Serious health disparities in pregnancy outcomes (maternal and infant mortality, preterm birth, and low birth weight) exist, and in many cases, are growing worse. Social determinants of health (race/class) and associated factors (trauma, violence, mental health issues, and substance abuse) are strongly associated with adverse outcomes in pregnancy. Health care providers and health systems are recognized to play an important role in addressing the health impacts of these factors; however, they are often under-recognized and under-treated in clinical practice. In addition, although they often overlap and intersect together, these factors have typically been analyzed separately in research. The purpose of this study is to address the gap in the literature regarding how women become mothers in the context of multiple, intersecting risk factors, and to develop culturally competent health promotion materials and policy recommendations to reduce adverse outcomes in pregnancy. This study will collaboratively develop the content of both an information resource for women, and a white paper that includes specific recommendations for practice, research and policies that will address social determinants of disparities in pregnancy outcomes, to be disseminated to nurses and other health care professionals and policy makers.
Specific aims are: l)Describe the experience of pregnancy and early motherhood among a sample of diverse, primarily low-income women, using an intersectional framework to analyze interwoven risk factors related to poor pregnancy outcomes, particularly stress and discrimination related to race, class, trauma, violence, mental health issues, and substance abuse. 2)Describe what women identifies as their needs and priorities, including information, services and policy changes, and the impact of health providers and systems, social services, housing, and other resources, and 3)To iteratively and collaboratively, with community advisors in the group, develop the content of a)a culturally competent health promotion information resource for women and b)a white paper for policy makers and health care providers with recommendations for practice, research, and policies to address women's needs. This study has two phases and combines quantitative, qualitative, and participatory action research methods. The long-term goal is a program of health disparities research that will test such collaboratively developed informational resources for diverse women, and a program of advocacy that will partner with women to lobby for improved resources and services. LAY SUMMARY: This study partners with women in the community to learn how they cope with serious problems like racism, poverty, violence, mental health problems, and drug and alcohol use, and what they need to help them be the best mothers they can be. The study will create ways to share this information with health care workers and policy makers, to improve health care and policy based on what women want and need. It will also bring needed health and resource information back to other women, for healthier mothers and babies in the future. ? ? ?
| Bloom, Tina; Glass, Nancy; Curry, Mary Ann et al. (2013) Maternal stress exposures, reactions, and priorities for stress reduction among low-income, urban women. J Midwifery Womens Health 58:167-74 |
