advocates. Black doulas were passionate about serving and advocating with Black clients. Participants also described how language and cultural barriers, particularly for Asian and Latinx people, reduce clients' ability to self-advocate, increasing the need for doulas. Doulas also discussed the ways that race influences their connections with clients and their dissatisfaction with the lack of cultural humility or sensitivity training in standard doula training. CONCLUSION Our findings indicate that Black doulas provide essential and supportive services to Black birthing people, and those services are more urgently needed than ever following the overturn of Roe v. Wade. Doula training must be improved to address the cultural needs of diverse clients. Increasing access to doula care for Asian and Latinx communities could also address language and cultural barriers that can negatively impact their maternal and child health outcomes.
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Affiliation(s)
- Ayeesha Sayyad
- Health Promotion and Behavior Concentration, School of Public Health, Georgia State University, Atlanta, GA, United States of America
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Alyssa Lindsey
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Subasri Narasimhan
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Daria Turner
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Priya Shah
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Ky Lindberg
- Healthy Mothers Healthy Babies Coalition of Georgia, Atlanta, GA, United States of America
| | - Elizabeth A Mosley
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Department of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
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Society for Maternal-Fetal Medicine Special Statement: Curriculum outline on patient safety and quality for maternal-fetal medicine fellows. Am J Obstet Gynecol 2023; 228:B2-B17. [PMID: 36738911 DOI: 10.1016/j.ajog.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To help fellows in maternal-fetal medicine gain a well-rounded education in patient safety and quality, we present a curriculum outline that addresses the requirements of the Accreditation Council for Graduate Medical Education and the American Board of Obstetrics and Gynecology. For each month of fellowship, the outline suggests brief video clips, readings, and activities. Emphasis is placed on helping fellows develop and complete a quality improvement project. If desired, the curriculum can be modified to fit program-specific needs and can be adapted for use with residents in obstetrics and gynecology.
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Gregory EF, Cronholm PF, Johnson GT, Maddox AI, Kellom K, Levine LD, Lorch SA, Fiks AG, Resnicow K. A Qualitative Study of Perspectives of Black Women on Autonomy and Motivational Interviewing. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:94-102. [PMID: 36874236 PMCID: PMC9983129 DOI: 10.1089/whr.2022.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/24/2023]
Abstract
Purpose Motivational interviewing (MI) is an evidence-based strategy to modify health behaviors, including some risk factors for adverse birth outcomes. Black women, who have disproportionately high rates of adverse birth outcomes, have reported mixed preferences on MI. This study explored the acceptability of MI among Black women who are at high risk for adverse birth outcomes. Methods We conducted qualitative interviews with women with a history of preterm birth. Participants were English-language proficient and had Medicaid-insured infants. We purposively oversampled women whose infants had medical complexity. Interviews explored experiences with health care and health behaviors after birth. The interview guide was iteratively developed to obtain specific reactions to MI by including videos demonstrating MI-consistent and MI-inconsistent counseling. Interviews were audio recorded, transcribed, and coded following an integrated approach in which we applied a priori codes related to MI and allowed themes to emerge from the data. Results We interviewed 30 non-Hispanic Black women from October 2018 to July 2021. Eleven viewed the videos. Participants emphasized the importance of autonomy in decision-making and health behavior. Participants expressed a preference for MI-consistent clinical approaches, including autonomy support and building rapport, considering them respectful, nonjudgmental, and likely to support change. Conclusions In this sample of Black women with a history of preterm birth, participants valued an MI-consistent clinical approach. Incorporating MI into clinical care may improve the experience of health care among Black women, thus serving as one strategy to promote equity in birth outcomes.
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Affiliation(s)
- Emily F Gregory
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter F Cronholm
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Geminesse T Johnson
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adya I Maddox
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine Kellom
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lisa D Levine
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Scott A Lorch
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander G Fiks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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OjiNjideka Hemphill N, Crooks N, Zhang W, Fitter F, Erbe K, Rutherford JN, Liese KL, Pearson P, Stewart K, Kessee N, Reed L, Tussing-Humphreys L, Koenig MD. Obstetric experiences of young black mothers: An intersectional perspective. Soc Sci Med 2023; 317:115604. [PMID: 36549014 PMCID: PMC9854070 DOI: 10.1016/j.socscimed.2022.115604] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Chicago, maternal morbidity and mortality is six times more likely among Black birthing people than white, despite policy initiatives to promote maternal health equity. Disparities in maternal morbidity and mortality reflect experiences of structural inequities - including limited quality obstetric care, implicit bias, and racism resulting patient mistrust in the health care system, inadequate social support, and financial insecurity. Although there is published literature on Black women's experiences with obstetric care, including experiences with individual and structural racism, little is known about the intersection of age and race and experiences with health care. The purpose of this study was to explore the maternal health and pregnancy experiences of young Black women utilizing an intersectional theoretical lens. METHODS In this study, we conducted two focus groups in a sample of 11 young Black pregnant people. We conducted a thematic analysis to identify codes, themes, and subthemes of the data. RESULTS We developed two overarching themes: obstetric racism and obstetric resistance. To elucidate how obstetric racism framed our participants' healthcare experiences, we identified sub-themes: intersectional identities as young Black women, medical mistrust, and pregnancy trauma. The second major theme describes ways in which participants protected themselves against obstetric racism to engender positive health experiences. These methods of resistance included identifying advocates and relying on trusted providers. CONCLUSIONS The current standard of obstetric care in the US is suboptimal due to individual and structural racism. This study provides unique data on the experiences with health care for young, Black pregnant individuals and delivers valuable insight into how individual and structural racism impacts obstetric care for young Black women.
