Prenatal Care Delivery for Black Women Needs Improvement

Prenatal care delivery is lacking for low-income Black pregnant women, according to a recent study published in JAMA Network Open.

“Black pregnant people with low income face inequities in health care access and outcomes in the US, yet their voices have been largely absent from redesigning prenatal care,” the study researchers stated.

In this qualitative study, the investigators surveyed 19 Black patients (average age, 28; 100% female; 89.5% with public insurance) and 19 health care workers (HCWs), including physicians, doulas, and social workers (average age, 48; 88.2% female; 76.5% Black) in Detroit, Michigan, between October 14, 2019, and February 7, 2020. The survey questions focused on 2 human-centered phases, observation (understanding patient problems) and ideation (generating novel solutions). The researchers used the questions to assess participants’ experiences with 3 aspects of prenatal care: medical care, anticipatory guidance, and social support. The main outcome of interest was defined as preferences for prenatal care redesign.

According to the findings, participants reported failures and potential solutions for each area of prenatal care delivery. The study subjects reported that, ideally, care structure would enable robust 2-way relationships between patients and practitioners. In this ideal care scenario, practitioners would coordinate all prenatal services, not just medical care. Overall, participants wished for care to be tailored to individuals using care navigators, flexible models, and various services to reduce barriers.

“In this qualitative study of low-income Black pregnant people in Detroit, Michigan, and the HCWs who care for them, prenatal care delivery failed to meet the goals and preferences of marginalized populations,” the researchers concluded. They added that future research “is needed to translate the ideal prenatal care model described by participants into reality.”