Objective To investigate perceptions of minority pregnant women and providers about obesity and gestational weight gain (GWG), and to explore strategies to improve management of obesity in pregnancy with an emphasis on group prenatal care. Methods Sixteen primarily non-Hispanic black pregnant women with a body mass index ≥30kg/m2 and 19 prenatal care providers participated in focus groups. Discussion topics included GWG goals, body image, health behaviors, and group prenatal care with additional emphasis on provider training needs. Results Women frequently stated a GWG goal >20lbs. Women described a body image not in line with clinical recommendations (“200 pounds is not that big.”). They avoided the term “obese.” They were interested in learning about nutrition and culturally-acceptable healthy cooking. Women would enjoy massage and exercise in group settings, though definitions of “exercise” varied. Family members could help, but generational differences posed challenges. Most had to “encourage myself” and “do this for me and the baby.” Providers expressed discomfort discussing GWG and difficulty finding the right words for obesity, which was partially attributed to their own weight. They noted the challenges they faced during prenatal care including time constraints, cultural myths, and system issues. Providers considered a group setting with social support an ideal environment to address health behaviors in obese women. Conclusions Culturally-tailored programs that use acceptable terms for obesity, provide education regarding healthy eating and safe exercise, and encourage support from social networks may be effective in addressing GWG in obese minority women. Provider training in communication skills is necessary to address obesity in pregnancy.

Ovarian function is examined in 35 Lese women inhabiting the Ituri Forest of northeastern Zaire over a period of 4 months through measurements of progesterone in saliva samples collected twice weekly. Ovulatory frequency is found to be only 56% on average, with a pattern of age variation similar to that observed in western women, though lower in level at each age. Average luteal progesterone levels of the Lese women are lower than those of Boston controls even if only ovulatory cycles are considered. Women with the poorest nutritional status, inferred from longitudinal weight changes and weight for height, show the greatest compromise of ovarian function, and the average ovulatory frequency of the whole sample declines in parallel with a period of weight loss over four months. It is suggested that low ovulatory frequency and luteal insufficiency contribute to the low fecundity of the Lese population and that nutritional status is likely to be one of the ecological factors modulating this effect.

Although significant progress has been made to increase prenatal care access, national organizations concerned with health equity emphasize that eliminating disparities will require greater attention to quality of care, assessed from both the biomedical and patient perspectives. In this study, we examined narratives about pregnancy experiences from low-income primiparous African American, Mexican American, Puerto Rican, and White women who participated in focus groups conducted in 1996. We reanalyzed transcripts from these discussions, extracting passages in which women talked about the content and quality of their prenatal care experiences. Data were mapped to four domains reflecting patient-centeredness markers identified in the 2005 U.S. National Healthcare Disparities Report (NHDR). These markers include the extent to which the women perceived that their provider listened carefully, explained things, showed respect, and spent enough time with them. The narratives provided by the study participants suggest a critical and intuitive understanding of the NHDR patient-centeredness markers and some shared understanding across cultural groups. Implications for improving quality and its measurement in prenatal care are discussed.

The Lese are subsistence farmers living in the Ituri Forest of north-east Zaire. They exhibit significant birth seasonality, with lowest frequencies of conception when food production is least, nutritional status is low and ovarian function, as measured by salivary steroid hormone levels, is reduced. Efe pygmy foragers, who live in the same geographical area but are less dependent on cultivated foods and have a more flexible life style, do not exhibit frequent fluctuations in nutritional status nor significant birth seasonality. These findings support a model of birth seasonality relating climatic variables to variation in fertility through a causal chain linking rainfall to food production to energy balance to ovarian function to fertility. The model, which emphasises an ecological approach to the study of human reproduction, should have broad applicability since seasonality of food production and energy balance is widespread geographically and across a wide variety of economies and cultures.

Scientists, activists, and health care professionals would be aided in forming initiatives aimed at reducing health disparities among African American women by heeding the insights on their health experiences that they express in popular media sources.