Role of Social Determinants of Health in Widening Maternal and Child Health Disparities in the Era of Covid-19 Pandemic

"It's what we perceive as different": an interpretative phenomenological analysis of Nigerian women's characterization of their health during the COVID-19 pandemic

BACKGROUND

Health has historically been adversely affected by social, economic, and political pandemics. In parallel with the spread of diseases, so do the risks of comorbidity and death associated with their consequences. As a result of the current pandemic, shifting resources and services in resource-poor settings without adequate preparation has intensified negative consequences, which global service interruptions have exacerbated. Pregnant women are especially vulnerable during infectious disease outbreaks, and the current pandemic has significantly impacted them.

METHODS

This study used an interpretive phenomenological analysis study with a feminist lens to investigate how women obtained healthcare in Ebonyi, Ogun, and Sokoto states Nigeria during the COVID-19 pandemic. We specifically investigated whether the epidemic influenced women's decisions to seek or avoid healthcare and whether their experiences differed from those outside of it.

RESULTS

We identified three superordinate themes: (1) the adoption of new personal health behaviour in response to the pandemic; (2) the pandemic as a temporal equalizer for marginalized individuals; (3) the impacts of the COVID-19 pandemic on maternal health care. In Nigeria, pregnant women were affected in a variety of ways by the COVID-19 epidemic. Women, particularly those socially identified as disabled, had to cross norms of disadvantage and discrimination to seek healthcare because of the pandemic's impact on prescribed healthcare practices, the healthcare system, and the everyday landscapes defined by norms of disadvantage and discrimination.

CONCLUSION

It is clear from the current pandemic that stakeholders must begin to strategize and develop plans to limit the effects of future pandemics on maternal healthcare, particularly for low-income women.

Disparities in Utilization and Delivery Outcomes for Women with Perinatal Mood and Anxiety Disorders

Perinatal mood and anxiety disorders (PMAD), which include depression and/or anxiety in the year before and/or after delivery, are common complications of pregnancy, affecting up to one in four perinatal individuals, with costs of over $15 billion per year in the US. In this paper, we provide an overview of the disparities in utilization and delivery outcomes for individuals with perinatal mood and anxiety disorders in the US. In addition, we discuss the current US screening and treatment guidelines as well as the high societal costs of illness of PMAD for both perinatal individuals and children. Finally, we outline opportunities for quality improvement of PMAD care in the US, including leveraging increased engagement with healthcare system during prenatal care, working toward a more cohesive national strategy to address PMAD, leaning into evidence-based policymaking through collaboration with a panel of experts, and generating state-level profiles focused on PMAD.

The heart of it all: Body dysmorphic disorder in cosmetic surgery

BACKGROUND

Body Dysmorphic Disorder (BDD) represents a prevalent mental health condition characterized by distress arising from self-perceived physical imperfections. BDD serves as a contraindication to aesthetic surgery. Recognizing BDD holds paramount importance for plastic surgeons, as it is instrumental in averting the exacerbation of this condition while ensuring appropriate referrals.

OBJECTIVE

This study aimed to investigate the prevalence of BDD in cosmetic surgery patients and to pinpoint key characteristics associated with BDD. This information provides plastic surgeons with specific factors to consider during preoperative evaluations.

METHODS

We employed TriNetX database to identify patients with BDD who underwent cosmetic surgery identified by Current Procedural Terminology codes. Demographics and patient characteristics were identified using the International Classification of Diseases 10 codes. We calculated odds ratios (OR) by using chi-squared tests to assess risk factors among patients with BDD.

RESULTS

Of 226,374 patients who underwent plastic surgery between August 2002 and August 2022, fewer than 0.1% were diagnosed with BDD. Of the BDD patients, 52.1% were diagnosed after cosmetic surgery. Compared with the control group, BDD patients were more likely to undergo rhinoplasty (OR=1.784, p = 0.004) and nonlocalized lipectomy (OR=1.448, p = 0.021) and less likely to undergo blepharoplasty (OR=0.451, p = 0.002). Findings indicated a strong association between BDD patients undergoing cosmetic procedures and comorbid psychiatric conditions such as depression (OR=4.279, p < 0.05), anxiety (OR=5.490, p < 0.05), and Attention-Deficit Hyperactivity Disorder (OR=3.993, p < 0.05).

