Presentation
Equity Challenges in Maternal Care: Experiences of Black Women and Birthing Persons Across the Care Continuum.
SessionPoster Session 1
DescriptionBackground
Black women and birthing persons (BWBPs) are disproportionately affected by adverse maternal health outcomes in high-income countries, including the United States (US), United Kingdom, Brazil, and Canada [1], [2], [3], [4], [5]. These inequities are mostly linked to negative social and structural determinants of health, which are sometimes reflected within healthcare systems that provide maternal care [6], [7]. In order to understand how inequities in maternal care contribute to disparities in adverse outcomes, it is important to center the experiences of BWBPs.
Prior research on racial/ethnic disparities and inequities in maternal care has largely been conducted in the US [8]. Although a few studies in Canada have explored maternal care experiences among BWBPs, equity challenges within the Canadian context remain understudied. Prior research has found that BWBPs receiving care in the Greater Toronto Area of Ontario, Canada may experience obstetric racism and discrimination based on intersecting identities such as race, age, and gender [9], [10]. Building on this existing evidence, further research is needed to deepen understanding of these challenges and to inform efforts to redesign maternal care in ways that promote equity and reproductive justice for BWBPs.
Understanding the lived experiences of BWBPs during their medical encounters can help uncover equity challenges and practices within the clinical system that undermine safe, equitable, and patient-centred care [11]. Existing Canadian research has largely focused retrospectively on isolated phases of maternal care, such as prenatal [12] or intrapartum [13]. However, because experiences in one phase (e.g., prenatal) can shape those in subsequent phases (e.g., intrapartum and postpartum) [14], [15], it is essential to examine BWBPs’ experiences across the full continuum of care in order to gain insights into current care practices, equity challenges and generate knowledge that is critical for redesigning equitable maternal care. Hence, the purpose of this study is to understand the ongoing experiences of BWBPs receiving maternal care in Ontario, Canada, and to identify the equity challenges they encounter. We use the SEIPS 3.0 framework to guide our exploration of participants’ maternal care journeys, collecting data on the prenatal, intrapartum, and postpartum phases as they engage with different clinical microsystems [16]. In addition, we incorporate the Reproductive Justice (RJ) framework, with its emphasis on the right to have a child, the right not to have a child, and the right to bodily autonomy, as an equity lens to frame questions and interpret experiences of care that either support or undermine these rights [17].
Methods
The participant population for this study consisted of BWBPs aged 18 or older who were receiving maternal care services in Ontario, Canada. Participants were recruited through hospitals, midwifery offices, community organizations, and social media platforms. A prenatal and postpartum cohort was recruited. For the prenatal cohort, we aimed to recruit 10–12 BWBPs. These participants completed surveys at 28, 32, and 36 weeks gestation and participated in a 60-minute interview exploring their prenatal care experiences. For the postpartum cohort, we aimed to recruit 10–12 BWBPs. Participants completed surveys at 2, 4, and 6 weeks postpartum and participated in an interview to explore their intrapartum and postpartum care experiences. Participants in the prenatal cohort had the option to continue into the postpartum phase of the study.
Surveys captured a broad range of experiences, including screenings, prenatal and postpartum education, virtual care, family planning, resource utilization, birthing experience, complications, and postpartum care utilization. Interviews provided an in-depth understanding of patients’ care experiences, including access to care, preparation for birth, perspectives on safety and risk, physical environments, pain management, health care team interactions, preparation for discharge, engagement with resources, transitions of care, and care challenges.
Survey responses, such as demographic data including race/ethnicity, age, and number of previous births, were summarized using descriptive statistics (means, medians, and standard deviations). Reflexive thematic analysis, as described by Braun and Clarke [18], [19], was used to analyze the prenatal and postpartum interview data. This mixed-methods approach allowed for the identification of patterns of meaning across participants’ experiences while recognizing the active role of the researcher in analysis and interpretation. In addition, we incorporated RJ as an interpretive lens to understand the equity challenges reflected in participants’ accounts.
Preliminary Results
Ten participants completed the prenatal phase of the study, and seven participants completed the postpartum phase. Six of the postpartum participants were from the prenatal cohorts. In the prenatal cohort, most of the participants (n=8) had at least a bachelor’s degree. Half (n=5) of the participants had no access to paid maternity leave, and half (n=5) did not engage in pregnancy support groups. While most participants in the postpartum cohort (n=5) wished they had been seen by the same provider who cared for them during their prenatal period, only three participants were actually attended to by a member of their prenatal care team during delivery. Four of the postpartum participants were not screened for depression and other mood disorders. Findings from the interviews showed that BWBPs continue to face equity challenges, such as not being taken seriously and acknowledged as experts of their own experience. Participants also described relying on their own “research” in order to receive sufficient prenatal education, which points to equity issues for those unable to do so. BWBPs who received midwifery care reported greater awareness of and access to additional community resources compared to those who did not use this model of care. Other concerns included deviations from the standard length of stay after a cesarean delivery, where women felt “forced” to go home before they were ready, and limited education about what to expect in the postpartum phase.
Conclusion
While recruitment is still ongoing, findings from the preliminary analysis suggest that BWBP may receive limited screenings on their mental health and may have varying access to and engagement with prenatal and postpartum community resources depending on the model of care. These findings align with previous studies that suggest disparity in perinatal depression screening for Black women [20] and the need for hospitals to partner with communities to provide support for Black maternal care [21]. The completed analysis will provide a detailed account of BWBPs’ experiences of receiving maternal care services in Ontario, Canada, through their prenatal, intrapartum, and postpartum phases. This account will provide an understanding of the current health care system, equity challenges, and patient safety issues that need to be addressed to improve care for BWBPs.
