Reducing Racial Disparities in SMM post COVID19: Assessing the integration of maternal safety bundles and community based doulas to improve outcomes for Black women

PI & Project Leader: Dr. Amutah-Onukagha, PhD

Project period: 5 years​

Funding Source: National Institutes of Health Minority Health Disparities
Objective: Our study will lead to a more systematic understanding of pregnancy outcomes for Black women establishing a foundation for development and testing of future interventions to improve maternal outcomes. ​

Project Summary: Black women experience stark disparities in pregnancy care, complications, and outcomes, compared to White women. Recognizing, tracking and understanding patterns of severe maternal mortality (SMM) and associated inequities by race/ethnicity, along with developing and carrying out interventions to improve the quality of maternal care, are essential to reducing SMM and thereby maternal mortality. To date, there has been little research specifically aimed at understanding whether the maternal health inequities as experienced by Black women can be ameliorated through an integrated care model that includes engagement of mothers of color in the planning and implementation of maternal safety bundles in addition to prenatal, birth and postpartum support from community doulas. We intend to use the Health Impact Pyramid to develop, implement and assess the effectiveness of such a system in reducing disparities in SMM and mortality. The data sources for this study will include state-level and hospital-specific discharge data collected as part of the Alliance for Innovation on Maternal Health (AIM) project; the Maternal Mortality Review Committee (MMRC); and the Pregnancy to Early Life Longitudinal (PELL) data system, which focuses on population-level data needed to examine health inequities among racial and ethnic minorities in Massachusetts. In addition to these existing data sources, we intend to establish a data collection tool to assess doula services as well as analyze qualitative data from interviews with black women, and focus groups with providers and doulas to explore the effect of incorporating doula-provided services into prenatal, birth and postpartum care. This proposal has three main study areas that will lead to a systematic understanding of ways to address and prevent SMM among black women and thus, establish a foundation for the development, testing and scale-up of future interventions to improve maternal health outcomes: 1) Use longitudinally linked hospital discharge data from PELL (2008-2018) to characterize preconception, prenatal and postpartum hospital encounters among women with SMM in order to identify key points where opportunities to intervene were missed. 2): Among hospitals that serve black women, to assess the impact of implementing maternal safety bundles to ensure that black women are receiving quality obstetric care 3): Examine how systems integrating community-based doula support could decrease the inequities of SMM among black and white mothers. Our study will lead to a more systematic understanding of pregnancy outcomes for Black women at highest risk of SMM, thus establishing a foundation for development and testing of future interventions to improve maternal outcomes.

Link to Project

Promoting Maternal Health Equity through Collaborative Community Partnerships: Teaming doulas, providers and families to create birth equity

PI & Project Leader: Dr. Amutah-Onukagha, PhD

Project period: 3 years​

Funding Source: Robert Wood Johnson Foundation

Project Period: 3 years 

Project Summary: In 2020, the CDC reported a national maternal mortality rate of 17.4 per 100,000 live births; Black women have rates three times higher than other racial groups. Many of the leading causes for maternal deaths (and morbidity) are preventable. The maternal morbidity and mortality rates and associated disparities, as experienced disproportionately by Black women, is a human rights crisis in America. Our primary research question is: How has the growing awareness of the maternal crisis influenced women of color’s perceptions of their risk, maternity care choices, and patient empowerment? We seek to understand this through a mixed methods approach consisting of both qualitative and quantitative methods including: interviews, focus groups and hospital discharge data among Black women of reproductive age, their male partners/fathers, doulas and delivering clinicians to assess: (1) the perceptions of the maternal morbidity and mortality statistics and disparities from both the patient and providers perspective and (2) the perceptions of strategies to address this crisis to provide opportunities to assist Black moms in moving from awareness of this data to empowerment during the pregnancy, delivery and postpartum periods. Science and medicine are just beginning to investigate the social determinants of maternal health and morbidity and how they intersect across disciplines. Thus, there is an urgent need to better understand and define them. With few studies that report the insights of Black women specifically; there is much to learn.

Recent policy enacted to address the disparity such as implicit bias training and cultural competency training do not account for the opinions of Black women and the community of providers working to save lives and implement the right solutions to this problem. We believe the right solution will include anti-racism work in maternity care to overcome systemic bias. We are curious to learn what Black women, fathers, doulas and providers can contribute to the conversation on birth equity and maternal health disparities.

​Link to Project

Stopping the Spread of HIV/AIDS through Research and Engagement:
The Share Study

PI & Project Leader: Dr. Amutah-Onukagha, PhD

Project Summary: The proposed study focuses on communication between HIV+ mothers and their daughters on issues such as perceptions of HIV risk, HIV/AIDS knowledge, and their attitudes and beliefs; the impact of intergenerational trauma and an adolescents’ HIV risk; and the knowledge, beliefs, and attitudes regarding use of PrEP in adolescents to reduce HIV incidence. HIV/AIDS is experienced disproportionately among African American women. Women of color worldwide are affected by HIV/AIDS at rates far higher than any other race.  In the last decade, the incidence of HIV/AIDS in these communities saw little decline and in 2016, African American women accounted for 4,560 (61%) of the estimated new HIV infections among all women (CDC, 2018). This is an alarming statistic as African American women over the ages of 18 make up only 13% of the female population, yet account for the majority of new HIV/AIDS cases. This statistic demonstrates the need to develop programs focusing on African women and their daughters. 

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