Understanding Perspectives of African American Medicaid-Insured Women on the Process of Perinatal Care: An Opportunity for Systems Improvement

Abstract

Objectives To address disparities in adverse birth outcomes, communities are challenged to improve the quality of health services and foster systems integration. The purpose of this study was to explore the perspectives of Medicaid-insured women about their experiences of perinatal care (PNC) across a continuum of clinical and community-based services. Methods Three focus groups (N = 21) were conducted and thematic analysis methods were used to identify basic and global themes about experiences of care. Women were recruited through a local Federal Healthy Start (HS) program in Michigan that targets services to African American women. Results Four basic themes were identified: (1) Pursuit of PNC; (2) Experiences of traditional PNC; (3) Enhanced prenatal and postnatal care; and (4) Women's health: A missed opportunity. Two global themes were also identified: (1) Communication with providers, and (2) Perceived socio-economic and racial bias. Many women experienced difficulties engaging in early care, getting more help, and understanding and communicating with their providers, with some reporting socio-economic and racial bias in care. Delays in PNC limited early access to HS and enhanced prenatal care (EPC) programs with little evidence of supportive transitions to primary care. Notably, women's narratives revealed few connections among clinical and community-based services. Conclusions The process of participating in PNC and community-based programs is challenging for women, especially for those with multiple health problems and living in difficult life circumstances. PNC, HS and other EPC programs could partner to streamline processes, improve the content and process of care, and enhance engagement in services.

Risk factors for alcohol use among pregnant women, ages 15–44, in the United States, 2002 to 2017

“…In middle/late pregnancy, higher risk was found in Black women and women with lower socioeconomic status. These women may be less likely to get adequate prenatal care 58,59 , perhaps due to perceived discrimination, inability to access providers who take public insurance, and difficulties with transportation [59][60][61][62] . Home-visiting programs may partially solve those problems and improve prenatal care among vulnerable subpopulations 59,63 .…”

Double Jeopardy – Missed care for the vulnerable in community settings

“…However, up until now there has been very little focus on missed care in older populations (Zúñiga et al., ). From the patients’ perspective, it has also been identified recently that communities can feel disadvantaged and underserved within the context of community health services (Roman et al., ). This US‐based study identified for example that African Americans availing of Medicaid cover felt marginalised within the community health structures and received suboptimal treatment and health education.…”

Skin Tone Matters: Racial Microaggressions and Delayed Prenatal Care

“…10,37,41 Indeed, a 2017 report on AA experiences of discrimination found that one fifth to one third of AAs report that they avoid seeking needed services (e.g., calling the police or medical care) to prevent potential discrimination. 41 Roman et al 40 found that AA women perceived their experiences (provider attitudes, extended wait times, staff facial expressions) across the continuum of clinical and community-based care were influenced by their race and insurance status. It could be that AA women in LIFE who perceived greater experiences of racial microaggressions, in general or in the healthcare setting, develop a sense of hypervigilance and avoid or delay PNC as a way to circumvent potential discrimination.…”