Center for Maternal Health Equity, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 30310, Atlanta, GA, USA.
Black Mamas Matter Alliance, Atlanta, GA, USA.
BMC Public Health. 2023 Mar 30;23(1):596. doi: 10.1186/s12889-023-15395-3.
Pregnancy-related mortality in the United States is the greatest among all high-income countries, and Georgia has one of the highest maternal mortality rates-almost twice the national rate. Furthermore, inequities exist in rates of pregnancy-related deaths. In Georgia, non-Hispanic Black women are nearly 3 times more likely to die from pregnancy-related complications than non-Hispanic White women. Unlike health equity, a clear definition of maternal health equity is lacking, overall and in Georgia specifically, but is needed to reach consensus and align stakeholders for action. Therefore, we used a modified Delphi method to define maternal health equity in Georgia and to determine research priorities based on gaps in understanding of maternal health in Georgia.
Thirteen expert members of the Georgia Maternal Health Research for Action Steering Committee (GMHRA-SC) participated in an iterative, consensus-driven, modified Delphi study comprised of 3 rounds of anonymous surveys. In round 1 (web-based survey), experts generated open-ended concepts of maternal health equity and listed research priorities. In rounds 2 (web-based meeting) and 3 (web-based survey), the definition and research priorities suggested during round 1 were categorized into concepts for ranking based on relevance, importance, and feasibility. Final concepts were subjected to a conventional content analysis to identify general themes.
The consensus definition of maternal health equity created after undergoing the Delphi method is: maternal health equity is the ultimate goal and ongoing process of ensuring optimal perinatal experiences and outcomes for everyone as the result of practices and policies free of interpersonal or structural bias that tackle current and historical injustices, including social, structural, and political determinants of health impacting the perinatal period and life course. This definition highlights addressing the current and historical injustices manifested in the social determinants of health, and the structural and political structures that impact the perinatal experience.
The maternal health equity definition and identified research priorities will guide the GMHRA-SC and the broader maternal health community for research, practice, and advocacy in Georgia.
美国的妊娠相关死亡率在所有高收入国家中最高，而佐治亚州的孕产妇死亡率居全国前列，几乎是全国平均水平的两倍。此外，妊娠相关死亡的发生率存在不平等现象。在佐治亚州，非西班牙裔黑人女性死于妊娠相关并发症的可能性几乎是西班牙裔白人女性的 3 倍。与卫生公平不同，孕产妇健康公平的定义并不明确，无论是整体上还是在佐治亚州具体情况下，都需要达成共识并协调利益相关者采取行动。因此，我们使用改良德尔菲法来定义佐治亚州的孕产妇健康公平，并根据佐治亚州对孕产妇健康的理解差距确定研究重点。
佐治亚州孕产妇健康研究与行动指导委员会（GMHRA-SC）的 13 名专家成员参与了一项迭代、共识驱动的改良德尔菲研究，该研究由 3 轮匿名调查组成。在第 1 轮（基于网络的调查）中，专家们提出了孕产妇健康公平的开放式概念，并列出了研究重点。在第 2 轮（基于网络的会议）和第 3 轮（基于网络的调查）中，第 1 轮提出的定义和研究重点根据相关性、重要性和可行性被归类为排名概念。最终概念经过常规内容分析，以确定一般主题。
经过德尔菲法处理后创建的孕产妇健康公平共识定义为：孕产妇健康公平是确保每个人都能获得最佳围产期体验和结果的最终目标和持续过程，这是通过实践和政策实现的，这些实践和政策没有人际或结构性偏见，解决当前和历史上的不公正现象，包括影响围产期和生命过程的健康的社会、结构和政治决定因素。这一定义强调了解决当前和历史上在健康社会决定因素中表现出来的不公正现象，以及影响围产期体验的结构和政治结构。
孕产妇健康公平定义和确定的研究重点将指导 GMHRA-SC 和更广泛的孕产妇健康社区在佐治亚州开展研究、实践和宣传工作。
