Critical disparities in perinatal health—understanding risks and changing the outcomes

Harris, Leslie M.; Forson-Dare, Zaneta; Gallagher, Patrick G.

doi:10.1038/s41372-020-00913-7

Cited by 10 publications

(7 citation statements)

References 8 publications

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“…The review highlights how equity/inequity influences prenatal patients’ access and use of care within prenatal healthcare practices and collates potential solutions to gaps in health equity for this population. The findings highly overlapped across PROGRESS-Plus equity factors and the barriers and facilitators that we identified are likely much more complex and intertwined [ 133 ]. This study adds value to the literature as it shows how current innovations, some of which are common across the globe, are utilized to overcome barriers to achieving equity.…”

Section: Discussionmentioning

confidence: 99%

Equity in prenatal healthcare services globally: an umbrella review

Ladak,

Grewal,

Kim

et al. 2024

BMC Pregnancy Childbirth

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Background Timely, appropriate, and equitable access to quality healthcare during pregnancy is proven to contribute to better health outcomes of birthing individuals and infants following birth. Equity is conceptualized as the absence of differences in healthcare access and quality among population groups. Healthcare policies are guides for front-line practices, and despite merits of contemporary policies striving to foster equitable healthcare, inequities persist. The purpose of this umbrella review is to identify prenatal healthcare practices, summarize how equities/inequities are reported in relation to patient experiences or health outcomes when accessing or using services, and collate equity reporting characteristics. Methods For this umbrella review, six electronic databases were searched (Medline, EMBASE, APA PsychInfo, CINAHL, International Bibliography of the Social Sciences, and Cochrane Library). Included studies were extracted for publication and study characteristics, equity reporting, primary outcomes (prenatal care influenced by equity/inequity) and secondary outcomes (infant health influenced by equity/inequity during pregnancy). Data was analyzed deductively using the PROGRESS-Plus equity framework and by summative content analysis for equity reporting characteristics. The included articles were assessed for quality using the Risk of Bias Assessment Tool for Systematic Reviews. Results The search identified 8065 articles and 236 underwent full-text screening. Of the 236, 68 systematic reviews were included with first authors representing 20 different countries. The population focus of included studies ranged across prenatal only (n = 14), perinatal (n = 25), maternal (n = 2), maternal and child (n = 19), and a general population (n = 8). Barriers to equity in prenatal care included travel and financial burden, culturally insensitive practices that deterred care engagement and continuity, and discriminatory behaviour that reduced care access and satisfaction. Facilitators to achieve equity included innovations such as community health workers, home visitation programs, conditional cash transfer programs, virtual care, and cross-cultural training, to enhance patient experiences and increase their access to, and use of health services. There was overlap across PROGRESS-Plus factors. Conclusions This umbrella review collated inequities present in prenatal healthcare services, globally. Further, this synthesis contributes to future solution and action-oriented research and practice by assembling evidence-informed opportunities, innovations, and approaches that may foster equitable prenatal health services to all members of diverse communities.

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Section: Discussionmentioning

confidence: 99%

Equity in prenatal healthcare services globally: an umbrella review

Ladak,

Grewal,

Kim

et al. 2024

BMC Pregnancy Childbirth

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“…We are convening 1-2 community advisory board meetings comprising individuals with lived experience of managing psychological distress during pregnancy and postpartum, as well as providers who deliver perinatal health and mental health services, such as doulas and therapists. The advisory board members will share their perspectives and advise on key decisions and approaches, particularly as they pertains to recruiting and retaining individuals from minoritized backgrounds in the trial given that these individuals experience the highest rates of maternal morbidity and mortality and are often not included in mindfulness-based intervention research [30,31]. In addition, we will meet with administrative and clinical personnel at community-based obstetrics clinics who primarily serve patients from under-resourced and minoritized communities to share information about the trial and develop informal partnerships to facilitate recruitment from their patient populations.…”

Section: Methodsmentioning

confidence: 99%

Mindfulness in Pregnancy and Postpartum: Protocol of a Pilot Randomized Trial of Virtually Delivered Mindfulness-Based Cognitive Therapy to Promote Well-Being during the Perinatal Period

Donofry,

Winograd,

Kothari

et al. 2024

IJERPH

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Background: During the period from pregnancy through the first year postpartum, vulnerable individuals are at elevated risk for the onset or worsening of psychological distress, and accessible (e.g., virtually delivered) mental health interventions are needed. Research suggests that Mindfulness-Based Cognitive Therapy (MBCT) can effectively mitigate psychological distress, although few studies have evaluated MBCT in the perinatal period, and samples have been clinically homogenous. Thus, we have designed and are conducting a pilot trial of virtually delivered MBCT with pregnant individuals experiencing a range of psychological symptoms to assess its feasibility and preliminarily explore its effectiveness. Here, we present the study protocol. Methods: Eligible participants (target N = 70) are ≥18 years with pregnancies between 12 and 30 weeks of gestation. Participants complete a diagnostic interview, self-report symptom ratings, and a computerized cognitive battery assessing self-regulation at the baseline. Participants are then randomized to either MBCT or care as usual. The MBCT intervention involves eight weekly group sessions delivered virtually, with each session focusing on a mindfulness practice followed by group discussion and skill development. Participants in the intervention group are also encouraged to practice mindfulness skills between sessions. Participants in the control condition are provided with information about mindfulness and treatment resources. Baseline measures are repeated following the eight-week intervention period and at three months postpartum. Conclusions: This pilot study is designed to evaluate the feasibility of virtually delivered MBCT and explore group differences in psychological symptoms during the perinatal period, and will lay the foundation for a larger clinical trial focused on optimizing this intervention to improve psychological functioning among diverse pregnant individuals.

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“…The increasing racial and ethnic diversity in North America, together with the recent national focus on the increased maternal mortality and morbidity among women of color ( Howell, 2018 ; Kozhimannil et al., 2020 ), has led to renewed social justice movements that call out structural racism and implicit bias ( Harris et al., 2021 ; Huggins et al., 2020 ; Matthews et al., 2021 ; Taylor, 2020 ). Although review articles have mapped the influence of the COVID-19 pandemic on maternal mental health issues across the globe, the race and ethnicity of research participants have not been discussed ( Iyengar et al., 2021 ; Kotlar et al., 2021 ; Suwalska et al., 2021 ; Yan et al., 2020 ) and remain unknown.…”

Section: Race and Ethnicity Of Participants In Perinatal Mental Healt...mentioning

confidence: 99%

Scoping Review of Racial and Ethnic Representation of Participants in Mental Health Research Conducted in the Perinatal Period During the COVID-19 Pandemic

Goyal¹,

Dol²,

Leckey³

et al. 2023

Journal of Obstetric, Gynecologic & Neonatal Nursing

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Critical disparities in perinatal health—understanding risks and changing the outcomes

Cited by 10 publications

References 8 publications

Equity in prenatal healthcare services globally: an umbrella review

Equity in prenatal healthcare services globally: an umbrella review

Mindfulness in Pregnancy and Postpartum: Protocol of a Pilot Randomized Trial of Virtually Delivered Mindfulness-Based Cognitive Therapy to Promote Well-Being during the Perinatal Period

Scoping Review of Racial and Ethnic Representation of Participants in Mental Health Research Conducted in the Perinatal Period During the COVID-19 Pandemic

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