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Affiliation(s)
- Nefertiti OjiNjideka Hemphill
- Department of Kinesiology and Nutrition, University of Illinois Chicago 1747 W Roosevelt Road, Chicago, IL, 60608, USA.
| | - Natasha Crooks
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Wenqiong Zhang
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Fareeha Fitter
- College of Liberal Arts and Sciences, University of Illinois Chicago 601 S. Morgan St., 4th Floor UH, Chicago, IL, 60607, USA.
| | - Katherine Erbe
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Julienne N Rutherford
- Biobehavioral Health Science Division at the University of Arizona, PO Box 210203, Tucson, AZ, 85721, USA.
| | - Kylea L Liese
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Pamela Pearson
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Karie Stewart
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Nicollette Kessee
- Department of Kinesiology and Nutrition, University of Illinois Chicago 1747 W Roosevelt Road, Chicago, IL, 60608, USA.
| | | | - Lisa Tussing-Humphreys
- Department of Kinesiology and Nutrition, University of Illinois Chicago 1747 W Roosevelt Road, Chicago, IL, 60608, USA.
| | - Mary Dawn Koenig
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
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Gillette‐Pierce KT, Richards‐McDonald L, Arscott J, Josiah N, Duroseau B, Jacques K, Wilson PR, Baptiste D. Factors influencing intrapartum health outcomes among Black birthing persons: A discursive paper. J Adv Nurs 2022; 79:1735-1744. [PMID: 36461641 DOI: 10.1111/jan.15520] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/18/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022]
Abstract
AIM To examine factors that influence intrapartum health outcomes among Black childbearing persons, including cisgender women, transmasculine and gender-diverse birthing persons. BACKGROUND Black childbearing persons are three to four times (243%) more likely to die while giving birth than any other racial/ethnic group. Black birthing persons are not just dying from complications but also from inequitable care from healthcare providers compared to their white counterparts. DESIGN Discursive paper. METHOD Searching national literature published between 2010 and 2021 in PubMed, CINAHL, Embase and SCOPUS, we explored factors associated with poor intrapartum health outcomes among Black childbearing persons. DISCUSSION Several studies have ruled out social determinants of health as sufficient causative factors for poor intrapartum health outcomes among Black birthing persons. Recent research has shown that discrimination by race heavily influences whether a birthing person dies while childbearing. CONCLUSIONS There is a historical context for obstetric medicine that includes harmful stereotypes, implicit bias and racism, all having a negative impact on intrapartum health outcomes. The existing health disparity among this population is endemic and requires close attention. IMPACT ON NURSING PRACTICE Nurses and other healthcare professionals must understand their role in establishing unbiased care that promotes respect for diversity, equity and inclusion. NO PATIENT OR PUBLIC CONTRIBUTION There was no patient or public involvement in the design or drafting of this discursive paper.
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Affiliation(s)
| | - Lynn Richards‐McDonald
- Department of Gynecology and Obstetrics The John Hopkins Medical Institutions Baltimore Maryland USA
| | - Joyell Arscott
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Nia Josiah
- Columbia University School of Nursing New York New York USA
- SAMHSA Minority Fellowship Program, SAMHSA Rockville Maryland USA
| | - Brenice Duroseau
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Keilah Jacques
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
- Johns Hopkins School of Nursing Baltimore Maryland USA
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28
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Senderowicz L, Kolenda A. "She told me no, that you cannot change": Understanding provider refusal to remove contraceptive implants. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100154. [PMID: 37304900 PMCID: PMC10257102 DOI: 10.1016/j.ssmqr.2022.100154] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Enthusiasm for long-acting reversible contraception (LARC) is growing among donors and NGOs throughout the global reproductive health field. There is an emerging concern, however, that the push to insert these methods has not been accompanied by a commensurate push for access to method removal. We use data from 17 focus group discussions with women of reproductive age in an anonymized African setting to understand how users approach providers to request method removal, and how they understand whether or not such a request will be granted. Focus group participants described how providers took on a gatekeeping role to removal services, adjudicating which requests for LARC removal they deemed legitimate enough to be granted. Participants reported that providers often did not consider a simple desire to discontinue the method to be a good enough reason to remove LARC, nor the experience of painful side-effects. Respondents discussed the deployment of what we call legitimating practices, in which they marshalled social support, medical evidence, and other resources to convince providers that their request for removal was indeed serious enough to be honored. This analysis examines the starkly gendered nature of contraceptive coercion, in which women are expected to bear the brunt of contraceptive side-effects, while men are expected to tolerate no inconvenience at all, even vicarious. This evidence of contraceptive coercion and medical misogyny demonstrates the need to center contraceptive autonomy not only at the time of method provision, but at the time of desired discontinuation as well.
