Addressing racial disparities in perinatal care for African American/Black individuals in the Chicago community health setting: a qualitative study

Abstract

Background There are persistent disparities in maternal and infant perinatal outcomes experienced by Black birthing persons compared with non-Hispanic white (NHW) individuals in the US. The differences in outcomes arise from not only socioeconomic factors and individual health behaviors but also structural racism. Recent research is beginning to elucidate the benefits of patient navigation to support underserved minoritized individuals who experience this constellation of barriers to equitable care. Qualitative research that utilizes both the experiences of Black birthing individuals and the expert opinion of healthcare providers working with them can serve to guide a patient navigation intervention to further decrease disparities in perinatal outcomes. Methods We conducted 30 interviews between August and December 2020 with Black birthing individuals in the Chicago metropolitan area and healthcare providers who care for this population both in Chicago and across the nation to explore their experiences, perceptions of barriers to care and ways to decrease inequities. Results Clinical care team members acknowledged the presence of health disparities experienced by Black pregnant individuals compared with their NHW counterparts stemming from racism, discrimination, and lack of resources. Patients similarly reported personal experiences with these disparities and barriers to care. The successful methods used by clinical care teams to help decrease these differences in the past included patient education on important topics such as breastfeeding and the use of patient advocates. Effectively screening for social determinants of health by someone the patient trusts was also cited as important. Regarding perinatal care practices, clinical care team members described the importance of patient education needs and care team cultural competency. Patients’ reported positive and negative experiences corroborated these findings, emphasizing the importance of trust, listening, education, access to care, support, and patient advocacy. Finally, the care team members and patients agreed that active trust-building can help the provider/patient relationship and ultimately improve outcomes. Conclusions These qualitative research findings improve the understanding of barriers to care and will help guide development of an intervention to reduce the health disparities experienced by Black pregnant persons.

Inclusion of Non–English-Speaking Participants in Pediatric Health Research

“…An important step in improving equity for NES communities is their inclusion in pediatric research . Inclusion of racial and ethnic minoritized individuals in research is critical to ensure that scientific findings are generalizable and relevant for all communities, to improve trustworthiness of research and health care, and to promote health equity .…”

Recommendations to improve maternal health equity among Black women in “The South”: A position paper from the SNRS minority health research interest & implementation group

“…These health inequities are worse in Southern states (Haley et al, 2022). Additionally, Black pregnant women are subjected to significantly higher rates than their White counterparts of mistreatment, inferior care, and feeling dismissed or unheard when speaking up about potentially dangerous symptoms and situations (Alhalel et al, 2022;Altman et al, 2019Altman et al, , 2020Sakala et al, 2018;Vedam et al, 2019). With more states in the South restricting abortion access, maternal health outcomes could continue to worsen (Stevenson, 2021).…”

Community‐Based Doulas' Roles Within the Birth Support System: Young Black Mothers’ Perspectives

“…Birth support may be particularly important for individuals from historically marginalized populations who face elevated risks for poor maternal and newborn health outcomes 3–7 . Adolescents and those who identify as Black or African American frequently experience or anticipate experiencing care from health care providers that is racist, disrespectful, or misaligned with their needs 8–15 …”

“…Qualitative studies have found that adolescent mothers value physical and emotional support from community‐based doulas and that their doulas function as advocates, counselors, and life coaches 24 . Black women have reported their doula as an essential source of support 14 with whom they felt understood and emotionally supported, providing a valuable experience in a health care system that can feel hostile 25 …”

“…[3][4][5][6][7] Adolescents and those who identify as Black or African American frequently experience or anticipate experiencing care from health care providers that is racist, disrespectful, or misaligned with their needs. [8][9][10][11][12][13][14][15] To better meet the needs of marginalized individuals, community-based doula models were developed. [16][17][18][19][20][21][22] Doulas are specially trained support persons who provide guidance, encouragement, and labor comfort measures to pregnant individuals during labor, birth, and postpartum.…”