The US's maternal mortality and morbidity rates are strikingly high, especially among Black and Indigenous individuals. Documenting the birthing experiences and preferences of Black, Indigenous, and Latinx pregnant and parenting women and others who can become pregnant is critical to informing and shaping policy conversations around initiatives and programs designed to improve outcomes and mitigate maternal and infant health inequities.

WHY THIS MATTERS

This research seeks to add to this conversation by documenting the preferences and lived experiences of Black and Brown mothers who recently gave birth. This information is vital for informing policy and assessing the degree to which current maternal health policy proposals align with the preferences of individuals of color who experience pregnancy and childbirth.

WHAT WE FOUND

Women shared that they often felt powerless to make informed decisions throughout their pregnancies that may have been improved by more comprehensive, patient-centered care. Women indicated the following preferences for their care throughout their pregnancies:

• Women desire providers who treat patients with compassion and respect so they can develop a relationship with them and feel comfortable raising questions and concerns.
• Women prefer providers who can equip them with information about the breadth of their care options, including different provider types (OB-GYNs, midwives, doulas, and community health workers) and birthing locations (birth centers and hospitals) available to them based on their risk level beginning in the prenatal period.
• Many Black women shared their preference for having providers who were racially concordant, with shared experiences, and who understood the maternal mortality landscape in the US.
• There was overwhelming support for extending postpartum Medicaid coverage to 12 months to access care over a longer period.
• Women shared their preferences for shifting the maternity care model from a clinical focus to a more holistic approach to include screenings and support for the social determinants of health.

Many responses to address the concerns and meet the preferences expressed by the people we spoke with are aligned with policy solutions recommended in the Momnibus and The White House Blueprint for Addressing the Maternal Health Crisis. Our findings support the importance of understanding people’s preferences to inform proposed policy and practice changes designed to improve their experience and care. Policies that expand the maternity care workforce and birthing options could give women of color greater autonomy throughout pregnancy and during and after the birthing process. Expanding options, education, and capacity around pregnancy and birth are essential for enhancing the experiences of underserved and historically marginalized women.

HOW WE DID IT

These findings are based on focus groups and phone interviews conducted in 2022 and 2023 with recently pregnant/postpartum women. We completed six focus groups at four locations: rural New Hampshire, Washington DC, rural North Carolina, and Texas. Twenty-six people participated in these focus groups. All had given birth in the last three years (2020–2023), and most participants identified as Black/African American. Concurrently, our team completed individual phone interviews with 19 women who had given birth in the last five years (2017–2022), with most interviewees identifying as Black/African American or Latinx. These women were recruited from the summer 2022 fielding of the Health Reform Monitoring Survey after indicating they would like to be contacted for follow-up interviews. To inform our research approach and interview questions, we also conducted stakeholder interviews with maternal health experts, advocates, and clinicians.