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Affiliation(s)
| | - Al Kolenda
- University of Wisconsin-Madison, Madison, USA
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Logan RG, McLemore MR, Julian Z, Stoll K, Malhotra N, Vedam S. Coercion and non-consent during birth and newborn care in the United States. Birth 2022; 49:749-762. [PMID: 35737547 DOI: 10.1111/birt.12641] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/19/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
UNLABELLED In the United States, Black, Indigenous, and People of Color (BIPOC) experience more adverse health outcomes and report mistreatment during pregnancy and birth care. The rights to bodily autonomy and consent are core components of high-quality health care. To assess experiences of coercion and nonconsent for procedures during perinatal care among racialized service users in the United States, we analyzed data from the Giving Voice to Mothers (GVtM-US) study. METHODS In a subset analysis of the full sample of 2700, we examined survey responses for participants who described the experience of pressure or nonconsented procedures or intervention during perinatal care. We conducted multivariable logistic regression analyses by racial and ethnic identity for the outcomes: pressure to have perinatal procedures (eg, induction, epidurals, episiotomy, fetal monitoring), nonconsented procedures performed during perinatal care, pressure to have a cesarean birth, and nonconsented procedures during vaginal births. RESULTS Among participants (n = 2490), 34% self-identified as BIPOC, and 37% had a planned hospital birth. Overall, we found significant differences in pressure and nonconsented perinatal procedures by racial and ethnic identity. These inequities persisted even after controlling for contextual factors, such as birthplace, practitioner type, and prenatal care context. For example, more participants with Black racial identity experienced nonconsented procedures during perinatal care (AOR 1.89, 95% CI 1.35-2.64) and vaginal births (AOR 1.87, 95% CI 1.23-2.83) than those identifying as white. In addition, people who identified as other minoritized racial and ethnic identities reported experiencing more pressure to accept perinatal procedures (AOR 1.55, 95% CI 1.08-2.20) than those who were white. DISCUSSION There is a need to address human rights violations in perinatal care for all birthing people with particular attention to the needs of those identifying as BIPOC. By eliminating mistreatment in perinatal care, such as pressure to accept services and nonconsented procedures, we can help mitigate long-standing inequities.
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Affiliation(s)
| | - Monica R McLemore
- Department of Family Health Care Nursing, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA, USA
| | - Zoë Julian
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.,Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nisha Malhotra
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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- The Birth Place Lab, Vancouver, BC, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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30
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Golden B, Asiodu IV, Franck LS, Ofori-Parku CY, Suárez-Baquero DFM, Youngston T, McLemore MR. Emerging approaches to redressing multi-level racism and reproductive health disparities. NPJ Digit Med 2022; 5:169. [PMID: 36333514 PMCID: PMC9636378 DOI: 10.1038/s41746-022-00718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
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Callegari LS, Benson SK, Mahorter SS, Nelson KM, Arterburn DE, Hamilton AB, Taylor L, Hunter-Merrill R, Gawron LM, Dehlendorf C, Borrero S. Evaluating the MyPath web-based reproductive decision support tool in VA primary care: Protocol for a pragmatic cluster randomized trial. Contemp Clin Trials 2022; 122:106940. [PMID: 36179982 DOI: 10.1016/j.cct.2022.106940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Counseling to identify and support individuals' desires for family formation is a key component of preventive health care that is often absent in primary care visits. This study evaluates a novel, web-based, person-centered intervention to increase the frequency and quality of communication about reproductive goals and healthcare needs in Veterans Health Administration (VA) primary care. METHODS We describe a hybrid type 1 effectiveness-implementation cluster randomized controlled trial in seven VA healthcare systems testing a web-based reproductive health decision support tool (MyPath). VA primary care providers are enrolled and randomized to intervention or usual care arms. Veterans scheduled to see intervention-arm providers receive a text message inviting them to use MyPath ahead of their appointment; Veterans scheduled to see control-arm providers receive usual care. Target enrollment is 36 providers and 456 Veterans. Outcomes are assessed by Veteran self-report after the visit and at 3- and 6-months follow-up. The primary outcome is occurrence of reproductive health discussions involving shared decision making; secondary outcomes include measures of communication, knowledge, decision conflict, contraceptive utilization, and receipt of services related to prepregnancy health. Data on implementation barriers, facilitators and cost are collected. RESULTS The trial is ongoing with no results to report. We have enrolled 36 primary care providers across 7 VA healthcare systems and recruitment of Veterans is ongoing. CONCLUSIONS Results will inform efforts to increase the quality and person-centeredness of reproductive healthcare delivery in primary care and to operationalize and scale up use of digital decision support tools in clinical settings. TRIAL REGISTRATION http://ClinicalTrials.gov Identifier: NCT04584294 Trial Status: Recruiting.
