The Cycle to Respectful Care: A Qualitative Approach to the Creation of an Actionable Framework to Address Maternal Outcome Disparities.

Carmen L Green,S Michelle Ogunwole,Tamika C Auguste,Joia A Crear-Perry,Tracey Estriplet,Susan L Perez,Ashlee Walker

doi:10.3390/ijerph18094933

Abstract

Despite persistent disparities in maternity care outcomes, there are limited resources to guide clinical practice and clinician behavior to dismantle biased practices and beliefs, structural and institutional racism, and the policies that perpetuate racism. Focus groups and interviews were held in communities in the United States identified as having higher density of Black births. Focus group and interview themes and codes illuminated Black birthing individual’s experience with labor and delivery in the hospital setting. Using an iterative process to refine and incorporate qualitative themes, we created a framework in close collaboration with birth equity stakeholders. This is an actionable, cyclical framework for training on anti-racist maternity care. The Cycle to Respectful Care acknowledges the development and perpetuation of biased healthcare delivery, while providing a solution for dismantling healthcare providers’ socialization that results in biased and discriminatory care. The Cycle to Respectful Care is an actionable tool to liberate patients, by way of their healthcare providers, from biased practices and beliefs, structural and institutional racism, and the policies that perpetuate racism.

Highlights

Introduction published maps and institutional affilBlack birthing people and babies are consistently the most impacted by adverse health outcomes in the United States, and growing literature suggests that experiences of racism and disrespect during healthcare encounters impacts health [1]
Qualitative findings illuminated the hospital birthing experiences of Black birthing people to inform an actionable framework for healthcare providers and birth workers to address persistent and widening disparities in maternal health outcomes
An iterative process to identifying a framework that appropriately contextualizes the themes and codes of the qualitative findings resulted in the Cycle to Respectful Care—an actionable framework to address biased and disrespectful care

Summary

Introduction

Black birthing people and babies are consistently the most impacted by adverse health outcomes in the United States, and growing literature suggests that experiences of racism and disrespect during healthcare encounters impacts health [1]. Women of color (i.e., Black, Latina, and Asian women) are more likely to experience a comorbid illness [2] and maternal death [3] and report being unfairly treated within healthcare settings based on their race or ethnicity [4,5]. In addition to increasing trends in maternal mortality overall, perhaps more distressing is the persistent, large, and increasing mortality gaps between Non-Hispanic (NH) Black and all other birthing persons in the United States [3,6]. Healthcare provider factors- delayed response to clinical warning signs, followed by ineffective care- were the most common type of contributor to iations.

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Conclusion