Evaluating Birth Outcomes From a Community-Based Pregnancy Support Program for Refugee Women in Georgia

Mosley, Elizabeth A.; Pratt, Michelle; Besera, Ghenet; Clarke, L; Miller, Heidi B.; Noland, Tracy; Whaley, Bridget; Cochran, Jennifer; Mack, Amber; Higgins, Melinda

doi:10.3389/fgwh.2021.655409

Cited by 13 publications

(14 citation statements)

References 38 publications

(54 reference statements)

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“…This study was conducted in collaboration with Embrace Refugee Birth Support, a program of the non-governmental organization Friends of Refugees, in Clarkson that supports refugee women through pregnancy and labor with health education classes and patient advocacy. Program evaluations indicate that refugee women who participated in Embrace programming were less likely to be induced for labor than their peers who had not received support from Embrace (Mosley et al, 2021). These findings suggest Embrace programming is associated with positive pregnancy and labor outcomes.…”

Section: Methodsmentioning

confidence: 99%

Refugee women's pregnancy and childbirth experiences in the US: Examining context through a reproductive justice framework

Kirkendall

Dutt

2023

Feminism & Psychology

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Maternal health in the United States is an area of immediate concern. The compounded disadvantages and unique global positions of refugee women highlight the need for research that explores the experiences of refugee women during pregnancy and childbirth. The present study examines how contextual factors shape pregnancy and childbirth experiences for Syrian, Afghan, Congolese, and Karen women living in Clarkston, Georgia, US. Qualitative data were collected via focus groups facilitated by community interpreters. We used a reproductive justice framework to center women's desires, needs, and experiences, and to highlight the importance of structural factors in the findings and analysis of this study. Using codebook thematic analysis, three themes were developed: (1) isolation and alienated knowledge, (2) gendered disparities and structural inequities, and (3) community support and precarity. The findings reflect both the diversity and constancy of women's experiences and highlight how the context of the US impacts women's ability to exercise agency during pregnancy and childbirth. Systemic change is needed to improve women's access to tools that increase their capacity to exercise agency both during pregnancy and childbirth, and beyond.

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Section: Methodsmentioning

confidence: 99%

Refugee women's pregnancy and childbirth experiences in the US: Examining context through a reproductive justice framework

Kirkendall

Dutt

2023

Feminism & Psychology

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“…Importantly, the inclusion of community-based, culturally competent doula support has been associated with fewer maternal complications among socially disadvantaged women facing disproportionately high rates of MM/SMM (Everson, Cheyney, & Bovbjerg, 2018; Gordon et al, 1999; K. J. Gruber et al, 2013; Hans et al, 2018; Mosley et al, 2021).…”

Section: A Reproductive Justice Approachmentioning

confidence: 99%

Applying the Theoretical Domains Framework to the Implementation of Medicaid Coverage for Doula Services: Doulas’ Perceptions of Barriers and Facilitators in the State of Florida

Applequist,

Wilson,

Perkins

et al. 2024

Preprint

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As of September 2023, more than half of US states have either expanded Medicaid to cover doula care or are in the process of implementing doula care into Medicaid services. However, little is known about doulas experiences with Medicaid. Doula uptake of these services is critical to support low-income clients. We explored Florida doulas experiences with and perceptions of Medicaid reimbursement. We conducted seven focus groups and seven in-depth interviews with 31 doulas providing perinatal support. An inductive approach to thematic analysis was used to generate primary findings. A deductive approach was then applied to these themes, drawing on the Theoretical Domains Framework to enhance understanding. Most participants reported wanting to engage with Medicaid to support marginalized communities, but not doing so due to misinformation, low reimbursement rates and a complicated reimbursement structure. Doulas that work with Medicaid patients reflected on their frustrations with insurers and the financial impact of delayed reimbursements. Misinformation spread amongst doula communities about the Medicaid reimbursement process (often based on outdated information) was found to be a significant barrier to implementation. Doulas relied on one another for information, as they reported few resources have been made available by Medicaid or managed care organizations for guidance on reimbursement processes. This highlights an opportunity for Medicaid education to ensure client access to doula services and maintenance of the doula workforce. Doula care is associated with better perinatal outcomes, but structural barriers hinder the ability for low-income families to receive doula care in Florida, creating further health inequities.

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“…[9][10][11][12] Furthermore, the inclusion of community-based, culturally competent doula support has been associated with fewer maternal complications among marginalized women facing higher rates of MM/SMM. [11][12][13][14][15] Historically, doulas were utilized in White, middle/higher class spheres, 16 and low income, as well as other marginalized, populations had limited access to these services.…”

Section: Introductionmentioning

confidence: 99%

Florida Doulas’ Perspectives on their Role in Reducing Maternal Morbidity and Health Disparities

Applequist

Wilson

Perkins

et al. 2023

Preprint

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Introduction: Maternal mortality rates continue to rise in the United States. Considerable racial disparities exist, as Black women are 2-3 times more likely to die from pregnancy-related complications than White women. Doulas have been associated with improved maternal outcomes. This study aimed to 1) investigate Florida doulas perspectives on severe maternal morbidity/mortality, related inequities, and their influence on these areas as well as 2) identify opportunities for actionable change. Methods: This qualitative study included seven online, in-depth interviews and seven focus groups with doulas (n = 31) in the state of Florida. Interview and focus group guides aimed to investigate how doulas perceive their role in the context of a) maternal morbidity and b) health disparities/inequities. Results: Doulas associated maternal morbidity and health disparities with Black pregnant people, attributing racism as a major contributor. Doulas identified their role in mitigating this problem as one that involves: providing positive social surveillance and emotional support, equipping clients with access to education and resources, and championing for advocacy in healthcare settings. Actionable steps utilizing the social ecological model and reproductive justice framework are provided. Discussion and Health Equity Implications: Doulas perceived their role as integral to mitigating maternal morbidity and maternal health disparities, particularly in the context of race. Equitable access to doulas for low-income and or minoritized populations may be one key strategy to improve maternal health equity.

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Evaluating Birth Outcomes From a Community-Based Pregnancy Support Program for Refugee Women in Georgia

Cited by 13 publications

References 38 publications

Refugee women's pregnancy and childbirth experiences in the US: Examining context through a reproductive justice framework

Refugee women's pregnancy and childbirth experiences in the US: Examining context through a reproductive justice framework

Applying the Theoretical Domains Framework to the Implementation of Medicaid Coverage for Doula Services: Doulas’ Perceptions of Barriers and Facilitators in the State of Florida

Florida Doulas’ Perspectives on their Role in Reducing Maternal Morbidity and Health Disparities

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