Black women and birthing persons (BWBPs) are disproportionately affected by adverse maternal health outcomes in high-income countries, including the United States (US), United Kingdom, Brazil, and Canada [1], [2], [3], [4], [5]. These inequities are mostly linked to negative social and structural determinants of health, which are sometimes reflected within healthcare systems that provide maternal care [6], [7]. In order to understand how inequities in maternal care contribute to disparities in adverse outcomes, it is important to center the experiences of BWBPs.
Prior research on racial/ethnic disparities and inequities in maternal care has largely been conducted in the US [8]. Although a few studies in Canada have explored maternal care experiences among BWBPs, equity challenges within the Canadian context remain understudied. Prior research has found that BWBPs receiving care in the Greater Toronto Area of Ontario, Canada may experience obstetric racism and discrimination based on intersecting identities such as race, age, and gender [9], [10]. Building on this existing evidence, further research is needed to deepen understanding of these challenges and to inform efforts to redesign maternal care in ways that promote equity and reproductive justice for BWBPs.
Understanding the lived experiences of BWBPs during their medical encounters can help uncover equity challenges and practices within the clinical system that undermine safe, equitable, and patient-centred care [11]. Existing Canadian research has largely focused retrospectively on isolated phases of maternal care, such as prenatal [12] or intrapartum [13]. However, because experiences in one phase (e.g., prenatal) can shape those in subsequent phases (e.g., intrapartum and postpartum) [14], [15], it is essential to examine BWBPs’ experiences across the full continuum of care in order to gain insights into current care practices, equity challenges and generate knowledge that is critical for redesigning equitable maternal care. Hence, the purpose of this study is to understand the ongoing experiences of BWBPs receiving maternal care in Ontario, Canada, and to identify the equity challenges they encounter. We use the SEIPS 3.0 framework to guide our exploration of participants’ maternal care journeys, collecting data on the prenatal, intrapartum, and postpartum phases as they engage with different clinical microsystems [16]. In addition, we incorporate the Reproductive Justice (RJ) framework, with its emphasis on the right to have a child, the right not to have a child, and the right to bodily autonomy, as an equity lens to frame questions and interpret experiences of care that either support or undermine these rights [17].
Methods
The participant population for this study consisted of BWBPs aged 18 or older who were receiving maternal care services in Ontario, Canada. Participants were recruited through hospitals, midwifery offices, community organizations, and social media platforms. A prenatal and postpartum cohort was recruited. For the prenatal cohort, we aimed to recruit 10–12 BWBPs. These participants completed surveys at 28, 32, and 36 weeks gestation and participated in a 60-minute interview exploring their prenatal care experiences. For the postpartum cohort, we aimed to recruit 10–12 BWBPs. Participants completed surveys at 2, 4, and 6 weeks postpartum and participated in an interview to explore their intrapartum and postpartum care experiences. Participants in the prenatal cohort had the option to continue into the postpartum phase of the study.
Surveys captured a broad range of experiences, including screenings, prenatal and postpartum education, virtual care, family planning, resource utilization, birthing experience, complications, and postpartum care utilization. Interviews provided an in-depth understanding of patients’ care experiences, including access to care, preparation for birth, perspectives on safety and risk, physical environments, pain management, health care team interactions, preparation for discharge, engagement with resources, transitions of care, and care challenges.
Survey responses, such as demographic data including race/ethnicity, age, and number of previous births, were summarized using descriptive statistics (means, medians, and standard deviations). Reflexive thematic analysis, as described by Braun and Clarke [18], [19], was used to analyze the prenatal and postpartum interview data. This mixed-methods approach allowed for the identification of patterns of meaning across participants’ experiences while recognizing the active role of the researcher in analysis and interpretation. In addition, we incorporated RJ as an interpretive lens to understand the equity challenges reflected in participants’ accounts.
Preliminary Results
Ten participants completed the prenatal phase of the study, and seven participants completed the postpartum phase. Six of the postpartum participants were from the prenatal cohorts. In the prenatal cohort, most of the participants (n=8) had at least a bachelor’s degree. Half (n=5) of the participants had no access to paid maternity leave, and half (n=5) did not engage in pregnancy support groups. While most participants in the postpartum cohort (n=5) wished they had been seen by the same provider who cared for them during their prenatal period, only three participants were actually attended to by a member of their prenatal care team during delivery. Four of the postpartum participants were not screened for depression and other mood disorders. Findings from the interviews showed that BWBPs continue to face equity challenges, such as not being taken seriously and acknowledged as experts of their own experience. Participants also described relying on their own “research” in order to receive sufficient prenatal education, which points to equity issues for those unable to do so. BWBPs who received midwifery care reported greater awareness of and access to additional community resources compared to those who did not use this model of care. Other concerns included deviations from the standard length of stay after a cesarean delivery, where women felt “forced” to go home before they were ready, and limited education about what to expect in the postpartum phase.
Conclusion
While recruitment is still ongoing, findings from the preliminary analysis suggest that BWBP may receive limited screenings on their mental health and may have varying access to and engagement with prenatal and postpartum community resources depending on the model of care. These findings align with previous studies that suggest disparity in perinatal depression screening for Black women [20] and the need for hospitals to partner with communities to provide support for Black maternal care [21]. The completed analysis will provide a detailed account of BWBPs’ experiences of receiving maternal care services in Ontario, Canada, through their prenatal, intrapartum, and postpartum phases. This account will provide an understanding of the current health care system, equity challenges, and patient safety issues that need to be addressed to improve care for BWBPs.
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery
Patient Safety Research and Initiatives