CONCLUSIONS

These findings underscore the ongoing significance of BDD in the context of cosmetic surgery, potentially indicating a lower surgery rate among BDD patients compared with previous estimates. Nevertheless, avenues for further improvement persist. Our data affirm the noteworthy occurrence of postsurgery BDD development, thereby highlighting the ongoing necessity for psychiatric evaluation in surgical patients.

"It is not by choice that I gave birth at home": the social determinants of home births during COVID-19 in peri-urban and urban Kenya, a qualitative study

BACKGROUND

The COVID-19 pandemic significantly impacted the provision of global maternal health services, with an increase in home births. However, there are little data on women's decision-making and experiences leading up to home births during the pandemic. The objective of this study is to examine the economic, social, and health system factors associated with home births in Kenya.

METHODS

Community health volunteers (CHVs) and village leaders helped identify potential participants for an in-depth, one-on-one, qualitative telephone interview in Nairobi and Kiambu County in Kenya. In total, the study interviewed 28 mothers who had home births.

RESULTS

This study identified a number of economic, social, neighborhood, and health system factors that were associated with birthing at home during the COVID-19 pandemic. Only one woman had planned on birthing at home, while all other participants described various reasons they had to birth at home. Themes related to home births during the pandemic included: (1) unmet preferences related to location of birth; (2) burdens and fear of contracting COVID-19 leading to delayed or missed care; (3) lack of perceived community safety and fear of encounters with law enforcement; and (4) healthcare system changes and uncertainty that led to home births.

CONCLUSION

Addressing and recognizing women's social determinants of health is critical to ensuring that preferences on location of birth are met.

MCH Leadership Training Program: An Innovative Application of an Implementation Science Framework

INTRODUCTION

MCH training programs in schools of public health provide specialized training to develop culturally competent and skilled MCH leaders who will play key roles in public health infrastructure. Previous literature has reported on the effectiveness of MCH training programs (e.g., number of trainees, improvement in knowledge/skills); less attention has been devoted to understanding factors influencing program implementation during times of rapid change, while considering internal and external contexts (e.g., global pandemic, social unrest, uncertainty of funding, mental health issues, and other crises).

PURPOSE

This article describes a graduate-level MCH leadership training program and illustrates how an implementation science framework can inform the identification of determinants and lessons learned during one year of implementation of a multi-year program.

ASSESSMENT

Findings reveal how CFIR can be applicable to a MCH training program and highlight how constructs across domains can interact and represent determinants that serve as both a barrier and facilitator. Key lessons learned included the value of accountability, flexibility, learner-centeredness, and partnerships.

CONCLUSION

Findings may apply to other programs and settings and could advance innovative training efforts that necessitate attention to the multi-level stakeholder needs (e.g., student, program, institution, community, and local/regional/national levels). Applying CFIR could be useful when interpreting process and outcome evaluation data and transferring findings and lessons learned to other organizations and settings. Integrating implementation science specifically into MCH training programs could contribute to the rigor, adaptability, and dissemination efforts that are critical when learning and sharing best practices to expand leadership capacity efforts that aim to eliminate MCH disparities across systems.

Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States

Black women in the United States (U.S.) disproportionately experience adverse pregnancy outcomes, including maternal mortality, compared to women of other racial and ethnic groups. Historical legacies of institutionalized racism and bias in medicine compound this problem. The disproportionate impact of COVID-19 on communities of color may further worsen existing racial disparities in maternal morbidity and mortality. This paper discusses structural and social determinants of racial disparities with a focus on the Black maternal mortality crisis in the United States. We explore how structural racism contributes to a greater risk of adverse obstetric outcomes among Black women in the U.S. We also propose public health, healthcare systems, and community-engaged approaches to decrease racial disparities in maternal morbidity and mortality.

Perceived COVID-19 susceptibility and preventive behaviors: moderating effects of social support in Italy and South Korea

BACKGROUND

The COVID-19 pandemic hit Italy much harder than South Korea. As a way of explaining the different impact in the two countries, this study examines the moderating role of social support on the relationship between perceived susceptibility and preventive behaviors in the two countries.

METHODS

Surveys were conducted in South Korea (n = 1396) and Italy (n = 487) of participants aged 50 to 89 years.

