Perinatal and neonatal nurses have a critical role to play in effectively addressing the disproportionate prevalence of adverse pregnancy outcomes experienced by black childbearing families. Upstream inequities in maternal health must be better understood and addressed to achieve this goal. The importance of maternal health before, during, and after pregnancy is illustrated with the growing and inequitable prevalence of 2 common illnesses, pregestational diabetes and chronic hypertension, and 2 common conditions during and after pregnancy, gestational diabetes and preterm birth. New care models are needed and must be structured on appropriate ethical principles for serving black families in partnership with nurses. The overarching purpose of this article is to describe the ethics of perinatal care for black women; to discuss how social determinants of health, health disparities, and health inequities affecting women contribute to poor outcomes among their children; and to provide tools to dismantle structural racism specific to “mother blame” narratives.” Finally, strategies are presented to enhance the provision of ethical perinatal care for black women by nurses.

Objective Barriers to removal of long-acting reversible contraception (LARC) threaten reproductive self-determination, but their influence on contraceptive behaviors is not well understood. We describe perspectives of women in Western Kenya concerning LARC removal barriers. Study design We used a qualitative descriptive approach with conventional content analysis to analyze transcripts for content and themes from eight focus group discussions ( n = 55 participants) and one client journey mapping workshop ( n = 9 participants) with women ages 18–49 in Western Kenya who were currently using or had formerly used contraceptives. Findings Our primary themes concerned women's experience of LARC removal barriers and the impact on their behaviors and attitudes towards contraception. Women described providers being unwilling to remove LARC, regardless of rationale (including expiration, seeking pregnancy, or experiencing intolerable side effects) or demanding unaffordable fees. Women were reluctant to try LARC for fear of having to use the method for its entire lifespan even if they did not like it. Women saw LARC removal barriers as increasing their risk of unintended pregnancy through non-replacement of expired devices and fostering distrust in the health system. Conclusion Barriers to LARC removal may discourage utilization of LARC and contraceptive services generally, which can undermine women's efforts to achieve reproductive self-determination. Implications Our findings affirm the importance of timely LARC removal to ensure that family planning programs uphold women's reproductive autonomy.

Introduction: Although elevated blood glucose is associated with adverse obstetrical outcomes, evidence suggests that women with diabetes may not be receiving comprehensive reproductive healthcare, including family planning and preconception care. Using a population-based sample, we evaluated the relationship between contraceptive use and biomarker-identified diabetes. Methods: This cross-sectional study used data from 5548 women in the nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health) from 2007–2009. Women were aged 24–32 years, sexually active with men, and not pregnant. Hemoglobin A1C identified prediabetes and diabetes from blood specimens. The primary outcome was most effective contraception used in the past year: more effective (sterilization, intrauterine device, implant, combined hormonal methods, or injectable), less effective (condoms, diaphragms, spermicides, natural family planning, or withdrawal), or none. Multinomial regression models were adjusted for race/ethnicity, education, insurance, healthcare access, and body mass index. Results: Of the women with diabetes, 37.6% used more effective contraception, 33.6% less effective contraception, and 28.8% none. Women with diabetes had higher odds of using no contraception, rather than more effective contraception, than women with normoglycemia (adjusted odds ratio [aOR], 1.90; 95% confidence interval [CI], 1.25–2.87). Women with diabetes who were undiagnosed had greater odds of using less effective contraception, rather than more effective contraception, compared to those who were diagnosed (aOR 3.39; 95% CI, 1.44−7.96). Contraceptive use did not differ between women with prediabetes and normoglycemia. Discussion: Less effective contraceptive methods were commonly used by women with diabetes. Certified nurse-midwives and other providers can support women with diabetes to reach their pregnancy goals by providing preconception care and family planning.

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