Mitigating the Impact of Implicit Bias on Maternal Morbidity and Mortality for African American Women

项目总结/摘要 非裔美国人（AA）妇女发生妊娠相关严重发病率的可能性高2-4倍， 比美国的白色母亲的死亡率要高。与怀孕有关的孕产妇死亡率中有一半被判定为 这是可以预防的，但获得优质护理对AA妇女来说是个问题。隐性偏见，种族主义和 与卫生保健提供者的文化上不适当的互动都与缺乏卫生保健有关 利用率扩大AA妇女的声音和支持AA妇女领导的解决方案对于 实现孕产妇保健公平。本1年期行政补充文件中建议的工作建立在以下目标之上： 环境对儿童健康结果的影响（ECHO）父母补助金（UG 3/UH 3 OD 023285，Paneth 联系PI），以评估怀孕期间和围产期的环境暴露， 与以后的儿童健康结果有关。我们将从底特律ECHO网站招募AA女性， 亚特兰大ECHO妊娠队列（Dunlop & Brennan，UG 3/UH 3 OD 023318），该队列招募美国出生的 黑人女性这项研究的假设是，从AA妇女和她们的健康护理中获得指导， 提供者可以通过生殖正义、尊重护理和健康公平的透镜提供关键服务 重要的信息，有助于改善AA妇女的治疗，在卫生保健环境和利用 和参与保健，从而减少不利孕产妇保健结果方面的差距。通过 与AA母亲、卫生保健提供者和社区团体进行访谈和焦点小组讨论，目的是1） 确定促进因素和障碍，以减轻隐性偏见和种族主义对AA妇女在健康方面的影响 护理环境，基于关键信息提供者的投入，包括面临风险的AA妇女和卫生保健提供者; 2）制定策略，优化AA母亲医疗服务的利用和有效性。 这项ECHO范围内的研究在从AA妇女及其医疗保健提供者那里获得指导方面具有创新性 通过生殖正义、尊重的护理和健康公平的透镜，它将有助于更好地 了解ECHO的产前、围产期和产后健康结果。它在批判性地发现 改善AA妇女在医疗保健环境中的治疗，提高参与率的重要信息 在卫生保健方面，从而减少不利的产妇保健结果方面的差距。结果将是 为母亲制定具体战略工具包，以应对负面互动， 集中的，尊重的照顾。目标是通过发现妇女和提供者的机制来赋予妇女权力 可以用来减少无意识或隐性偏见的影响，在卫生保健设置，从而减少 严重发病率和死亡率的风险。

Project Summary/Abstract African American (AA) women are 2-4 times more likely to experience pregnancy-related severe morbidity and mortality than are white mothers in the US. Half of pregnancy-related maternal mortality is judged to be preventable, but access to quality care is problematic for AA women. Implicit bias, perceived racism and culturally inappropriate interactions with health care providers have all been linked to a lack of health care utilization. The amplification of AA women's voices and the support of AA women-led solutions are critical to achieving maternal health equity. The work proposed in this 1-yr Administrative Supplement builds on the aims of the Environmental influences on Child Health Outcomes (ECHO) parent grant (UG3/UH3OD023285, Paneth Contact PI), which are to assess environmental exposures during pregnancy and the perinatal period in relation to later child health outcomes. We will enroll AA women from our Detroit ECHO site and work closely with the Atlanta ECHO pregnancy cohort (Dunlop & Brennan, UG3/UH3OD023318), which enrolls US-born Black women. The hypothesis for this study is that eliciting guidance from AA women and their health care providers through the lens of reproductive justice, respectful care, and health equity, can offer critically important information useful in improving AA women's treatment in the health care setting and their utilization and participation in health care, thereby reducing disparities in adverse maternal health outcomes. Through interviews and focus groups with AA mothers, health care providers, and community groups, the aims are to 1) identify facilitators and barriers for mitigating the impact of implicit bias and racism on AA women in the health care setting, based on input from key informants, including both AA women at risk and health care providers; and 2) develop strategies that will optimize utilization and effectiveness of healthcare services for AA mothers. This ECHO-wide study is innovative in eliciting guidance from AA women and their health care providers through the lens of reproductive justice, respectful care, and health equity and it will contribute to better understanding of ECHO's Pre, Peri, and Postnatal health outcomes. It is significant in discovering critically important information for improving AA women's treatment in health care settings that will improve participation in health care, thereby reducing disparities in adverse maternal health outcomes. The result will be the development of a toolkit of specific strategies for mothers to counter negative interactions and obtain patient centered, respectful care. The goal is to empower women by discovering mechanisms women and providers can employ to lessen the impact of unconscious or implicit bias in the health care setting and thus reduce the risk of severe morbidity and mortality.