African American (AA) women are 2-4 times more likely to experience pregnancy-related severe morbidity and mortality than are white mothers in the US. Half of pregnancy-related maternal mortality is judged to be preventable, but access to quality care is problematic for AA women. Implicit bias, perceived racism and culturally inappropriate interactions with health care providers have all been linked to a lack of health care utilization. The amplification of AA women's voices and the support of AA women-led solutions are critical to achieving maternal health equity. The work proposed in this 1-yr Administrative Supplement builds on the aims of the Environmental influences on Child Health Outcomes (ECHO) parent grant (UG3/UH3OD023285, Paneth Contact PI), which are to assess environmental exposures during pregnancy and the perinatal period in relation to later child health outcomes. We will enroll AA women from our Detroit ECHO site and work closely with the Atlanta ECHO pregnancy cohort (Dunlop & Brennan, UG3/UH3OD023318), which enrolls US-born Black women. The hypothesis for this study is that eliciting guidance from AA women and their health care providers through the lens of reproductive justice, respectful care, and health equity, can offer critically important information useful in improving AA women's treatment in the health care setting and their utilization and participation in health care, thereby reducing disparities in adverse maternal health outcomes. Through interviews and focus groups with AA mothers, health care providers, and community groups, the aims are to 1) identify facilitators and barriers for mitigating the impact of implicit bias and racism on AA women in the health care setting, based on input from key informants, including both AA women at risk and health care providers; and 2) develop strategies that will optimize utilization and effectiveness of healthcare services for AA mothers. This ECHO-wide study is innovative in eliciting guidance from AA women and their health care providers through the lens of reproductive justice, respectful care, and health equity and it will contribute to better understanding of ECHO's Pre, Peri, and Postnatal health outcomes. It is significant in discovering critically important information for improving AA women's treatment in health care settings that will improve participation in health care, thereby reducing disparities in adverse maternal health outcomes. The result will be the development of a toolkit of specific strategies for mothers to counter negative interactions and obtain patient centered, respectful care. The goal is to empower women by discovering mechanisms women and providers can employ to lessen the impact of unconscious or implicit bias in the health care setting and thus reduce the risk of severe morbidity and mortality.
In the US, illness and death around the time of childbirth are much higher in African American women than white women, partly because of bias and racism experienced in the health care setting. In this study, we will ask questions and listen to answers about respectful health care practices from groups of African American mothers and their health care providers. The result will be the development of a toolkit of specific strategies for mothers to counter negative interactions and obtain patient centered, respectful care.
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