Advancing Perinatal Health Equity through a Community-engaged Model of Healthcare Services

PROJECT SUMMARY In the US, disparities between non-Hispanic Black and White patients in pregnancy-related outcomes, including perinatal depression symptomology, are stark and pervasive. Depression symptoms, which can result from social stress, including racism-related stress, contribute to racial and ethnic disparities in pregnancy-related outcomes. Interventions that buffer against social stress, including racism-related stress, in perinatal care have potential to reduce racial and ethnic disparities in postpartum depression symptomology. Patient-centered care and social support are key components for addressing racism-related stress in the healthcare setting. However, to our knowledge, there are no interventions for prevention and treatment of postpartum depression symptoms for Black birthing people that are delivered in perinatal care and explicitly promote patient-centered care and provide social supports. The proposed project engages Beloved Birth Black Centering (BBBC) program in generating evidence to improve perinatal care interventions that address racism-related stress using a community-engaged model of perinatal health services created by and for Black birthing people. BBBC incorporates five evidence- based practices (EBPs): racially concordant care, midwifery-led group perinatal visits, doula support, wrap- around care, and culturally aligned black birthing education. Through these bundled EBPs, BBBC promotes patient autonomy, respectful interactions, social connection, and connection to community resources – all of which have the potential to reduce postpartum depression symptoms. We will employ a pragmatic trial using a mixed-methods analytic approach to analyze secondary, longitudinal data from electronic health records (EHRs) and patient surveys. The overall objective of the proposed research is to test a bundled perinatal care intervention on postpartum depression symptomology and explore mechanisms by which postpartum depression symptoms can be prevented and treated among Black birthing people. This research proposal’s overall objective aligns with the NIMHDs’ 2021-2025 strategic goal 3: “Develop and test interventions to reduce health disparities”. Aim 1 will estimate the association of between BBBC and postpartum depression symptoms among Black birthing people and will use propensity score analyses to compare postpartum depression symptoms among patients who received perinatal care through BBBC (treatment group) to those receiving routine perinatal care (comparison group). Aim 2 will assess the extent to which patient autonomy in decision-making and respectful clinician-patient interactions in perinatal care is associated with postpartum depression symptoms among BBBC participants using data from EHRs and patient surveys. Aim 3 will explore how BBBC patient experiences of perinatal care may impact postpartum depression symptoms using data from patient surveys. This work is responsive to the growing evidence showing that racism-related stress impacts health, and will ultimately advance the science of health disparities research.