Combating Racial Disparities in Maternal and Infant Health

Source: Andrae Ricketts/Unsplash

By Lauren Morrison, M.A., Ph.D. candidate in Social & Health Psychology, Stony Brook University

Among developed countries, the United States has some of the highest rates of maternal and infant death, especially among Black families.¹ Between 2020 and 2022, Black infants had the highest rates of low birth weight and preterm birth in the country.² Additionally, Black birthing people experience pregnancy-related death at a rate three times higher than White birthing people.³ Efforts to address racial disparities (differences) in maternal and infant health often prioritize structural factors, like insurance coverage, as the main cause of differences.⁴ While structural factors are important, they don’t provide a full picture of the many factors contributing to these disparities.

Addressing the social aspects of pregnancy care may be crucial in reducing racial disparities in maternal and infant health. Black parents often report negative experiences with providers during pregnancy care, such as having their concerns dismissed or ignored, not being treated with respect, not being properly informed about medical procedures, and facing discrimination.⁵ Research suggests that these negative experiences are more common among Black families due to the broader culture of racism in medicine and society.⁶ These negative interactions can also be seen as a lack of social support from healthcare providers, leading to prenatal stress and impacting the quality and outcomes of pregnancy care for Black families.

Prenatal stress refers to stress experienced during pregnancy. Exposure to prenatal stress can increase the risk of mental health conditions and high blood pressure disorders during and after pregnancy, which are among the leading causes of pregnancy-related death.⁷ Prenatal stress can also increase the risk of preterm delivery and low birth weight, which are two leading causes of Black infant health disparities.^{8, 9} Since the culture of racism in society puts Black families at a higher risk for pregnancy-related illness and death, targeting prenatal stress through social aspects of pregnancy care could be a way to address these health disparities.

Group Prenatal Care

Group prenatal care is a holistic care model where trained healthcare providers lead small group sessions with pregnant people with similar due dates. These models are intended to improve patient education and provide opportunities for social support while maintaining core components of individual prenatal care, such as health assessment and risk screenings.¹⁰ Importantly, group prenatal care sessions are discussion-based and longer than individual prenatal care visits (about two hours). This dynamic provides space for parents and providers to develop more meaningful relationships and ensures that they are equally important agents in their pregnancy care. Therefore, group prenatal care models may be especially beneficial to Black families by improving the social dynamics of their pregnancy care.

Although there are several group prenatal care models, CenteringPregnancy is the first and most well-researched. Studies suggest that it is a promising evidence-based intervention for addressing racial disparities in maternal and infant health, particularly by reducing preterm delivery rates for Black families and improving satisfaction with care.^{10, 11} However, no research has incorporated the perspective of Black families to explore why group prenatal care models are so effective for them.

The Importance of Research as an Area for Impact

To better understand the benefits of group prenatal care for Black families, scholars and funders should prioritize research that focuses on (1) implementing monitoring and evaluation frameworks, (2) adapting evidence-based models of group prenatal care to fit the needs of Black families, and (3) identifying barriers and solutions for delivering evidence-based group prenatal care.

Research using monitoring and evaluation frameworks can help stakeholders track the most beneficial aspects of group prenatal care for Black families and determine best practices for delivering it to this at-risk population. This data can also guide funding decisions and promote accountability in efforts to reduce Black maternal and infant health disparities.

Research aimed at adapting existing care models can help reduce disparities by creating targeted interventions to meet the specific needs of Black families. For instance, the culture of racism predisposes Black families to several social determinants of health – like transportation, employment, or insurance status – that can impede participation in existing group prenatal care models.¹² Adapting existing evidence-based models is crucial to ensuring that group prenatal care is an accessible and effective alternative to individual prenatal care.

Finally, research in partnership with patients and providers is essential to identify challenges in implementing evidence-based group prenatal care models. Studies have shown that implementation of group prenatal care models can be challenging due to factors like training requirements, childcare restrictions, or initiation costs.¹⁰ Highlighting patient and provider perspectives in research helps to ensure that the implementation of group prenatal care models is accessible and sustainable by meeting the needs of patients and providers.

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The United States is in desperate need of interventions that target drastic racial disparities in maternal and infant health. Research suggests that group prenatal care may be an important pathway to achieving this goal through improved social support and patient education. However, more research is needed to understand why group prenatal care models seem to work well for Black families and how they can be better suited to meet the needs of patients and providers.

Edited by Ashley M. Votruba, J.D., Ph.D., SPSSI Blog Editor, Assistant Professor, University of Nebraska-Lincoln.