
Evidence Tools
Perinatal Care Discrimination
Introduction
This toolkit summarizes content from the Perinatal Care Discrimination Evidence Accelerator and the MCHbest database. The peer-reviewed literature supporting this work can be found in the Established Evidence database. Use the resources below as you develop effective evidence-based/informed programs and measures.
From the MCH Block Grant Guidance. Significant disparities exist in maternal health outcomes especially for some racial and ethnic minority populations in the United States. Black and American Indian/Alaska Native people have pregnancy- related mortality rates that are 2-3 times higher than for White people.1 These health disparities have persisted over time and are attributable to a combination of factors, including patient, community, health care provider, and systems factors. Racism is a key driver of racial and ethnic inequities that adversely impacts a population’s mental and physical health.2 In particular, discrimination, a domain of racism, has been found to beassociated with poor mental health, adverse physical health outcomes (e.g., hypertension, obesity, cardiovascular disease), and other poor health behaviors and outcomes.3 As a key risk factor for maternal mortality and morbidity, it is important to understand the experiences of racial discrimination, particularly in healthcare settings where pregnant and postpartum people seek care, to more effectively address its impact on maternal health outcomes.
Goal. To reduce the percent of women who experience racial/ethnic discrimination while getting healthcare during pregnancy, delivery, or postpartum.
Note. Access other related measures in this Population Domain through the Toolkits page.
Detail Sheet: Start with the MCH Block Grant Guidance
DEFINITION
Numerator:
Number of women who reported experiencing discrimination or were prevented from doing something, hassled, or made to feel inferior while getting healthcare during their pregnancy, at delivery, or at postpartum care because of their race, ethnicity or skin color.
Denominator:
Number of women with a recent live birth
Units: 100
Text: Percent
HEALTHY PEOPLE 2030 OBJECTIVE
DATA SOURCES
Pregnancy Risk Assessment Monitoring System (PRAMS)
MCH POPULATION DOMAIN
Women/Maternal Health or Perinatal/Infant Health
MEASURE DOMAIN
Social Determinants of Health
1. Accelerate with Evidence—Start with the Science
The first step to accelerate effective, evidence-based/informed programs is ensuring that the strategies we implement are meaningful and have high potential to affect desired change. Read more about using evidence-based/informed programs and then use this section to find strategies that you can adopt or adapt for your needs.
Evidence-based/Informed Strategies: MCHbest Database
The following strategies have emerged from studies in the scientific literature as being effective in advancing the measure. Use the links below to read more about each strategy or access the MCHbest database to find additional strategies.
Evidence-Informed |
Evidence-Based |
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Mixed Evidence |
Emerging Evidence |
Expert Opinion |
Moderate Evidence |
Scientifically Rigorous |
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Field-Based Strategies: Find promising programs from AMCHP’s Innovation Hub
Cutting Edge:
- 12-Month Perinatal Wellness Training Program (OK; 2022)
- Improve Care and Reduce Childbirth-Related Disparities Tool (NJ; 2022)
- Labor Support and Comprehensive Childbirth Education (MS; 2023)
- Maternal Mortality Prevention Program (CO; 2020)
- Perinatal Health Support System (DC; 2020)
Emerging:
- Culturally Integrated Interventions for Health (UT; 2023)
- Quality Improvement Provider Training (CA; 2023)
- Reproductive Health Education (SC; 2023)
- Train-the-Trainer on Leading Causes of Infant Death (AR; 2017)
Promising:
- Community Education and Engagement Series (UT; 2018)
- Health Education, Case Management, and Patient Navigation (NY; 2019)
- Culturally Relevant and Accessible Midwifery-Based Model (FL; 2020)
- Promote The Resilience and Empowerment of Women of Color to Advance Health and Wellness (MA; 2015)
Best:
- Community-Based Doula Program (National; 2015)
2. Think Upstream with Planning Tools—Lead with the Need
The second step in developing effective, evidence-based/informed programs challenges us to plan upstream to ensure that our work addresses issues early and is measurable in “turning the curve” on big issues that face MCH populations. Read more about moving from root causes to responsive programs and then use this section to align your work with the data and needs of your populations.
Move from Need to Strategy
Use Root-Cause Analysis (RCA) and Results-Based Accountability (RBA) tools to build upon the science to determine how to address needs.
Planning Tools: Use these tools to move from data to action
3. Work Together with Implementation Tools—Move from Planning to Practice
The third step in developing effective, evidence-based/informed programs calls us to work together to ensure that programs are implementable and moveable within the realities of Title V programs and lead to improved health outcomes for all people. Read more about implementation tools designed for MCH population change and then use this section to develop responsive strategies to bring about change that is responsive to the needs of your populations.
Additional MCH Evidence Center Resources: Access supplemental materials from the literature
- Find field-based resources focused on reducing perinatal care discrimination relevant to Title V programs in the MCH Digital Library.
- Search the Established Evidence database for peer-reviewed research articles related to strategies for reducing perinatal care discrimination.
- Request Technical Assistance from the MCH Evidence Center
- MCH Evidence Center Frameworks and Toolkits:
Implementation Resources: Use these field-generated resources to affect change
PRACTICE. The following tools can be used to translate evidence to action to advance this NPM:
- Black Maternal Health Toolkit (Network of the National Library of Medicine). This resource provides quick actionable information for Black women from prenatal through postpartum.
- Tools to Measure Respectful Maternity Care (The Birth Place Lab). This portal contains various instruments to improve the evaluation of maternity care.
PARTNERSHIP. The following organizations focus efforts to decrease perinatal care discrimination:
- National Partnership for Women and Families. Aims to improve the lives of women and families by achieving equality for all women.
- Black Mamas Matter Alliance. A national network striving to advance black maternal health and rights.
References
Introductory References: From the MCH Block Grant Guidance
1 Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System. 22 June 2022. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm (
2 Centers for Disease Control and Prevention. Racism and health. 24 November 2021. https://www.cdc.gov/minorityhealth/racism-disparities/index.html
3 Williams DR, Lawrence JA, Davis BA. Racism and Health: Evidence and Needed Research. Annu Rev Public Health. 2019;40:105-125. doi:10.1146/annurev-publhealth-040218-043750 https://www.annualreviews.org/doi/10.1146/annurev-publhealth-040218-043750