Tapping Community Partners to Codesign Black Maternal Care
Black women in the U.S. experience maternal mortality rates at nearly three times that of white women, regardless of income or education level. This longstanding and stark disparity is multifaceted, stemming from systemic racism, societal factors and health care inequities.
By codesigning care with community partners, hospitals can proactively and collaboratively work toward improving Black maternal health outcomes. This strategy enables health care organizations to create more inclusive, responsive and effective maternal health initiatives that address the unique challenges Black women encounter during pregnancy and childbirth.
For the 2024 Black Maternal Health Week (April 11-17), the AHA convened health care leaders from across the country to share their strategies for improving Black maternal health outcomes.
Here are six key takeaways from that robust conversation.
Know Your Community. Community-based organizations have deep roots within the communities they serve. Their deep community knowledge is an invaluable asset in ensuring hospitals and health systems offer a coordinated and comprehensive continuum of care and support for Black women throughout preconception, pregnancy and postpartum.
Summa Health in Akron, Ohio, says that when it was implementing the CenteringPregnancy model, their team recognized the need to partner with community-based organizations to offer more targeted care to address the unique needs of Black women, and those in living in low-socioeconomic conditions. Together with Summa Health Medical Group, Project Ujima and Minority Behavioral Health Group, Summa Health’s modified CenteringPregnancy program offers women two-hour long, weekly services and resources with a consistent care team, such as consultations with a Black OB/GYN, certified community health workers, breastfeeding support, mental health counseling and social services. As a result, Summa Health saw an increase in breastfeeding rates and postpartum visits, and a decrease in preterm deliveries and infant mortality.
“These outcomes speak to the power of bringing Black women and communities together,” pointed out Cheryl Johnson, M.D., FACOG, clerkship director, obstetrics and gynecology for Summa Health System-Akron City Hospital.
Increase Provider Diversity and Representation. By increasing diversity and representation among health care providers to better reflect the racial and ethnic diversity of patient populations, health care organization help foster trust and rapport between providers and patients.
“Our biggest partners are doulas and birth advocates who educate women about health care terms and lingo, and make them aware of wraparound services,” shared, Cedars-Sinai’s Kim Gregory, M.D., who is director of maternal-fetal medicine and vice chair of women's healthcare quality and performance improvement in the department of obstetrics and gynecology. This supplemental support, she said, allows patients to feel seen and heard.
Use Data to Guide Quality Improvement. Stratifying maternal health outcomes data by race, ethnicity and socioeconomic factors help identify gaps in care, tailor interventions and measure progress accordingly. For example, Memorial Healthcare System in South Florida implemented teal bracelets for patients with high-risk of preeclampsia and other hypertensive disorders to wear during their pregnancy and postpartum visits. This cost-effective strategy served as a visible marker for health care providers and first responders to identify and treat these high-risk patients in a timely manner.
“We extended education and resources of the program to our community partners such as fire stations, emergency medical services and other hospitals in the health care system to raise awareness and increase our capacity to provide care,” shared Todra Anderson-Rhodes, M.D., chief medical officer and perinatal patient safety lead at Memorial Healthcare System-Memorial Hospital Miramar.
Cedars-Sinai, on the other hand, discovered through stratifying its data a disparity in the use of low-dose aspirin among Black pregnant women to prevent or decrease the incidence of preeclampsia. The health system partnered with March of Dimes and other community partners to educate both patients and pharmacies about the benefits of low-dose aspirin. Cedars-Sinai integrated prompts in its EMR system to identify at-risk patients as potential candidate for aspirin. This collaborative strategy increased the use of a low-dose aspirin among Black pregnant patients from 25% to 80%.
Involve Pregnant People in Shared Decision-making. Black women who were involved in shared decision-making about their maternal care were empowered to become active advocates of their own care, said Dr. Gregory.
“We must listen and listen well,” she emphasized, which allows a pathway for building a trusting provider-patient relationship and potentially reducing the fear and anxiety Black pregnant women may feel.
Integrate Culturally Appropriate Care. Ongoing training and education on culturally appropriate care helps health care professionals better understand and meet the diverse needs of their patients.
“Health care providers and their community-based partners have to be humble, recognize each other’s expertise, work alongside each other and hold each other accountable,” explained Dr. Anderson-Rhodes.
Invest in Interdisciplinary Care Teams. Community health workers and doulas are uniquely positioned to provide personalized care and serve as bridges between clinicians and patients. Their reach can expand from home visits to telehealth consultations and other wraparound services, such as identifying and supporting barriers to care like transportation, food and housing. It is imperative to advocate for establishing funding streams for such positions, which offer competitive wages to community health workers and doulas.
Additionally, investing in the education and training of midwives and nurse practitioners can increase the pool of qualified health care professionals who are equipped to provide culturally appropriate, comprehensive prenatal care to women in both urban and underserved communities.
By having a finger on the pulse of the community and making room and amplifying their voices, codesigning care offers a promising approach to improving Black maternal health outcomes and move us closer to achieving maternal health equity. Let us unite to create a future where every Black mother receives the quality care and support she and her child deserves.
Watch AHA’s event, Codesigning Care to Improve Black Maternal Health Outcomes, and visit AHA’s Better Health for Mothers and Babies page to access more resources on maternal health equity.
Aisha Syeda, MPH, is a senior program manager for AHA’s strategic initiatives.