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Affiliation(s)
- Lisa S Callegari
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA; Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA.
| | - Samantha K Benson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Siobhan S Mahorter
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Karin M Nelson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA; Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Alison B Hamilton
- Health Services Research and Development, VA Greater Los Angeles Healthcare System, Los Angeles, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, USA
| | - Leslie Taylor
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Rachel Hunter-Merrill
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Lori M Gawron
- Health Services Research and Development, VA Salt Lake City Health Care System, Salt Lake City, USA; Department of Obstetrics & Gynecology, University of Utah School of Medicine, Salt Lake City, USA
| | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, USA
| | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, USA; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Leister J, Allen J, Owusu Amoah D, Rosfeld C, Trevillian K. Re: “Social and Structural Determinants of Health Inequities in Maternal Health,” by Crear-Perry et al. J Womens Health (Larchmt) 2022; 31:1664-1665. [DOI: 10.1089/jwh.2022.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jeff Leister
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jenna Allen
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Doris Owusu Amoah
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chelsea Rosfeld
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kayla Trevillian
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
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Palmquist AE, Asiodu IV, Tucker C, Tully KP, Asbill DT, Malloy A, Stuebe AM. Racial Disparities in Donor Human Milk Feedings: A Study Using Electronic Medical Records. Health Equity 2022; 6:798-808. [PMID: 36338802 PMCID: PMC9629910 DOI: 10.1089/heq.2022.0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction The aim of this study was to evaluate differences in the use of pasteurized donor human milk (PDHM) by maternal race-ethnicity during postpartum hospitalization using electronic medical records (EMRs). Materials and Methods A retrospective cohort study of all live-born infants at our academic research institution from July 1, 2014, to June 30, 2016, was conducted. EMR data were used to determine whether each infant received mother's own milk (MOM), PDHM, or formula. These data were stratified based on whether the infant received treatment in the Neonatal Critical Care Center. Generalized estimating equation models were used to calculate the odds of receiving PDHM by maternal race-ethnicity, adjusting for gestational age, birth weight, insurance, preferred language, nulliparity, and mode of delivery. Results Infant feeding data were available for 7097 infants, of whom 49% were fed only MOM during their postpartum hospitalization. Among the 15.9% of infants admitted to neonatal critical care, infants of non-Hispanic Black (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.31-0.72), Hispanic (OR 0.65, 95% CI 0.36-1019), and Other (OR 0.63, 95% CI 0.32-1.26) mothers had lower rates of PDHM feedings than infants of non-Hispanic White mothers in the adjusted models. Among well infants, the use of PDHM was lower among non-Hispanic Black and Hispanic mothers (OR 0.25, 95% CI 0.18-0.36, and OR 0.38, 95% CI 0.26-0.56) compared with non-Hispanic White mothers. Conclusions Inequities in exclusive human milk feeding and use of PDHM by maternal race-ethnicity were identified. Antiracist interventions are needed to promote equitable access to skilled lactation support and counseling for PDHM use.
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Affiliation(s)
- Aunchalee E.L. Palmquist
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ifeyinwa V. Asiodu
- Department of Family Health Care Nursing, University of California, San Francisco, California, USA
| | - Christine Tucker
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristin P. Tully
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Angela Malloy
- Momma's Village of Fayetteville, Fayetteville, North Carolina, USA
| | - Alison M. Stuebe
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Attanasio LB, Ranchoff BL, Paterno MT, Kjerulff KH. Person-Centered Maternity Care and Health Outcomes at 1 and 6 Months Postpartum. J Womens Health (Larchmt) 2022; 31:1411-1421. [PMID: 36067084 PMCID: PMC9618378 DOI: 10.1089/jwh.2021.0643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Person-centered care has been increasingly recognized as an important aspect of health care quality, including in maternity care. Little is known about correlates and outcomes of person-centered care in maternity care in the United States. Materials and Methods: Data were from a prospective cohort of more than 3000 individuals who gave birth to a first baby in a Pennsylvania hospital. Person-centered maternity care was measured via a 13-item rating scale administered 1-month postpartum. Content validity was established through exploratory factor analysis. The resulting scale had scores ranging from 13 to 54, with Cronbach's alpha of 0.86. Using linear and logistic regression models to control for covariates, we examined associations between participants' characteristics and person-centered maternity care and between person-centered maternity care and postpartum outcomes. Results: Participants had a mean total score of 47.80 on the person-centered maternity care scale. Patient factors independently associated with more person-centered maternity care included older age, more positive attitude toward vaginal birth during pregnancy, and spontaneous vaginal birth. In adjusted models, higher person-centered maternity scale scores were strongly associated with many positive physical and mental health outcomes at 1 and 6 months postpartum. Conclusions: Our findings underscore the importance of person-centered maternity not just due to its intrinsic value but also because it may be associated with both mental and physical health outcomes through the postpartum period. Results suggest that policy efforts are necessary to ensure person-centered maternity care, especially for delivery hospitalization experience.
