Community and Systems Contributors and Strategies to Reduce Racial Inequities in Maternal Health in the Deep South: Provider Perspectives.

IF 2.6 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Health Equity Pub Date : 2023-09-13 eCollection Date: 2023-01-01 DOI:10.1089/heq.2023.0114
Molly B Richardson, Angelina A Toluhi, Monica L Baskin, Henna Budhwani, Zoë I Julian, Candace C Knight, Rachel Sinkey, Jeff M Szychowski, Alan T N Tita, Martha S Wingate, Janet M Turan
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Abstract

Purpose: Black pregnant individuals in Alabama are disproportionately affected by severe maternal morbidity and mortality (SMM). To understand why racial disparities in maternal health outcomes persist and identify potential strategies to reduce these inequities, we sought perspectives from obstetric health care providers, health administrators, and members of local organizations who provide pregnancy, delivery, and postpartum care services in Alabama.

Methods: We conducted qualitative in-depth interviews with stakeholders (n=20), purposively recruited from community-based organizations, clinical settings, government organizations, and academic institutions. Interview guides were based on Howell's conceptual model of pathways to racial disparities in maternal mortality. Data were coded using a modified framework theory approach and analyzed thematically.

Results: Racism, unjust laws and policies, and poverty/lack of infrastructure in communities emerged as major themes contributing to racial disparities in maternal health at the community and systems levels. Inadequate health insurance coverage was described as a strong driver of the disparities. Service providers suggested strategies for Alabama should be community focused, evidence based, and culturally sensitive. These should include Medicaid expansion, expanded parental leave, and removal of laws restricting choice. Community- and systems-level interventions should include community infrastructure improvements, choice in maternity services, and provision of digital communication options.

Conclusions: Providers shared perspectives on community and structural areas of intervention to reduce racial inequities in SMM. These results can inform discussions with health system and community partners about Alabama and other Deep South initiatives to improve maternal health outcomes in black communities.

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减少深南地区孕产妇保健种族不平等的社区和系统贡献者和战略:提供者视角。
目的:阿拉巴马州的黑人孕妇受到严重孕产妇发病率和死亡率(SMM)的影响尤为严重。为了了解为什么孕产妇健康结果中的种族差异持续存在,并确定减少这些不平等的潜在战略,我们从产科保健提供者、卫生行政人员和提供妊娠、分娩、,方法:我们对来自社区组织、临床环境、政府组织和学术机构的利益相关者(n=20)进行了定性深入访谈。访谈指南基于豪厄尔关于孕产妇死亡率种族差异途径的概念模型。数据使用修改的框架理论方法进行编码,并进行主题分析。结果:种族主义、不公正的法律和政策以及社区贫困/缺乏基础设施成为造成社区和系统层面孕产妇健康方面种族差异的主要主题。医疗保险覆盖不足被描述为造成这种差异的一个主要原因。服务提供商建议阿拉巴马州的策略应该以社区为中心,以证据为基础,并对文化敏感。这些措施应该包括扩大医疗补助、扩大育儿假以及取消限制选择的法律。社区和系统层面的干预措施应包括改善社区基础设施、选择产科服务和提供数字通信选项。结论:提供者就减少SMM中种族不平等的社区和结构干预领域分享了观点。这些结果可以为与卫生系统和社区合作伙伴讨论阿拉巴马州和其他深南倡议提供信息,以改善黑人社区的孕产妇健康结果。
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来源期刊
Health Equity
Health Equity Social Sciences-Health (social science)
CiteScore
3.80
自引率
3.70%
发文量
97
审稿时长
24 weeks
期刊最新文献
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