RESULTS

South Koreans felt higher levels of perceived social support than their Italian counterparts. As would be expected, greater perceived susceptibility was associated with increased preventive behavior. Furthermore, a significant three-way interaction effect was found for perceived susceptibility, social support, and country. For Italians, a person who feels him/herself highly susceptible will increase preventive behaviors, if there is a lot of social support. On the other hand, for South Koreans, those with a low level of susceptibility perform more preventive measures than people with a high level of susceptibility if there is a lot of social support.

CONCLUSIONS

This study provides insights into how cognitive factors, such as susceptibility and severity, as well as social and environmental factors can be taken into account, and the public be told the real risk and given behavioral guidelines when a pandemic is approaching. Given the critical role of social support as a coping mechanism in crisis situations, societies should mull over ways to increase emotional and instrumental support.

Developing a Public Health Maternal and Child Health Training Program: Lessons Learned from Five Schools of Public Health

Maternal and child health (MCH), as a core sub-field of public health, continues to be an essential area in which additional workforce development and investment are needed. Recent public health workforce assessments in the United States reveal there will be a significant number of vacancies in MCH public health positions in the near future, creating the need for a well-trained and skilled public health MCH workforce. In order to address this potential critical workforce gap, the U.S. Department of Health and Human Services, Health Resources and Services Administration's Maternal and Child Health Bureau initiated the Maternal and Child Health Public Health Catalyst Program in 2015 to support the creation of MCH training programs in accredited schools of public health that previously did not have a MCH concentration. This article details the accomplishments and lessons learned from the first five MCH Catalyst Program grantees: Drexel University; Florida International University; Rutgers, The State University of New Jersey; Texas A&M University; and the University at Albany.

Characteristics of People With and Without Laboratory-Confirmed SARS-CoV-2 Infection During Pregnancy, Massachusetts, March 2020-March 2021

OBJECTIVES

Pregnant people infected with SARS-CoV-2, the virus that causes COVID-19, are at increased risk for severe illness and death compared with nonpregnant people. However, population-based information comparing characteristics of people with and without laboratory-confirmed SARS-CoV-2 infection during pregnancy is limited. We compared the characteristics of people with and without SARS-CoV-2 infection during pregnancy in Massachusetts.

METHODS

We compared maternal demographic characteristics, pre-pregnancy conditions, and pregnancy complications of people with and without SARS-CoV-2 infection during pregnancy with completed pregnancies resulting in a live birth in Massachusetts during March 1, 2020-March 31, 2021. We tested for significant differences in the distribution of characteristics of pregnant people by SARS-CoV-2 infection status overall and stratified by race and ethnicity. We used modified Poisson regression analyses to examine the association between race and ethnicity and SARS-CoV-2 infection during pregnancy.

RESULTS

Of 69 960 completed pregnancies identified during the study period, 3119 (4.5%) had laboratory-confirmed SARS-CoV-2 infection during pregnancy. Risk for SARS-CoV-2 infection was higher among Hispanic (adjusted risk ratio [aRR] = 2.3; 95% CI, 2.1-2.6) and non-Hispanic Black (aRR = 1.9; 95% CI, 1.7-2.1) pregnant people compared with non-Hispanic White pregnant people.

CONCLUSIONS

This study demonstrates the disproportionate impact of SARS-CoV-2 infection on Hispanic and non-Hispanic Black pregnant people in Massachusetts, which may widen existent inequities in maternal morbidity and mortality. Future research is needed to elucidate the structural factors leading to these inequities.

Building the MCH Public Health Workforce of the Future: A Call to Action from the MCHB Strategic Plan

Introduction

In 2021, the Maternal and Child Health Bureau (MCHB) released a new strategic plan to guide its work over the next 10–15 years. The plan highlights four goals—access, equity, workforce capacity, and impact—that are essential to achieving MCHB’s vision.

Methods

We present 13 recommendations to highlight opportunities for ongoing and new activities aligned with Goal 3 of the plan—“Strengthen Public Health Capacity and Workforce for MCH.”

