Kemet Shakkaura, Yang Yihui, Nseyo Onouwem, Bell Felicha, Gordon Anastasia Yinpa-Ala, Mays Markita, Fowler Melinda, Jackson Andrea
University of California San Francisco School of Medicine, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
Chinatown Public Health Center (a Member of San Francisco Health Network), 1490 Mason St, San Francisco, CA, 94133, USA.
Matern Child Health J. 2022 Apr;26(4):778-787. doi: 10.1007/s10995-021-03226-z. Epub 2021 Sep 14.
Black people give birth joyously despite disproportionate rates of adverse perinatal outcomes. Given that group prenatal care shows promise in mitigating these inequities, we sought to solicit the opinions of Black peripartum women on how group prenatal care could be tailored to fit their specific needs. In this study, we describe attitudes about a proposed Black group prenatal care in a single focus group of 11 Black women who receive maternal health services from Black Infant Health (BIH, a state and federal funded state-wide program for Black pregnant people with the goal to improve infant and maternal health). These data were used to design a race-conscious group prenatal care curriculum specifically for Black women at UCSF.
This study was an analysis of focus group data generated as part of a larger project focused on community involvement in Black maternal health. English speaking pregnant or recently postpartum women age 18 or older who receive services from BIH were recruited to participated in the focus group analyzed in this study. All facilitators of the focus group were Black women in order to facilitate candid conversation about racism in prenatal care.
The need for mental health care was common thread underlying all conversations about prenatal health improvements desired by our focus groups. Participants expressed the centrality of mental health access during our discussion of other themes (e.g.: ease of access, inclusion of partners, special classes for teen moms) by discussing them in terms of their relationship to mental health. Our participants' clear expression of the centrality of mental health care to their prenatal health guided our decision to focus on mental health as a necessary pillar of any group prenatal care intervention designed to mitigate perinatal healthcare disparities in this paper. Three themes related to mental health integration into group prenatal care emerged from thematic analysis of the transcripts. Participants expressed insufficient access and advocacy, and provider distrust.
Evidence exists supporting group prenatal care as a tool for mitigation of perinatal health disparities among Black women. There is also a large body of data describing the disproportionate burden of mental health needs among Black women. The rich data we present here from Black women on their desire for the integration of these two needs fits well into the parallel conversation occurring in the literature. To our knowledge, this is the first study investigating desires of Black women regarding group prenatal care designed specifically for them. They expressed a strong desire for more access to mental health care providers who are racially conscious and aware of white supremacy, and nuanced opinions on the role of racial concordance in health equity.
尽管黑人围产期不良结局发生率较高，但黑人女性仍能快乐分娩。鉴于团体产前护理有望缓解这些不平等现象，我们试图征求黑人围产期女性对如何调整团体产前护理以满足其特定需求的意见。在本研究中，我们描述了在一个由11名从黑人婴儿健康项目（BIH，一项由州和联邦资助的全州性项目，旨在改善黑人孕妇及其婴儿的健康状况）接受孕产妇健康服务的黑人女性组成的焦点小组中，对一项拟议的黑人团体产前护理的态度。这些数据被用于设计一门专门针对加州大学旧金山分校黑人女性的、具有种族意识的团体产前护理课程。
本研究是对作为一个更大项目一部分所产生的焦点小组数据的分析，该项目聚焦于社区参与黑人孕产妇健康。招募了年龄在18岁及以上、说英语、从BIH接受服务的怀孕或产后不久的女性参与本研究中所分析的焦点小组。焦点小组的所有主持人都是黑人女性，以便促进关于产前护理中种族主义的坦诚对话。
对心理健康护理的需求是我们焦点小组关于期望改善产前健康的所有对话的共同主线。在我们讨论其他主题（如：就医便利性、伴侣参与、为青少年妈妈开设的特别课程）时，参与者通过讨论这些主题与心理健康的关系，表达了获得心理健康服务的核心地位。我们的参与者明确表达了心理健康护理对其产前健康的核心地位，这指导我们在本文中将心理健康作为任何旨在缓解围产期医疗保健差异的团体产前护理干预措施的必要支柱。对记录进行主题分析后，出现了与将心理健康纳入团体产前护理相关的三个主题。参与者表示获得服务和维权不足，以及对医疗服务提供者不信任。
有证据支持团体产前护理可作为缓解黑人女性围产期健康差异的一种手段。也有大量数据描述了黑人女性心理健康需求方面不成比例的负担。我们在此呈现的来自黑人女性关于将这两种需求结合起来的愿望的丰富数据，与文献中正在进行的平行讨论非常契合。据我们所知，这是第一项调查黑人女性对专门为她们设计的团体产前护理的愿望的研究。她们表达了强烈的愿望，希望能更多地接触到具有种族意识且意识到白人至上主义的心理健康护理提供者，并对种族一致性在健康公平中的作用提出了细致入微的看法。
