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Community Support Counters Racism Affecting Maternal Health Experience

A community support person during a childbirth hospitalization can reduce the racism that oftentimes taints many Black maternal health experiences, according to a recent study.

Involving community support persons in the birthing experience can counter obstetric racism impacting the maternal health experience for Black mothers. This approach contributes to safer hospital environments and effectively addresses implicit bias, according to recent research published in the Annals of Family Medicine.

Black mothers and other birthing people are disproportionately affected by hospital-based obstetric outcome inequities. Researchers mentioned that despite continuous advancements in medical care, stark racial disparities in maternal and infant health have persisted for decades in the country.

Obstetric racism is a key factor behind health inequities in pregnancy and postpartum, which persist across social protections such as being married, having a high income, and being better educated.

The role of community health workers has gained momentum in addressing persistent racial inequalities.  Researchers investigated whether having community support persons (CSPs), such as midwives, doulas, partners, parents, and siblings, present during hospital birth care could alleviate obstetric racism.

In the study, 37 Black cisgender women with prior hospital births participated in in-person focus groups. Subsequently, 806 participants from 34 states and Washington DC completed an online survey about their birth experiences. Of those, 89 percent reported having at least one community support person (CSP) present during labor, birth, and postpartum care.

Additionally, researchers utilized the PREM-OB Scale to evaluate three domains of obstetric racism: humanity, kinship, and anti-Black racism or "misogynoir." These domains refer to a range of experiences, including violations of safety and accountability, disruption of community and familial bonds, and the use of societal stereotypes to perpetuate gendered anti-Black racism in hospital care.

Based on the PREM-OB Scale suite, the absence of a CSP during childbirth hospitalization was linked to less empathetic treatment, poor communication, and more violations of bodily autonomy for Black birthing individuals. Scores for all three domains of obstetric racism were higher in this group with a CSP, and the presence of a community support person led to a greater reduction in kinship disruption.

"The results of our study emphasize the need for democratizing birth spaces in a way that expands our understanding, recognition, and use of expertise and support," the study authors wrote. "Radical democratization of birth spaces through the prioritization of given or chosen kin as CSPs, compared with use of doulas and perinatal support workers who require compensation, addresses structural barriers and burdens to achieving emotional and sociocultural safety such as costs, access to community birth professionals, and hospital policies that limit the type and/or number of visitors allowed during childbirth hospitalization."

Researchers highlighted the importance of collaboration between the health sector and community members to improve the safety of Black birthing people in hospitals. They suggested investing in community-focused solutions, such as community health workers, perinatal support workers, and doulas, and ensuring equitable compensation for these evidence-based interventions.

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