Identifying and Understanding the Social and Policy Determinants of Obstetric-Care, Maternal Mortality, and Morbidity

University Of Houston, Houston TX

Investigators

Abstract

Maternal mortality (defined as death during pregnancy or within 1 year of giving birth) and maternal morbidity (any health condition linked to pregnancy or birth that causes negative consequences) occur at alarming rates in the United States. In fact, the U.S. has the highest rates of maternal mortality and morbidity of all industrialized countries. Black, Indigenous, and People of Color (BIPOC) who give birth in the U.S. die nearly three times as often as White women. Research also shows vast, nationwide racial disparities in the access to and use of care by these groups. The research on this topic generally is done in many disconnected fields of study, which delays progress toward solutions. This project addresses limitations in past research by using an innovative, multi-disciplinary, comprehensive approach to understanding how individual factors like socioeconomic status, community-level factors like racism, and health behavior factors like substance use and obesity can interact to increase the risk of complications during pregnancy and birth. By using a nationally representative data set, researchers identify how inequality factors can predict the risk of negative maternal health outcomes and care use. Using the findings from a vast dataset assists in shaping the interviews with 100 mothers. The mothers interviewed have lived experience and a variety of risk factors found in the dataset. The high rates of maternal mortality and morbidity in a nation that spends over $4 trillion on healthcare are problematic and require both a statistical and a lived-experience approach to develop solutions for providers, families, and policymakers. This project uses a mixed methods approach to analyze maternal health outcomes across the U.S. First, researchers conduct a statistical analysis of maternal mortality using data from the National Center for Health Statistics (NCHS), and of maternal morbidity and obstetric risk using data from the Pregnancy Risk Assessment Monitoring System (PRAMS). Those findings can assist in informing participant interviews with 100 women from a Texas, which has the country’s highest uninsured rates and a complicated history with Medicaid expansion. These contextual factors and the state’s extensive racial and ethnic diversity make it a natural laboratory for research into the maternal experiences of pregnancy and health. Interviews focus on eliciting the experiences and behaviors of people who give birth in order to understand their access to and utilization of health-promoting resources and their exposure to social, environmental, and economic risk factors prior to and after the prenatal period. These interviews provide information on how health risks are internalized and relate to pregnant and postpartum people's perceptions of their health status, as well as about their health behavior and medical care utilization. Likewise, interviews investigate trust in the care system, as there are stories of women not coming to obstetric care or to the hospital due to distrust. The mixed-method approach provides a more comprehensive understanding of maternal risks and how people who give birth make sense of, experience, and try to manage those risks. Much of the existing quantitative research in this area examines policies and solutions, without understanding how people who give birth make sense of their risks and how people may or may not mitigate the impact of policy. The research team utilizes a broader understanding of maternal risk to track how these factors affect maternal health during pregnancy and delivery and up to a year after birth. This interdisciplinary research team comes from diverse scientific backgrounds with direct contact with community organizations, enabling them to bring this research to the public to produce actionable change on these issues. This project has potential to help improve maternal health policy and practice. This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.