We aimed to explore factors affecting prenatal care attendance and preferences for prenatal care experiences among low-income black women by conducting a focus group study using a community-based participatory research framework and nominal group technique. Discussions were audiorecorded, transcribed, and coded by trained reviewers. Friends/family and baby's health were the top attendance motivators. Greatest barriers were insurance, transportation, and ambivalence. Facilitators included transportation services, social support, and resource education. In a "perfect system," women wanted continuity of care, personal connection, and caring/respect from providers. Relationship-centered maternity care models may mitigate disparities. Group prenatal care may provide the continuity and support system desired.

As the COVID-19 pandemic has unfolded across the United States, troubling disparities in mortality have emerged between different racial groups, particularly African Americans and Whites. Media reports, a growing body of COVID-19-related literature, and long-standing knowledge of structural racism and its myriad effects on the African American community provide important lenses for understanding and addressing these disparities. However, troubling gaps in knowledge remain, as does a need to act. Using the best available evidence, we present risk- and place-based recommendations for how to effectively address these disparities in the areas of data collection, COVID-19 exposure and testing, health systems collaboration, human capital repurposing, and scarce resource allocation. Our recommendations are supported by an analysis of relevant bioethical principles and public health practices. Additionally, we provide information on the efforts of Chicago, Illinois’ mayoral Racial Equity Rapid Response Team to reduce these disparities in a major urban US setting.

Our findings underscore the importance of presenting clear information on disability and eliciting the factors that parents deem most important in making decisions about periviable birth.

Shared decision making (SDM)-when clinicians and patients make medical decisions togetheris moving swiftly from an ethical ideal toward widespread clinical implementation affecting millions of patients through recent policy initiatives. We argue that policy initiatives to promote SDM implementation in clinical practice carry the risk of several unintended negative consequences if limitations in defining and measuring SDM are not addressed. We urge policy makers to include prespecified definitions of desired outcomes, offer guidance on the tools used to measure SDM in the multitude of contexts in which it occurs, evaluate the impact of SDM policy initiatives over time, review that impact at regular intervals, and revise SDM measurement tools as needed.

Importance Despite increasing attention to the importance of father involvement during pregnancy, the literature on fathers' roles in perinatal decision making is scant. Objective The aim of this study was to conduct a narrative review of the literature exploring fathers' preferences, perspectives, and involvement in perinatal decision making. Evidence Acquisition We searched PubMed, Ovid, EMBASE, Cochrane Library, and CINAHL databases using the terms father, spouse(s), husband, and paternal separately with the combined terms of attitude, preference, involvement, influence, informed consent, decision making, pregnancy, labor induction, genetic testing, prenatal diagnosis, amniocentesis, fetal surgery, genetic abnormalities, congenital anomalies, birth defects, perinatal, and antenatal. The search was limited to English-language studies that were published anytime and conducted between July and September 2018. Results The initial search identified 616 articles; 13 articles met criteria for inclusion. Fathers view themselves as serving distinct roles in perinatal decision making and have specific informational needs that would support their involvement in decision making. Although fathers want to support their partners and learn about fetal health, they often feel excluded from perinatal screening decisions. Mothers and fathers also have different needs, concerns, and preferences regarding key perinatal decisions that, if unresolved, can impact the couples' relationship and perinatal outcomes. Conclusions Findings provide import insights into the distinct experiences, roles, needs, and perspectives of fathers facing perinatal decision making. Relevance Advancing research and policy on fathers' involvement in perinatal decision making could lead to a paradigm shift in how maternity care is structured, how obstetric services are delivered, and how perinatal interventions are designed and implemented. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to describe why fathers are important to perinatal health; assess gaps in care practices that limit father involvement in perinatal decision making; evaluate situations where fathers wish to be involved in perinatal decision making; and list opportunities for future research in this area.

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Racial/ethnic differences exist in patterns of periviable resuscitation, which may reflect underlying differences in patient preference. Alternatively, institutional practices or resources may account for these differences. These findings have important implications for patient care and institutional practice. Our results lay the foundation for additional work to investigate how social, cultural, and institutional factors influence patient-provider decision-making regarding periviable care.

OBs' willingness to intervene can impact periviable outcomes. These findings suggest that personal and institutional factors may influence obstetrical counseling and decision-making.