Purpose Structural racism and systemic failures contribute to disparities in obstetric outcomes for Black birthing people (BBP). Community Based Organizations (CBOs) play an important role in mitigating barriers in access to critical resources for BBP. However, little is known about these organizations’ perspectives on BBP’s reproductive health or their strategies to improve health and wellbeing in their communities. The purpose of this study was to explore CBOs’ perspectives on i)the impact of systemic failures and structural racism on Black birthing people across levels of the Socio-Ecological Model ii) the actions and activities CBOs engage in to mitigate this impact and iii) how, if at all, CBOs might themselves inadvertently uphold structural racism. Methods In-depth interviews were conducted with 14 CBO staff and leadership. Results A thematic analysis of qualitative data found that structural racism and systemic failures impact Black birthing people through prejudice, inequitable care, neighborhood disinvestment, poorly designed programs and housing and food insecurity and a complex and disjointed benefits system at the policy level. Furthermore, CBOs revealed nuanced strategies to promote wellbeing for Black birthing people. Conclusion Findings from this study shed light on perspectives of often-underrepresented constituents in maternal health, can help strengthen capacity building for CBOs and offer important insights for new and emerging CBOs interested in advancing equitable outcomes for Black birthing people.
Background Postpartum health inequities are understudied yet can have profound effects on physical, mental, and social well-being. The majority of pregnancy-related deaths occur in the postpartum period among historically oppressed and racialized groups. The evidence regarding these inequities is impacted by how research conceptualizes and measures them. Methods We conducted a scoping review guided by PRISMA-ScR of 5 databases (MEDLINE®, Embase, CINAHL, Web of Science, and PsychInfo) of U.S. research measuring postpartum maternal outcomes from hospital discharge to one year that compared outcomes across at least 2 groups. The National Institute for Minority Health and Health Disparities (NIMHD) Research and PROGRESS-Plus Frameworks guided data extraction. Result Among 120 studies (113 quantitative, 7 qualitative), 105 (87.5%) identified at least one postpartum health inequity. Sample Characteristics (PROGRESS-Plus): studies reported between 0 and 11 of the 23 PROGRESS-Plus variables, with race, ethnicity, and age most commonly reported. Postpartum outcomes (NIMHD): clustered at the individual level, most in the behavioral and biological domains. Few studies measured outcomes at the community or societal level. Variables explored for association (NIMHD): independent variables concentrated at the individual level, with sociodemographic (e.g. race, ethnicity, age) most frequent. Race and ethnicity were typically operationalized as fixed individual characteristics and rarely referenced as proxies for exposure to racism, bias, or discrimination. Equity-centered practices that shape knowledge construction were uncommon. Only 26 (21.56%) studies included a theoretical/conceptual framework and 2 (both qualitative) included author positionality statements. Conclusion Postpartum health equity research can benefit from expanded use of theoretical frameworks that hypothesize drivers of inequity, examines measurement beyond individual characteristics to capture interpersonal, community and societal exposures, and adopts equity-centered publication practices. This review can inform conceptualization and measurement of postpartum health inequities to interrupt reductionist narratives that may harm historically oppressed and racialized groups and address intersectional axes.
This visual essay integrates art, reproductive health education, and lived experience to explore how visual storytelling can transform perinatal care. Clinical realities and equitable care — attention to a patient’s dignity, autonomy, and wholeness — are too often framed as a binary, as though one must be prioritized and dictate the course of care. My experience as a community-based birth worker, educator, and patient points in another direction: these goals are not oppositional but interdependent. Clinical effectiveness and equity can — and must — coexist, and visual storytelling can help disrupt the false binary between them. The accompanying illustrations and reflections reimagine what equitable care looks like when every parent is seen (and shown) in their full humanity. The figures intentionally reflect a broad spectrum of identities and experiences — including BIPOC families, trans and non-binary parents, larger-bodied people, parents with disabilities, and others often marginalized or misrepresented in perinatal spaces. Each image serves as a counter-narrative to the narrow, pathologizing representations that dominate health education and clinical settings, modeling instead a culture of care grounded in recognition and respect. This work positions visual storytelling as a practical and cultural intervention within perinatal care. The imagery displayed in clinical spaces, the visuals used in education, and the design of patient-facing materials all shape how belonging is understood. By expanding who is depicted, we expand who is imagined as central to care. When patients see themselves reflected with dignity — and providers are surrounded by imagery that normalizes the full range of birthing people — the culture of care itself shifts. Ultimately, this submission argues that art is infrastructural as much as representational: a means to embed equity within the visual, spatial, and cultural fabric of perinatal care. Seeing the whole person is not an aspirational ideal; it is the foundation of safe, just, and human-centered healthcare.
Introduction Our qualitative study aimed to determine the critical components of postpartum care for Black individuals in order to design and implement a reimagined postpartum care model that promotes health and wellness for families experiencing racism in Washington, D.C. (DC). Methods We partnered with Community of Hope, a DC community-based organization, to conduct focus group discussions with Black postpartum individuals and health workers. We used the 5D Cycle for Health Equity to explore Black postpartum individuals’ and health workers’ definitions and measures of harm and health equity (ReDefine), practices to achieve wellness (Discover), and dreams for equitable and anti-oppressive care (Dream) during the postpartum period. Results We conducted eight focus groups - four with Black postpartum individuals (n=23) and four with health workers (n=19). Participants critiqued the 6-week limit to care and lack of time and resources for comprehensive postpartum support. They recalled circumventing inadequate care by seeking material and community support. They dreamed of a holistic, accessible, and attentive care team to address physical and mental health, social support, and material postpartum needs. Discussion and Conclusion We applied the 5D Cycle for Health Equity to a community-engaged participatory research methodology and determined the critical components of postpartum care from the perspective of Black postpartum individuals and health workers. Health Equity Implications By centering the needs, experiences, and expertise of an oppressed group, these study findings suggest reimagining comprehensive care models to enhance quality, holistically address complex postpartum needs, and lay a foundation for just care for all.
Introduction: Widespread inequities in infectious disease outcomes breach the human rights of Indigenous peoples and other marginalized ethnic groups. Appropriate antibiotic prescribing is essential for effective treatment of many infectious diseases and antimicrobial stewardship (AMS); however, there is limited research examining how inappropriate antibiotic prescribing contributes to health inequities. We aimed to develop a conceptual framework to guide measurement of ethnic inequities in appropriate and inappropriate antibiotic prescribing. Methods: Research was grounded in a rights-based, structural determinants approach. Framework development was informed by three critical theories and a scoping review of methods for measuring ethnic inequities in appropriate and inappropriate antibiotic prescribing. Experts in Indigenous health, public health, infectious disease, and AMS provided feedback to refine the framework. Results: This framework illustrates how colonization, racism, and privilege create ethnic inequities in infectious disease outcomes by influencing the distribution of socioeconomic opportunities, design and accessibility of health care services, and the quality of health care delivered. Inappropriate (under- and overprescribing) and appropriate antibiotic prescribing are measures of health care quality and occur within racialized environments influenced by individual and institutional biases. Conclusions: This framework can guide future research and comprehensive measurement of ethnic inequities in appropriate and inappropriate antibiotic prescribing. Embedding an equity approach in AMS efforts requires robust measurement of both under- and overprescribing by ethnicity to optimize infectious disease treatment and AMS. Transformative solutions are required to support culturally safe, equitable antibiotic prescribing and slow the development of antimicrobial resistance.