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Affiliation(s)
- Laura B. Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Brittany L. Ranchoff
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Mary T. Paterno
- Cooley Dickinson ObGyn and Midwifery, Cooley Dickinson Medical Group, Northampton, Massachusetts, USA
| | - Kristen H. Kjerulff
- Department of Public Health Sciences and Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania, USA
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White VanGompel E, Lai J, Davis D, Carlock F, Camara TL, Taylor B, Clary C, McCorkle‐Jamieson AM, McKenzie‐Sampson S, Gay C, Armijo A, Lapeyrolerie L, Singh L, Scott KA. Psychometric validation of a patient-reported experience measure of obstetric racism© (The PREM-OB Scale™ suite). Birth 2022; 49:514-525. [PMID: 35301757 PMCID: PMC9544169 DOI: 10.1111/birt.12622] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perinatal quality improvement lacks valid tools to measure adverse hospital experiences disproportionately impacting Black mothers and birthing people. Measuring and mitigating harm requires using a framework that centers the lived experiences of Black birthing people in evaluating inequitable care, namely, obstetric racism. We sought to develop a valid patient-reported experience measure (PREM) of Obstetric Racism© in hospital-based intrapartum care designed for, by, and with Black women as patient, community, and content experts. METHODS PROMIS© instrument development standards adapted with cultural rigor methodology. Phase 1 included item pool generation, modified Delphi method, and cognitive interviews. Phase 2 evaluated the item pool using factor analysis and item response theory. RESULTS Items were identified or written to cover 7 previously identified theoretical domains. 806 Black mothers and birthing people completed the pilot test. Factor analysis concluded a 3 factor structure with good fit indices (CFI = 0.931-0.977, RMSEA = 0.087-0.10, R2 > .3, residual correlation < 0.15). All items in each factor fit the IRT model and were able to be calibrated. Factor 1, "Humanity," had 31 items measuring experiences of safety and accountability, autonomy, communication, and empathy. A 12-item short form was created to ease respondent burden. Factor 2, "Racism," had 12 items measuring experiences of neglect and mistreatment. Factor 3, "Kinship," had 7 items measuring hospital denial and disruption of relationships between Black mothers and their child or support system. CONCLUSIONS The PREM-OB Scale™ suite is a valid tool to characterize and quantify obstetric racism for use in perinatal improvement initiatives.
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Affiliation(s)
- Emily White VanGompel
- Departments of Family Medicine and Obstetrics and GynecologyPritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA,NorthShore University HealthSystem (NSUHS) Research InstituteEvanstonIllinoisUSA
| | - Jin‐Shei Lai
- Departments of Medical Social Sciences and PediatricsNorthwestern University Feinberg School of MedicineEvanstonIllinoisUSA
| | - Dána‐Ain Davis
- Queens CollegeCity University of New YorkNew YorkNew YorkUSA
| | - Francesca Carlock
- NorthShore University HealthSystem (NSUHS) Research InstituteEvanstonIllinoisUSA
| | | | - Brianne Taylor
- California Preterm Birth InitiativeUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Chakiya Clary
- California Preterm Birth InitiativeUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Ashlee M. McCorkle‐Jamieson
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA,Department of Obstetrics and GynecologyHighland General HospitalAlameda Health SystemOaklandCaliforniaUSA
| | - Safyer McKenzie‐Sampson
- California Preterm Birth InitiativeUniversity of CaliforniaSan FranciscoCaliforniaUSA,Department of Epidemiology & BiostatisticsUniversity of California San Francisco School of MedicineSan FranciscoCaliforniaUSA
| | - Caryl Gay
- Department of Family Health Care NursingUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Amanda Armijo
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lillie Lapeyrolerie
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lavisha Singh
- Queens CollegeCity University of New YorkNew YorkNew YorkUSA
| | - Karen A. Scott
- Birthing Cultural Rigor, LLCOaklandCaliforniaUSA,Departments of Obstetrics, Gynecology, and Reproductive Sciences, and Humanities and Social SciencesUniversity of California San Francisco School of MedicineSan FranciscoCaliforniaUSA
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Ogunwole SM, Karbeah J, Bozzi DG, Bower KM, Cooper LA, Hardeman R, Kozhimannil K. Health Equity Considerations in State Bills Related to Doula Care (2015-2020). Womens Health Issues 2022; 32:440-449. [PMID: 35610121 PMCID: PMC10224765 DOI: 10.1016/j.whi.2022.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/07/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Racial inequities in birth outcomes persist in the United States. Doula care may help to decrease inequities and improve some perinatal health indicators, but access remains a challenge. Recent doula-related state legislative action seeks to improve access, but the prioritization of equity is unknown. We reviewed recent trends in doula-related legislation and evaluated the extent to which new legislation addresses racial health equity. METHODS We conducted a landscape analysis of the LegiScan database to systematically evaluate state legislation mentioning the word "doula" between 2015 and 2020. We identified and applied nine criteria to assess the equity focus of the identified doula-related legislative proposals. Our final sample consisted of 73 bills across 24 states. RESULTS We observed a three-fold increase in doula-related state legislation introduced over the study period, with 15 bills proposed before 2019 and 58 proposed in 2019-2020. Proposed policies varied widely in content and scope, with 53.4% focusing on Medicaid reimbursement for doula care. In total, 12 bills in 7 states became law. Seven of these laws (58.3%) contained measures for Medicaid reimbursement for doula services, but none guaranteed a living wage based on the cost of living or through consultation with doulas. Only two states (28.6%; Virginia and Oregon) that passed Medicaid reimbursement for doulas also addressed other racial equity components. CONCLUSIONS There has been an increase in proposed doula-related legislation between 2015 and 2020, but racial health equity is not a focus among the laws that passed. States should consider using racial equity assessments to evaluate proposed doula-related legislation.
