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Cited by 45Maternal and Neonatal HealthcareRacial and Ethnic Identity ResearchCultural Competency in Health Care

A paradigm shift to address racial inequities in perinatal healthcare

Carter, Ebony B., Mazzoni, Sara E.·2021·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2020.11.040
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Abstract

Health inequities are not caused by personal failings or shortcomings within disadvantaged groups, which can be erased with behavioral interventions. The scope of the problem is much greater and will only fully be addressed with the examination of the systems, structures, and policies that perpetuate racism, classism, and an economic, class, race, or gender divide between patients and the people who care for them. Solution-oriented strategies to achieve health equity will remain elusive if researchers continue to focus on behavior modification in patients while failing to do harder work that includes focusing on the institutions, community, and societal contexts in which pregnant women are living; addressing social determinants of health; considering racism in study design, analysis, and reporting; valuing the voices of patients, practitioners, and researchers from historically disadvantaged groups; disseminating research findings back to the community; and developing policy and reimbursement structures to support care delivery change that advances equitable outcomes. A case study shows us how group prenatal care may be one viable vehicle through which to affect this change. Group prenatal care is one of the few interventions shown to improve pregnancy outcomes for black women. Studies of group prenatal care have predominantly focused on the patient, but here we propose that the intervention may exert its greatest impact on clinicians and the systems in which they work. The underlying mechanism through which group prenatal care works may be through increased quantity and quality of patient and practitioner time together and communication. We hypothesize that this, in turn, fosters greater opportunity for cross-cultural exposure and decreases clinician implicit bias, explicit bias, and racism, thus increasing the likelihood that practitioners advocate for systems-level changes that directly benefit patients and improve perinatal outcomes.

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Authors
Carter, E. B., & Mazzoni, S. E.
Affiliations
  • Washington University in St. Louis (US)
  • University of Washington (US)
Corresponding author
Carter, Ebony B.
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2021-04
Volume
224
Issue
4
Pages
359-361
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2020.11.040
OpenAlex
W3111639358
Cited by
45
References
29
Citations by year
2026: 2 · 2025: 3 · 2024: 11 · 2023: 13 · 2022: 12 · 2021: 4
FWCI
7.57
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute of Mental Health (R01MH125158-01)
  • National Institutes of Health
  • Missouri Foundation for Health (19-0414-IM-20, 16-0373-IM-16)
Topics
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
Keywords
racial disparities in health, group prenatal care, Black women, social determinants of health, structural racism, implicit bias, clinician bias, health equity, systems-level change, patient-practitioner communication, cross-cultural exposure, research dissemination
MeSH terms
Health Equity, Female, Health Services Research, Humans, Pregnancy, Perinatal Care, Organizational Case Studies, Health Status Disparities

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