Maternal mortality (MM) and severe maternal morbidity (SMM) are higher in the United States (US) than any other high-income country and have increased over time. This national maternal health crisis is also characterized by significant racial disparity. MM is three times as likely among non-Hispanic black women as non-Hispanic white women. Likewise, non-Hispanic black women are twice as likely to experience SMM even when controlling for sociodemographic confounders. Given that over 60% of US maternal deaths could be prevented, there is an urgent need for research to better understand and address the pervasive and persistent health disparities. Consistent with the goals of this Notice of Special Interest (NOT-OD-20-104), we will utilize established community-engaged approaches to better understand racial disparities in pregnancy-related and pregnancy-associated MM and SMM in the priority region of the US South. Our multidisciplinary team will leverage the clinical research informatics and community engagement resources of the Center for Clinical and Translational Science (CCTS) to identify multi-level (individual, interpersonal, community, and sociocultural) determinants of maternal health disparities, as well as factors that contribute to optimal maternal outcomes in high risk Southern communities. This research will focus on women in Alabama, the state with the third highest MM in the country. The first specific aim is retrospective cohort study of over 40,000 obstetric patients over the past 10 years to better evaluate the individual (race, age, education, payer status, medical history), community (residence), and system (clinic/provider) factors associated with MM and SMM. The second specific aim is to identify provider, system and community-based perspectives on potential areas of intervention to improve maternal outcomes and reduce racial inequities in MM and SMM. The third specific aim is a prospective mixed- methods study of obstetric patients to examine healthcare system distrust, perceived discrimination and racism experienced by black women receiving obstetric care (hypothesized contributing factors to the 3 to 4 times higher rate of MM experienced by black mothers). We believe that accomplishing the aims below will significantly contribute to the evidence-base for NIH?s forthcoming Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) initiative and future longitudinal studies by this research team.
The goal of the proposed study is to better articulate multi-level (individual, interpersonal, community, and sociocultural) determinants of maternal mortality and severe maternal mortality and associated health disparities. Findings from this study have the potential to improve clinical care and prevention strategies to improve overall maternal outcome and attain equity in maternal health.