Research Magazine

Maternal health outcomes in the United States rank lower than in many developed and underdeveloped countries. African American women are disproportionately affected with mortality rates 3.5 to 4 times higher compared to other racial groups. Despite the growing body of research related to maternal morbidity and mortality, few studies have focused solely on maternal health outcomes in African American women.

Dr. Katilya Ware, assistant professor in the College of Nursing, recently conducted a study to identify facilitators and barriers to prenatal care in African American women and investigate the feasibility of group prenatal care with partnerships from faith-based organizations.

According to Ware, a woman ideally receives prenatal care services as soon as she finds out she is pregnant. “This can be as early as six weeks or after her first missed period. Studies have found that African American women are less likely to utilize prenatal care services or delay initial prenatal care until the second and third trimesters. Hence, inadequate prenatal care is associated with maternal mortality.”

During the study, she was able to interview and examine concerns from the perspective of participants — African American women who are currently pregnant or delivered in the last two years, health experts (nurses, nurse practitioners and physicians), and faith-based leaders in African American churches from multiple counties in Alabama. She included faith-based leaders in her study because they were essential to the African American community, and the church is where trust is found and resources are sought.

Prenatal care is an opportunity for women to access the health care system and to receive preventive services, education, nutritional support and other social services to improve pregnancy outcomes.

“Good prenatal care is critically important for healthy pregnancies and healthy children. Many women do not understand the importance of attending prenatal visits and how they assist in determining the health of the mother and child,” Ware said.

During her initial conversations with different groups, she became aware of several important factors. “There were a variety of perceptions related to prenatal care. Providing women with education on the importance of attendance to prenatal care visits and the resources available during pregnancy can assist in overcoming some of the barriers experienced during pregnancy,” Ware said.

“Besides receiving care during pregnancy, I want to emphasize the importance of care after delivery. It is important that women also attend their postpartum visits,” she added. “These are often poorly attended, especially in low-income women. Attending this session is equally important because it aids in identification of adverse maternal conditions. Some women experience conditions unique to pregnancy such as gestational diabetes or preeclampsia and assume that once the baby is delivered the issue no longer exists. However, these women are at increased risk of developing Type 2 diabetes or hypertension. Therefore, it is essential for them to attend to the postpartum visit and continue to seek care from a primary care provider to aid in early identification and management of these conditions.”

In addition, Ware found the pandemic has placed a strain on families. “Prior to the pandemic, the transition to motherhood following pregnancy was often accompanied by support from partners, family and friends. Since the pandemic, older family members are now unable to assist which has resulted in some young mothers feeling overwhelmed by the duties of motherhood.”

A member of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWOHNN), Ware advocates cross-cultural communication underscored by the organization. AWOHNN supports the Institute of Medicine’s definition of good quality “as providing patients with appropriate services in a technically competent manner, with good communication, shared decision making and cultural sensitivity.” Ware expects this investigation will highlight the importance of continued emphasis on education, and cross-cultural communication skills when working with this population. This can potentially lead to greater trust in providers, increase satisfaction with care, and reduce disparities in quality of care and health behaviors for pregnant African American women.

To improve African American maternal health outcomes, social determinants of health must be addressed through policies that raise incomes and build wealth; provide access to clean, safe, and affordable housing; improve the quality of education; prioritize reliable public transportation and transport for medical appointments; and increase the availability of healthy, affordable food.

“This study highlights the unique need of African American women during pregnancy,” said Dr. Pao-Feng Tsai, associate dean for research in the College of Nursing. “The pilot work will provide needed information for a future major study that develops tailored, pregnancy-related interventions for African American women. Dr. Ware’s research has the potential to raise awareness, improve prenatal care, and aid in promoting maternal health in this population.”