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Affiliation(s)
- S Michelle Ogunwole
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Baltimore, Maryland.
| | - J'Mag Karbeah
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Debra G Bozzi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kelly M Bower
- Johns Hopkins University School of Nursing, Baltimore, Maryland; Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rachel Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota; Center for Antiracism Research for Health Equity, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Katy Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Akerson S, Taiwo TK, Denmark MA, Collins-Fulea C, Emeis C, Davis R, Pilliod RA. Quality Improvement in Community Birth: A Call to Action. J Midwifery Womens Health 2022; 67:544-547. [PMID: 35993827 DOI: 10.1111/jmwh.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/13/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | - Cathy Emeis
- Frontier Nursing University, Versailles, Kentucky, Silver Spring, Maryland, USA.,California Association of Licensed Midwives, San Leandro, California, USA
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Destigmatizing and Democratizing Postpartum Care: A "Black Woman-Person First" Approach. Clin Obstet Gynecol 2022; 65:663-675. [PMID: 35723647 PMCID: PMC9301983 DOI: 10.1097/grf.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Optimizing postpartum care highlights the need for care coordination, enhancement, and expansion of health care services after childbirth. Yet the prioritization of disease surveillance, management, and mitigation during birth and beyond within the American College of Obstetrics and Gynecology facilitates the medicalization and pathologization of Black bodies, voices, and power. Thus, we offer the Building and Bridging Black Futures Beyond Birth Model: A 12-Step Black Woman-Person First Approach, as a more humane and holistic model of culturally affirming and clinically responsive care. Destigmatizing and democratizing care bridges the gap between intent and impact in postpartum care optimization, particularly for Black women, girls, and gender expansive people and their communities.
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39
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How Can We Get to Equitable and Effective Postpartum Pain Control? Clin Obstet Gynecol 2022; 65:577-587. [PMID: 35703219 DOI: 10.1097/grf.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Postpartum pain is common, yet patient experiences and clinical management varies greatly. In the United States, pain-related expectations and principles of adequate pain management have been framed within established norms of Western clinical medicine and a biomedical understanding of disease processes. Unfortunately, this positioning of postpartum pain and the corresponding coping strategies and pain treatments is situated within cultural biases and systemic racism. This paper summarizes the history and existing literature that examines racial inequities in pain management to propose guiding themes and suggestions for innovation. This work is critical for advancing ethical practice and establishing more effective care for all patients.
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40
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Perinatal quality collaboratives and birth equity. Curr Opin Anaesthesiol 2022; 35:299-305. [PMID: 35671016 DOI: 10.1097/aco.0000000000001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss how state perinatal quality collaboratives are addressing birth equity to reduce disparities in maternal morbidity and mortality. RECENT FINDING Perinatal quality collaboratives are adopting core practices to advance birth equity, reduce disparities and confront racism and bias in obstetric care including securing leadership commitments to equity, providing education on the causes of inequities and mitigation strategies, collecting accurate race/ethnicity data, addressing social determinants of health, and integrating patient and community knowledge, experiences, and narratives in the quality improvement work. SUMMARY Inequities in maternal morbidity and mortality particularly affecting Black birthing people are driven by racism, inequities in the social determinants of health, and variations in care practices and quality. Perinatal quality collaboratives are an important resource for driving improvement changes to mitigate these factors and improve outcomes. VIDEO ABSTRACT Mason CL, Collier CH, Penny SC. Perinatal Quality Collaboratives and Birth Equity. Produced by CLMB Productions for use in this publication. January 10, 2022, http://links.lww.com/COAN/A86.
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Carmichael SL, Abrams B, El Ayadi A, Lee HC, Liu C, Lyell DJ, Lyndon A, Main EK, Mujahid M, Tian L, Snowden JM. Ways Forward in Preventing Severe Maternal Morbidity and Maternal Health Inequities: Conceptual Frameworks, Definitions, and Data, from a Population Health Perspective. Womens Health Issues 2022; 32:213-218. [PMID: 34972599 PMCID: PMC9351612 DOI: 10.1016/j.whi.2021.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Alison El Ayadi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Henry C Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Can Liu
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Deirdre J Lyell
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Audrey Lyndon
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Elliott K Main
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; California Maternal Quality Care Collaborative, Stanford University, Stanford, California
| | - Mahasin Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon; Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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42
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Brown CE, Curtis JR, Doll KM. A Race-Conscious Approach Toward Research on Racial Inequities in Palliative Care. J Pain Symptom Manage 2022; 63:e465-e471. [PMID: 34856335 PMCID: PMC9018527 DOI: 10.1016/j.jpainsymman.2021.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022]
Abstract
Racial inequities in palliative and end-of-life care have been well-documented for many years. This inequity is long-standing and resistant to many intervention efforts. One reason for this may be that research in racial inequity in palliative care, and the interventions developed, do not account for the effects of race and the everyday racism that patients of color experience while navigating the healthcare system. Public Health Critical Race Praxis (PHCRP) offers researchers new routes of inquiry to broaden the scope of research priorities in palliative care and improving racial outcomes through a novel conceptual framework and methodology. PHCRP, based off critical race theory (CRT), contains 10 principles within four foci to guide researchers toward a more race conscious approach for the generation of research questions, research processes, and development of interventions targeting racial inequities.
