Community and Systems Contributors and Strategies to Reduce Racial Inequities in Maternal Health in the Deep South: Provider Perspectives.
Community and Systems Contributors and Strategies to Reduce Racial Inequities in Maternal Health in the Deep South: Provider Perspectives.
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作者：
阿拉巴马州的黑人孕妇受到严重孕产妇发病率和死亡率（SMM）的影响尤为严重。为了了解孕产妇健康结果中种族差异持续存在的原因并确定减少这些不平等的潜在策略，我们向产科医疗保健提供者、卫生管理者以及在阿拉巴马州提供怀孕、分娩和产后护理服务的当地组织成员征求了意见。我们对利益相关者（n=20）进行了定性深入访谈，这些利益相关者是从社区组织、临床环境、政府组织和学术机构中招募的。访谈指南基于豪厄尔关于孕产妇死亡率种族差异路径的概念模型。使用修改后的框架理论方法对数据进行编码并进行主题分析。种族主义、不公正的法律和政策以及社区贫困/缺乏基础设施成为导致社区和系统层面孕产妇健康种族差异的主要主题。健康保险覆盖范围不足被认为是造成这种差异的一个重要因素。服务提供商建议阿拉巴马州的策略应以社区为中心、基于证据且具有文化敏感性。这些措施应包括扩大医疗补助、扩大育儿假以及取消限制选择的法律。社区和系统层面的干预措施应包括社区基础设施的改善、孕产服务的选择以及数字通信选项的提供。提供者分享了对社区和结构性干预领域的看法，以减少 SMM 中的种族不平等。这些结果可以为与卫生系统和社区合作伙伴就阿拉巴马州和其他南方腹地倡议进行讨论提供信息，以改善黑人社区的孕产妇健康结果。
Black pregnant individuals in Alabama are disproportionately affected by severe maternal morbidity and mortality (SMM). To understand why racial disparities in maternal health outcomes persist and identify potential strategies to reduce these inequities, we sought perspectives from obstetric health care providers, health administrators, and members of local organizations who provide pregnancy, delivery, and postpartum care services in Alabama. We conducted qualitative in-depth interviews with stakeholders (n=20), purposively recruited from community-based organizations, clinical settings, government organizations, and academic institutions. Interview guides were based on Howell's conceptual model of pathways to racial disparities in maternal mortality. Data were coded using a modified framework theory approach and analyzed thematically. Racism, unjust laws and policies, and poverty/lack of infrastructure in communities emerged as major themes contributing to racial disparities in maternal health at the community and systems levels. Inadequate health insurance coverage was described as a strong driver of the disparities. Service providers suggested strategies for Alabama should be community focused, evidence based, and culturally sensitive. These should include Medicaid expansion, expanded parental leave, and removal of laws restricting choice. Community- and systems-level interventions should include community infrastructure improvements, choice in maternity services, and provision of digital communication options. Providers shared perspectives on community and structural areas of intervention to reduce racial inequities in SMM. These results can inform discussions with health system and community partners about Alabama and other Deep South initiatives to improve maternal health outcomes in black communities.
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影响因子：
2.3
作者：
Chambers, Brittany D.;Arega, Helen A.;McLemore, Monica R.
通讯作者：
McLemore, Monica R.
影响因子：
2.7
作者：
Alson JG;Robinson WR;Pittman L;Doll KM
通讯作者：
Doll KM
影响因子：
4
作者：
Gale NK;Heath G;Cameron E;Rashid S;Redwood S
通讯作者：
Redwood S
影响因子：
7.2
作者：
Admon, Lindsay K.;Winkelman, Tyler N. A.;Dalton, Vanessa K.
通讯作者：
Dalton, Vanessa K.
DOI：
10.33552/wjgwh.2022.05.000622
发表时间：
2022-01-01
期刊：
World journal of gynecology & womens health
影响因子：
--
作者：
Kramer, Katherine J;Rhoads-Baeza, M Elena;Recanati, Maurice-Andre
通讯作者：
Recanati, Maurice-Andre