Results

Recommendations 1–3 highlight the need to support pathways into state and local MCH public health (PH) positions, to offer accessible and high-quality training for the practicing workforce, and to build capacity to address health and social inequities. Recommendations 4–7 discuss the need to build a racially and ethnically diverse workforce, ensure equity and anti-racism are foundational concepts in training, and strengthen engagement of community members and those with lived experience as part of the MCH PH workforce. Recommendations 8–10 outline opportunities to enhance MCH workforce data and measurement frameworks, and support practice-based research. Recommendations 11–12 discuss the importance of academic-practice partnerships and the need to spur innovation. Recommendation 13 highlights the need to define and amplify the unique skillset of the MCH PH workforce.

Conclusions

The release of the MCHB strategic plan comes at a time of critical need to build and sustain a MCH PH workforce to achieve equity for MCH populations. We encourage the field to engage in dialogue around the recommendations presented in this paper, and to offer additional actions to build and support the MCH PH workforce.

Pregnancy and Childbirth Expectations During COVID-19 in a Convenience Sample of Women in the United States

The COVID-19 pandemic has transformed the health care landscape and shifted individuals’ expectations for and interactions with essential health services, including pregnancy-related care. This study explores alterations to individuals’ pregnancy and childbirth decisions during an infectious disease pandemic. A convenience sample of 380 pregnant individuals with an expected delivery date between April and December 2020 consented to enroll and complete an online questionnaire on their pregnancy and childbirth expectations during the COVID-19 pandemic; a subset of respondents (n = 18) participated in semi-structured phone interviews. Survey data were analyzed quantitatively while interview data were analyzed using a thematic content analysis until a consensus on key themes was achieved. Respondents reported substantial stressors related to shifting policies of health care facilities and rapidly changing information about COVID-19 disease risks. As a result, respondents considered modifying their prenatal and childbirth plans, including the location of their birth (25%), health care provider (19%), and delivery mode (13%). These findings illuminate the concerns and choices pregnant individuals face during the COVID-19 pandemic and offer recommendations to engage in compassionate, supportive, and person-centered care during a time of unprecedented risk and uncertainty.

A Framework for Protecting Pregnant Women in the Era of COVID-19 Pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent for the coronavirus disease 2019 (COVID-19) pandemic, highlighted and compounded problems while posing new challenges for the pregnant population. Although individual organizations have provided disparate information, guidance, and updates on managing the pregnant population during the current COVID-19 pandemic, it is important to develop a collective model that highlights all the best practices needed to protect the pregnant population during the pandemic. To establish a standard for ensuring safety during the pandemic, we present a framework that describes best practices for the management of the pregnant population during the ongoing COVID-19 pandemic.

Principles for Guiding the Selection of Early Childhood Neurodevelopmental Risk and Resilience Measures: HEALthy Brain and Child Development Study as an Exemplar

The vast individual differences in the developmental origins of risk and resilience pathways combined with sophisticated capabilities of big data science increasingly point to the imperative of large, neurodevelopmental consortia to capture population heterogeneity and key variations in developmental trajectories. At the same time, such large-scale population-based designs involving multiple independent sites also must weigh competing demands. For example, the need for efficient, scalable assessment strategies must be balanced with the need for nuanced, developmentally sensitive phenotyping optimized for linkage to neural mechanisms and specification of common and distinct exposure pathways. Standardized epidemiologic batteries designed for this purpose such as PhenX (consensus measures for Phenotypes and eXposures) and the National Institutes of Health (NIH) Toolbox provide excellent "off the shelf" assessment tools that are well-validated and enable cross-study comparability. However, these standardized toolkits can also constrain ability to leverage advances in neurodevelopmental measurement over time, at times disproportionately advantaging established measures. In addition, individual consortia often expend exhaustive effort "reinventing the wheel," which is inefficient and fails to fully maximize potential synergies with other like initiatives. To address these issues, this paper lays forth an early childhood neurodevelopmental assessment strategy, guided by a set of principles synthesizing developmental and pragmatic considerations generated by the Neurodevelopmental Workgroup of the HEALthy Brain and Child Development (HBCD) Planning Consortium. These principles emphasize characterization of both risk- and resilience-promoting processes. Specific measurement recommendations to HBCD are provided to illustrate application. However, principles are intended as a guiding framework to transcend any particular initiative as a broad neurodevelopmentally informed, early childhood assessment strategy for large-scale consortia science.