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Affiliation(s)
- Crystal E Brown
- Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.R.C.), University of Washington, Seattle, Washington; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine (C.E.B., J.R.C.), University of Washington, Seattle, Washington.
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.R.C.), University of Washington, Seattle, Washington; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine (C.E.B., J.R.C.), University of Washington, Seattle, Washington
| | - Kemi M Doll
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (K.M.D.), University of Washington, Seattle, Washington
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Bach S, Heavey E. How NPs can eliminate practice barriers to intrauterine device use. Nurse Pract 2022; 47:22-30. [PMID: 35470331 DOI: 10.1097/01.npr.0000827120.41973.df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABSTRACT Barriers to intrauterine device use include cost, absence of qualified providers, the lack of simplified insertion protocols, cultural hesitation, and misconceptions of appropriateness of use. This article outlines how NPs can eliminate practice barriers to intrauterine device use and prevent unintended pregnancy.
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Chambers BD, Taylor B, Nelson T, Harrison J, Bell A, O'Leary A, Arega HA, Hashemi S, McKenzie-Sampson S, Scott KA, Raine-Bennett T, Jackson AV, Kuppermann M, McLemore MR. Clinicians' Perspectives on Racism and Black Women's Maternal Health. WOMEN'S HEALTH REPORTS 2022; 3:476-482. [PMID: 35651994 PMCID: PMC9148644 DOI: 10.1089/whr.2021.0148] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/13/2022]
Abstract
Objective: Materials and Methods: Results: Conclusion:
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Affiliation(s)
- Brittany D. Chambers
- Department of Human Ecology, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, California, USA
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brianne Taylor
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Tamara Nelson
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Jessica Harrison
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Arielle Bell
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Allison O'Leary
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Helen A. Arega
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sepehr Hashemi
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Karen A. Scott
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Andrea V. Jackson
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Miriam Kuppermann
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Monica R. McLemore
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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Ectogenesis, inequality, and coercion: a reproductive justice-informed analysis of the impact of artificial wombs. BIOSOCIETIES 2022. [DOI: 10.1057/s41292-022-00279-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Greenberg MB, Gandhi M, Davidson C, Carter EB. Society for Maternal-Fetal Medicine Consult Series #62: Best practices in equitable care delivery-Addressing systemic racism and other social determinants of health as causes of obstetrical disparities. Am J Obstet Gynecol 2022; 227:B44-B59. [PMID: 35378098 DOI: 10.1016/j.ajog.2022.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The Centers for Disease Control and Prevention define social determinants of health as "the conditions in the places where people live, learn, work, and play" that can affect health outcomes. Systemic racism is a root cause of the power and wealth imbalances that affect social determinants of health, creating disproportionate rates of comorbidities and adverse outcomes in the communities of racial and ethnic minority groups. Focusing primarily on disparities between Black and White individuals born in the United States, this document reviews the effects of social determinants of health and systemic racism on reproductive health outcomes and recommends multilevel approaches to mitigate disparities in obstetrical outcomes.
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Welch L, Branch Canady R, Harmell C, White N, Snow C, Kane Low L. We Are Not Asking Permission to Save Our Own Lives: Black-Led Birth Centers to Address Health Inequities. J Perinat Neonatal Nurs 2022; 36:138-149. [PMID: 35476768 DOI: 10.1097/jpn.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE While favorable outcomes of birth centers are documented, Black-led birth centers and maternal health models are rarely highlighted. Such disparities are manifestations of institutional racism. A nascent body of literature suggests that culturally affirming care provided by Black-led birth centers benefit all birthing people-regardless of race. Birth Detroit is one such maternal health model led by Black women that offers a justice response to inequitable care options in Black communities. METHODS This article describes a departure from traditional White supremacist research models that privilege quantitative outcomes to the exclusion of iterative processes, lived experiences, and consciousness-raising. A community organizing approach to birth center development led by Black women and rooted in equity values of safety, love, trust, and justice is outlined. RESULTS Birth Detroit is a Black-led, community-informed model that includes integration of evidence-based approaches to improving health outcomes and that embraces community midwifery prenatal care and a strategic trajectory to open a birth center in the city of Detroit. CONCLUSION Birth Detroit demonstrates the operationalization of a Black feminist standpoint, lifts up the power of communities to lead in their own care, and offers a blueprint for action to improve inequities and maternal-infant health in Black communities.
