In light of a newly-announced study at UNC, in this edition of Addressing Taboo Topics, we take a look at how racial inequities in maternal care are part of a larger, systemic issue affecting the U.S. healthcare system – and what some community partners are doing to address it.
A new study at UNC hopes to address systemic racism in the U.S. healthcare system specifically by reducing racial inequities in maternal care.
With a $10 million award from the Patient-Centered Outcomes Research Institute, the new study, dubbed ACURE4Moms, plans to implement various accountability methods and doula support at 40 prenatal practices across North Carolina.
“The inequity in maternal health outcomes has been long-standing since at least the 1980s, when the CDC first started collecting maternal mortality data, and that inequity has only increased,” said Dr. Jennifer Tang, an associate professor of OBGYN at UNC and one of the lead investigators of the ACURE4Moms study. “Black women are now three times more likely to die in childbirth and pregnancy than a white woman, which is unacceptable.”
Tang said the primary goals of the study are to decrease low birthweight deliveries among Black women, decrease experiences with discrimination during prenatal care, and improve community-based social support during pregnancy.
“There’s longstanding, institutional systemic racism in this country that unfortunately creates more barriers to care for a lot of Black patients,” Tang said. “So, our hope was to try to address that kind of institutional, systemic racism by a couple of interventions.”
One study intervention involves data accountability. This means Tang’s team will improve accountability by setting up electronic maternal warning systems, which notify clinics whenever a patient has a risk factor for low birthweight or misses a scheduled appointment.
The study team will also improve transparency by showing clinics their pregnancy-related complication data for different racial groups every three months. Through this “disparities dashboard,” Tang hopes clinics will be encouraged to come up with ways to improve the quality of their care to decrease those differences.
The second study intervention will be to provide community doula support for new and expectant mothers. Tang said these doulas not only help mothers through the pregnancy process, but also serve as advocates for patients while in healthcare settings.
“When we see patients, obviously as providers we want to do the best job, but the truth is we’re only given 15, 20 minutes with each patient,” Tang said.
To bridge that gap, the ACURE4Moms study is teaming up with two community-based doula organizations to provide “culturally relevant care” for high-risk patients after their first prenatal appointment.
Angela Tatum Malloy, a certified doula and the founder of Momma’s Village Fayetteville, will help facilitate the training of the doulas needed for this study.
“We’re going to look to train up to 30 to 40 doulas,” Tatum Malloy said. “And this training will be extensive and full spectrum to include not only birth support, postpartum support, childbirth education – the normal things that you receive in a doula training – but we’re going further in making sure that racial equity and cultural competency is included.”
Tatum Malloy said she has seen firsthand how racial disparities in healthcare affect pregnant and expectant mothers, in both her professional work and personal life.
“Many times, our birthing parents are really in tune with their bodies. They may not have the formal terminology or the medical terms to use to describe what’s going on, but they know something is off because they are their body’s expert,” Tatum Malloy said. “And so they know when something just doesn’t feel right. Oftentimes they’re not heard, or what they’re saying is not valued because they may not know how to express themselves correctly so that the physicians are taking them seriously.”
She said she hopes the study’s dual-intervention approach not only helps address and bring awareness to a systemic issue in healthcare, but also better helps mothers navigate through the system.
“I am optimistic because I do believe that a lot of the challenges and barriers and disparities that our Black mothers face, it comes from a lack of knowledge and connection between our mothers, our birth workers and our providers,” Tatum Malloy said. “And I do believe that this project is the very thing that’s going to connect all three.”
Researchers hope to start recruiting practices into the ACURE4Moms study this fall and begin implementing interventions and collecting data in the summer of 2022.
Lead photo via Johnson & Johnson.
Check out the last issue of “Addressing Taboo Topics” on period poverty here.
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