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

Abstract

Purpose: The maternal mortality ratio for the United States (US) has consistently risen over recent decades. This mortality is especially pronounced within minority populations who experience a maternal mortality and morbidity rate that are much higher than their non-Hispanic white counterparts. Qualitative data are critical in gaining true insight from minority pregnant and postpartum persons. Such data should serve as the basis for building interventions and programs that seek to eradicate perinatal inequities. This review examines the qualitative literature on racial and ethnic minority pregnant patients with low income and their experiences during perinatal care (PNC) to identify recurrent themes that can be addressed through targeted interventions. Methods: PubMed, CINAHL, and Web of Science databases were searched for qualitative studies on racial and ethnic minority pregnant patients with low income and their experiences during PNC. Twenty-two articles were included for analysis. Thematic synthesis was performed to identify categories and recurring themes in each article. Results: Five major categories were identified as consistent experiences of pregnant patients with PNC clinicians: support, education, connection, communication, and trust. Of these, clinician support was the most consistently coded category. Eighteen of the 23 articles discussed tangible support patients had received from their clinicians, such as care coordination and referrals to support services. The second most coded category was education, which was represented in 16 articles. Education was mostly represented negatively as lack of adequate perinatal care education given during the perinatal period. Finally, the categories of connection, communication, and trust were represented by 18, 17, and 17 articles, respectively. Conclusions: These qualitative studies provided specific examples of what racial and ethnic minority pregnant patients with low income deemed positive and negative during the perinatal period and outline ways that these experiences can be improved. Future studies can take the experiences reported in this review to help inform interventions to improve patient experiences and health outcomes that minority persons face in the perinatal period.

Integrative Review of Black Birthing People’s Interactions With Clinicians During the Perinatal Period

“…The findings from scoping review of low-income, underserved patients’ experiences with perinatal care by Wishart et al 12 are consistent with the results arrived at with this current review. Specifically, there are commonalities between Wishart’s themes of Communication, Connection, and Support and our themes of Ineffective Communication, Disrespect, and Lack of Established Relationship.…”

“…In a recent scoping review, Wishart et al 12 examined perinatal care experiences for low-income, underserved pregnant women. The authors concluded that support, education, connection, communication, and trust were vital to perinatal care.…”

“…The authors concluded that support, education, connection, communication, and trust were vital to perinatal care. 12 This review only included qualitative studies, included populations from all underserved communities, but was limited to those with low socioeconomic status. Health disparities, however, exist for Black birthing people despite socioeconomic status.…”

Mental state, well-being and coping are affected by a high-risk pregnancy

“…The USA has the highest maternal mortality rate of developed countries, where African American women are 2–3 times likely to die and experience morbidities during pregnancy compared with Caucasian women 4. Publicly insured, low-income women especially need prenatal care that mitigate health and racial disparities 5. In 2013, there were 289 000 maternal deaths, of which 60% occurred in sub-Saharan Africa and 24% in Asia 6.…”

A scoping review of interventions seeking to improve aspects of patient–provider relationships involving Black pregnant and post‐partum people

“…Yet, despite this, the landscape of interventions that are in development or testing to target improvements in patient-provider relationships for Black pregnant people is largely unknown. Previous work has synthesized the types of communication and interaction that Black pregnant people perceive as biased or stigmatizing (Wishart et al, 2021), but a review of interventions to mitigate the harmful effects of poor patient-provider relationships or change the way patients and providers interact does not exist.…”