Toward a Better Birth for All Women: Introducing a Blog Series

Katy B. Kozhimannil, PHD, MPA, is an associate professor in the Division of Health Policy and Management at the University of Minnesota School of Public Health and Director of Research at the University of Minnesota Rural Health Research Center. Her research applies health policy and health services research to the field of women’s health, with a focus on maternal and child health. Dr Kozhimannil conducts research to inform the development, implementation, and evaluation of health policy that impacts reproductive-age women and their families. Twitter @katybkoz. E-mail kbk@umn.edu
This series of blogs will illuminate aspects of racial equity in childbirth and highlight promising practices to ensure access to a safe, empowering, healthy, and positive birth for all people.
In Minnesota and across the nation, African American and American Indian babies are more than twice as likely as white babies to die before reaching their first birthday. While average rates of infant mortality have declined over the past century, this disparity has not budged. What can be done?
 
My colleagues Rachel Hardeman and Rebecca Polston and I are engaged in a unique collaborative project to address that question, as part of the Robert Wood Johnson Foundation’s Interdisciplinary Research Leaders Program. Our project focuses on dismantling disparities and improving childbirth for women in our community, and using that to inform broader efforts to achieve a “culture of health”. This is the first monthly blog in a year-long series that will highlight issues relevant to our project. 
 
Like many others, we have grown weary of studies documenting racial disparities in healthcare generally, and birth outcomes specifically. It’s time to document solutions and to provide managed care organizations, healthcare administrators, employers, policymakers, clinicians, and families themselves with information that empowers them to participate, not only in the erasure of disparities but also to the improvement of safety, quality, and dignity in the childbirth experience for all families. 
 
While Rachel, Rebecca, and I come from different backgrounds and disciplines, we share the goal of  intervening in the structural racism that shapes children’s lives. Also, we agree on an entry point for these discussions: pregnancy, as a critical juncture in the lifecourse and as a time of deep personal relevance to women and families. Prenatal care is an important determinant of maternal-infant outcomes. However, for African American women, who experience some of the most extreme maternal health disparities, clinical care alone is woefully inadequate for addressing the role that structural and interpersonal racism may play in their day-to-day experiences and their encounters with the health care system.
 
Our collaborative research builds on the experience of Roots Community Birth Center, Minnesota’s first and only African American–owned and operated birth center. In partnership with the Roots clients and community, we will investigate whether and how community-connected and culturally-centered clinical and support services can disrupt the well-worn pathways between social determinants and birth outcomes that have produced disparate outcomes for African American infants for more than a century. Documenting, in detail, a culturally-centered model of care, and describing—using robust statistical comparisons and cost modeling—the results of this approach will provide much-needed information to health plans and others whose decisions shape the choices that pregnant women have available to them. 
 
Over the coming year, we will explore key themes that are relevant to our overall goal of ensuring that African American moms in Minneapolis and beyond will have access to care options that support a safe, empowering, healthy, and positive birth.  


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