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Affiliation(s)
- Leseliey Welch
- Birth Detroit, Detroit, Michigan (Mss Welch, Harmell, White, and Snow); Birth Center Equity, Boston, Massachusetts (Ms Welch); Michigan Public Health Institute, Lansing (Dr Canady); Public Health, Michigan State University, Lansing (Dr Canady); and School of Nursing, Women's and Gender Studies, Obstetrics and Gynecology, University of Michigan, Ann Arbor (Dr Kane Low)
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Moniz MH, Spector-Bagdady K, Perritt JB, Heisler M, Loder CM, Wetmore MK, Harris LH. Balancing Enhanced Contraceptive Access with Risk of Reproductive Injustice: A United States Comparative Case Study. Contraception 2022; 113:88-94. [DOI: 10.1016/j.contraception.2022.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/03/2022]
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Duncan R, Coleman J, Herring S, Kawan M, Santoro C, Atre M, Mason A, Moore S, Kumar A. Breastfeeding Awareness and Empowerment (BAE): A Black Women-Led Approach to Promoting a Multigenerational Culture of Health. SOCIETIES (BASEL, SWITZERLAND) 2022; 12:28. [PMID: 36160938 PMCID: PMC9499340 DOI: 10.3390/soc12010028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
1 Background Critical gaps in the U.S. healthcare system perpetuate adverse reproductive health outcomes for Black people. Grounded in reproductive justice and trauma-informed care, Breastfeeding Awareness and Empowerment (BAE) has developed a program titled BAE Cafe to directly address these gaps by providing community-based lactation and perinatal mental health support. A literature review identified key programmatic gaps, namely, access to knowledge relevant to troubleshooting breastfeeding, peer support, community support and healthcare system support, and system-level factors that impede families and communities from accessing lactation support. 2 Methods This paper describes BAE Cafe through a group process observation and participant survey. 3 Results The observation of groups highlighted the core elements of the BAE Cafe model: knowledge, support and mental health support in a peer driven format. Participant survey feedback was overwhelmingly positive and highlighted the critical importance of lactation support for Black women by Black women and BAE's role in participants' decisions to continue breastfeeding. 4 Conclusions BAE Cafe is a replicable, scalable, peer-driven and low-barrier intervention that has the potential to improve outcomes for Black families. Additional research and investment are now needed to assess large-scale implementation to reduce disparities and address health inequity across different contexts and settings.
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Affiliation(s)
- Rebecca Duncan
- Breastfeeding Awareness and Empowerment (BAE), Philadelphia, PA 19132, USA
| | - Jabina Coleman
- Breastfeeding Awareness and Empowerment (BAE), Philadelphia, PA 19132, USA
| | - Sharon Herring
- Obstetrics and Reproductive Sciences, Temple University, Philadelphia, PA 19140, USA
| | - Meg Kawan
- Children’s Hospital of Philadelphia (CHOP) Karabots Center, Philadelphia, PA 19139, USA
| | - Christy Santoro
- Obstetrics and Reproductive Sciences, Temple University, Philadelphia, PA 19140, USA
| | - Meghana Atre
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Aleigha Mason
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shawana Moore
- College of Nursing, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Aparna Kumar
- College of Nursing, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Byrd TE, Ingram LA, Okpara N. Examination of maternal near-miss experiences in the hospital setting among Black women in the United States. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221133830. [PMID: 36325622 PMCID: PMC9638691 DOI: 10.1177/17455057221133830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 09/17/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The high rate of maternal mortality among Black women in the United States continues to gain attention; yet research has not yet fully illuminated the precursors to these events, most impactful among them being "maternal near misses." A maternal near miss occurs when a woman nearly dies but survives a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Researchers have focused on reviewing patient medical records after sentinel maternal events to help determine major contributors to them; however, qualitative studies with near-miss survivors, especially among Black women, may be a more useful approach. METHODS Using a qualitative methodology, we conducted semi-structured interviews with 12 Black women to explore how they perceived the care provided to them during their near-miss experiences. Our study also employed a phenomenology framework to understand the lived experience of Black women who had a maternal near miss in the context of a hospital setting. RESULTS We interviewed 12 women between October 2020 and March 2021. All participants had a maternal near miss between the years 2010 and 2020 and were aged between 19 and 41 years when they had their near-miss experience. These women identified communication, patient-provider relationship, skills/competency of staff, provider discrimination, systems issues, and emotional distress as major contributors to their experiences. CONCLUSION Maternal near misses serve as a precursor to maternal mortality events. By listening to patients and their families recount their perspectives on what leads up to these near misses, we can unearth valuable lessons that can aid in the development of strategies and interventions to decrease the numbers of pregnancy-related deaths; especially among Black women who suffer disproportionately from maternal morbidity and mortality. Based on these findings, we recommend that hospitals and OB-GYN practices consider the unique predispositions of their Black patients; account for their own personal biases, revisit the near-miss experiences of past patients to keep patients central to care and build rapport between patients and hospital birthing support staff; and center discussions about improvements in care around racist structures and systems.
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Affiliation(s)
- Tiffany E Byrd
- Department of Health Promotion, Education, and
Behavior, Arnold School of Public Health, University of South Carolina,
Columbia, SC, USA
| | - Lucy A Ingram
- Department of Health Promotion, Education, and
Behavior, Arnold School of Public Health, University of South Carolina,
Columbia, SC, USA
| | - Nkechi Okpara
- Department of Health Promotion, Education, and
Behavior, Arnold School of Public Health, University of South Carolina,
Columbia, SC, USA
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