Abstract
Background:
Racial inequities in perinatal care outcomes in the U.S., including maternal morbidity and mortality, are exacerbated by systemic and institutional racism. The “Family & Pregnancy Pop-Up Village” (PV) is a community-institutional collaboration that provides a one-stop-shop for clinical, city and wraparound services at a convenient time and location in an uplifting environment for Black, Indigenous, and pregnant people of color (BIPOC) and their families. This study aims to examine the acceptability and accessibility of PV for pregnant people and their families.
Methods:
We used a convergent mixed-methods design. Survey data were obtained from 116 PV participants (n=58 pregnant/postpartum recipients; n=58 family recipients) followed by semi-structured in-depth interviews with 13 pregnant and postpartum people and 5 family members between July 2021 and June 2022. Surveys and interviews were conducted in English or Spanish. Surveys were self-administered and data entered directly by respondents in REDCap. Interviews conducted by a team member were audio-recorded and transcribed. Acceptability was assessed using the Theoretical Framework of Acceptability domains. We conducted descriptive, bivariate, and multivariate analyses of the quantitative data and framework analysis of the qualitative data.
Results:
The average acceptability score for the full quantitative sample was 91.9 (SD = 14.4) out of 100. Controlling for other factors, respondents who reported experiencing some discrimination during prenatal care encounters had significantly lower acceptability scores than those who reported never experiencing discrimination. From the qualitative data, most respondents held positive attitudes toward PV, citing its welcoming, supportive, and vibrant atmosphere. The mean accessibility score was 76.0 (SD = 21.0) out of 100. The burden of participation was mixed, with some respondents noting the difficulty in timely access to services at PV and making recommendations for reducing this burden. Respondents had high perceived efficacy of PV in being linked to services, attributed to providers’ effective communication with respondents.
Conclusions:
BIPOC pregnant people and their families found the PV model as an acceptable and accessible option for receiving perinatal care services. Continued community-institutional co-creation of this model will ensure integration of community priorities and long-term sustainability.
Journals:
NPJ Women’s Health
BMC Women’s Health
Introduction
The U.S. has the highest maternal mortality rate among high income countries, with stark inequities in critical perinatal outcomes including severe maternal morbidity, preterm birth, and infant death (1). Black women are about three times more likely than White women to die from pregnancy-related complications and their infants twice as likely to die before the age of one (2,3) Even in states like California, where maternal mortality rates have been on the decline and are lower than the national average, these disparities persist (4).
The factors driving inequities in maternal and neonatal health are complex, but there is clear evidence that a key driver is racism, which manifests as inequities in access to and experience of care (6,11,12). For instance, Black people and other racial and ethnic minority groups are more likely to live on low incomes and face barriers to receiving high quality care (3,6). Even if public insurance, such as Medicaid, bridges the financial gap, barriers such as lack of transportation, childcare and other factors create difficulty with accessing care. Several studies also highlight discrimination and lack of person-centered care (i.e. care that is responsive to and respectful of individual’s needs, preferences, and values) (13) experienced by Black women and birthing people during care encounters, including disrespect, not being listened to, and not being believed when reporting concerns, which reflect interpersonally mediated racism (12,14,15). These experiences affect receipt of timely care even where geographic access is not a barrier (5,16). Inequitable experiences in accessing and receiving healthcare compound the pervasive stress of everyday discrimination, reducing the health and wellbeing of Black people. Thus, to improve birth outcomes, interventions that address equitable access to care and eliminate experiences of racism and discrimination in care settings are needed.
Members of our team embarked on a one year Human-Centered Design (HCD) process in 2017 to better understand and inform intervention development around the experiences of San Francisco (SF) residents who face the most severe inequities in pregnancy care and outcomes: individuals insured by Medicaid and particularly those who identify as Black (17). Despite being a progressive city with many equity-focused pregnancy care programs, participants described excessive practical barriers to care and rampant experiences of interpersonal racism, ranging from overt to more subtle discrimination (such as not making eye contact, leaving someone waiting while attending to others, etc.). Referrals between agencies were also a source of stress because services were fragmented and disconnected. Our results confirmed extensive evidence demonstrating that current U.S. care delivery structures, built within a culture of white supremacy, have resulted in care that is difficult to access (18–20), does not meet the stated needs of individuals, and does not support autonomy and dignity of Black pregnant people (11,19,21–24). This informed the development of the Family & Pregnancy Pop-Up Village (PV): a one-stop-shop for comprehensive services (clinical, city/government, and wraparound) based on the stated needs of community, in a safe, healing, and empowering environment, with a focus on improving the comprehensive health and wellness of individuals, families and communities. Key components of the model include co-locating multiple organizations to provide easier “one-stop-shop” access to comprehensive services organized within five distinct areas (Health & Wellness; Food & Agriculture; Youth Zone; Local Economy; and Arts & Culture); using anti-racism principles in all aspects of model design and service delivery; and leveraging community-institutional partnership to ensure an effective and sustainable model (Figure 2). In addition, creating an environment that felt safe and uplifting was a priority, given our findings that women of color in particular feel that their pregnancies are often pathologized rather than being celebrated.
PV was launched, through a collaborative institutional-community partnership process, in San Francisco’s Bayview district in July 2021. PV events have been held monthly since the July 2021 launch through the writing of this paper, apart from annual scheduled breaks for strategic planning and two cancelled events due to safety concerns (large Covid exposure in August 2021 and unsafe weather conditions March 2023).
