Identifying and Understanding the Social and Policy Determinants of Obstetric-Care, Maternal Mortality, and Morbidity

在美国，孕产妇死亡率（定义为怀孕期间或分娩后1年内的死亡）和孕产妇发病率（与怀孕或分娩有关的任何导致负面后果的健康状况）的发生率惊人。事实上，美国是所有工业化国家中孕产妇死亡率和发病率最高的国家。在美国分娩的黑人、土著和有色人种（BIPOC）的死亡率几乎是白人妇女的三倍。研究还显示，这些群体在获得和使用医疗服务方面存在巨大的全国性种族差异。关于这一主题的研究通常是在许多互不相关的研究领域进行的，这拖延了解决方案的进展。该项目通过采用创新的、多学科的、综合的方法来了解社会经济地位等个人因素、种族主义等社区因素以及物质使用和肥胖等健康行为因素如何相互作用，从而增加怀孕和分娩期间并发症的风险，从而解决了过去研究中的局限性。通过使用具有全国代表性的数据集，研究人员确定了不平等因素如何预测负面孕产妇健康结果和护理使用的风险。使用来自大量数据集的发现有助于对100位母亲进行采访。接受采访的母亲有生活经验，并在数据集中发现了各种风险因素。在一个医疗保健支出超过4万亿美元的国家，孕产妇死亡率和发病率很高，这是一个问题，需要统计和实际经验的方法来为提供者、家庭和政策制定者制定解决方案。该项目使用混合方法来分析美国各地的孕产妇健康结果。首先，研究人员使用国家卫生统计中心（NCHS）的数据对孕产妇死亡率进行统计分析，并使用妊娠风险评估监测系统（PRAMS）的数据对孕产妇发病率和产科风险进行统计分析。这些发现有助于为来自德克萨斯州的100名女性的参与者访谈提供信息，德克萨斯州的未参保率是全国最高的，医疗补助计划（Medicaid）的扩张有着复杂的历史。这些背景因素和该州广泛的种族和民族多样性使其成为研究母亲怀孕和健康经历的天然实验室。访谈的重点是引出产妇的经历和行为，以便了解她们在产前前后获得和利用促进健康的资源以及她们对社会、环境和经济风险因素的暴露情况。这些访谈提供了关于健康风险是如何内化的信息，并与孕妇和产后妇女对其健康状况的看法有关，以及她们的健康行为和医疗保健利用情况。同样，访谈调查了对护理系统的信任，因为有妇女因为不信任而不去产科护理或医院的故事。混合方法提供了对产妇风险的更全面的了解，以及分娩的人如何理解、体验和尝试管理这些风险。这一领域现有的许多定量研究考察的是政策和解决方案，而没有了解生育的人如何理解他们的风险，以及人们如何可能或可能不会减轻政策的影响。研究小组利用对孕产妇风险的更广泛了解来跟踪这些因素在怀孕和分娩期间以及分娩后一年对孕产妇健康的影响。这个跨学科的研究团队来自不同的科学背景，并与社区组织直接接触，使他们能够将研究成果带给公众，从而在这些问题上产生可操作的变化。该项目有可能有助于改善孕产妇保健政策和做法。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

Maternal mortality (defined as death during pregnancy or within 1 year of giving birth) and maternal morbidity (any health condition linked to pregnancy or birth that causes negative consequences) occur at alarming rates in the United States. In fact, the U.S. has the highest rates of maternal mortality and morbidity of all industrialized countries. Black, Indigenous, and People of Color (BIPOC) who give birth in the U.S. die nearly three times as often as White women. Research also shows vast, nationwide racial disparities in the access to and use of care by these groups. The research on this topic generally is done in many disconnected fields of study, which delays progress toward solutions. This project addresses limitations in past research by using an innovative, multi-disciplinary, comprehensive approach to understanding how individual factors like socioeconomic status, community-level factors like racism, and health behavior factors like substance use and obesity can interact to increase the risk of complications during pregnancy and birth. By using a nationally representative data set, researchers identify how inequality factors can predict the risk of negative maternal health outcomes and care use. Using the findings from a vast dataset assists in shaping the interviews with 100 mothers. The mothers interviewed have lived experience and a variety of risk factors found in the dataset. The high rates of maternal mortality and morbidity in a nation that spends over $4 trillion on healthcare are problematic and require both a statistical and a lived-experience approach to develop solutions for providers, families, and policymakers.This project uses a mixed methods approach to analyze maternal health outcomes across the U.S. First, researchers conduct a statistical analysis of maternal mortality using data from the National Center for Health Statistics (NCHS), and of maternal morbidity and obstetric risk using data from the Pregnancy Risk Assessment Monitoring System (PRAMS). Those findings can assist in informing participant interviews with 100 women from a Texas, which has the country’s highest uninsured rates and a complicated history with Medicaid expansion. These contextual factors and the state’s extensive racial and ethnic diversity make it a natural laboratory for research into the maternal experiences of pregnancy and health. Interviews focus on eliciting the experiences and behaviors of people who give birth in order to understand their access to and utilization of health-promoting resources and their exposure to social, environmental, and economic risk factors prior to and after the prenatal period. These interviews provide information on how health risks are internalized and relate to pregnant and postpartum people's perceptions of their health status, as well as about their health behavior and medical care utilization. Likewise, interviews investigate trust in the care system, as there are stories of women not coming to obstetric care or to the hospital due to distrust. The mixed-method approach provides a more comprehensive understanding of maternal risks and how people who give birth make sense of, experience, and try to manage those risks. Much of the existing quantitative research in this area examines policies and solutions, without understanding how people who give birth make sense of their risks and how people may or may not mitigate the impact of policy. The research team utilizes a broader understanding of maternal risk to track how these factors affect maternal health during pregnancy and delivery and up to a year after birth. This interdisciplinary research team comes from diverse scientific backgrounds with direct contact with community organizations, enabling them to bring this research to the public to produce actionable change on these issues. This project has potential to help improve maternal health policy and practice.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.