Interventions Addressing Social Needs in Perinatal Care: A Systematic Review

Abstract

Introduction: Health is impacted by a wide range of nonmedical factors, collectively termed the social determinants of health (SDoH). As the mechanisms by which these factors influence wellness and disease continue to be uncovered, health systems are beginning to assess their roles in addressing patient's social needs. This study seeks to identify and analyze clinic-based interventions aimed at addressing patients' social needs in perinatal care, including prenatal, antepartum, and postpartum care. Methods: We conducted a search of six databases through May 2020 for articles describing screening or intervention activities addressing social needs in at least one SDoH domain as defined by Healthy People 2020. We required that studies include pregnant or postpartum women and be based in a clinical setting. Results: Thirty-one publications describing 26 unique studies were identified. Most studies were either randomized-controlled trials (n = 10) or observational studies (n = 7) and study settings were both public and private. The mean age of women ranged from 17.4 to 34.1 years. Most studies addressed intimate partner violence (n = 19). The next most common need addressed was social support (n = 5), followed by food insecurity (n = 3), and housing (n = 2). Types of interventions varied from simple screening to ongoing counseling and case management. There was wide heterogeneity in outcomes investigated. Most IPV interventions that included counseling or ongoing support resulted in reduced IPV recurrence and severity. No intervention with only screening showed a reduction in rate of IPV. Conclusion: This systematic review shines light on several avenues to support pregnant and postpartum women through interventions that embed acknowledgment of social needs and actions addressing these needs into the clinical environment. The results of this review suggest that interventions with counseling or ongoing support may show promise in alleviating social risk factors and improving some clinical outcomes. However, the strength of this evidence is limited by the paucity of studies. More rigorous research is imperative to augment the knowledge of social needs interventions, especially in domains outside of IPV.

Racial and Ethnic Minority Pregnant Patients with Low-Income Experiences of Perinatal Care: A Scoping Review

“…Current interventions that aim to improve experiences for minority patients receiving PNC are a good start to address the inequities, but must be improved upon to reduce the disparity in mortality and morbidity. 17 A review of minority pregnant patients' experiences during PNC is necessary to best inform an intervention that improves PNC for this population. While previous reviews have focused on the PNC experience of all pregnant patients, or on the quantitative-based studies of NHB pregnant patients' PNC, we aim to complete a review that highlights the qualitative, narrative-based literature to capture a more in-depth perspective of racial and ethnic minority pregnant patients, with low-income experiences, with their PNC clinicians.…”

Maternal characteristics as indications for routine induction of labor: A nationwide retrospective cohort study

“…Conditions in which people are born, grow, live, work, and age, shape health in powerful ways. 39,40 It has been argued that ethnicity and SES act as proxies for complex societal processes, 41 and that the association with TM is mediated by discrimination and inequity. 29 (p247),42 Thus, the extent to which medical interventions, such as IOL, can intervene upon these social processes is limited.…”

“…29 (p247),42 Thus, the extent to which medical interventions, such as IOL, can intervene upon these social processes is limited. 40 Nevertheless, often, social determinants of health are used as biological or genetic determinants, and differences between subgroups are medicalized. Consequently, efforts to reduce TM predominantly focus on improving and using medical interventions instead of addressing underlying societal processes.…”

Missed opportunities to improve food security for pregnant people: a qualitative study of prenatal care settings in Northern New England during the COVID-19 pandemic

“…There is a critical need to understand how to best screen for and address social risk factors-including food, housing, transportation, and other factors [11]within health care settings generally [12]. This is particularly important in prenatal care settings, given mounting evidence that supports interventions to reduce risk factors such as food insecurity [13]. Screening for food insecurity during prenatal care visits identifies those at-risk and provides an early opportunity for intervention to support the health of mother and child [5].…”