This session includes two presentations that examine current inequities and potential solutions to make maternal and child care more equitable.
- Presentation 1: Diverse Colorado Voices: Community-based Solutions for the Perinatal Period: Feedback from 5 Statewide Listening Sessions with Community Members and Birth Equity Leaders in Colorado (Kayla Frawley, Holley Murphy - Clayton Early Learning; Lynn VanderWielen - End Grain Research & Evaluation LLC // Families Forward Resource Center)
- Presentation 2: Ethnic Disparities in the Care of Opioid Exposed Newborns in Colorado Birthing Hospitals (Blair Weikel, Mauricio Palau - University of Colorado Anschutz Medical Campus Department of Pediatrics; Sunah Hwang - University of Colorado Anschutz Medical Campus Department of Pediatrics, Children's Hospital Colorado Section of Neonatology)
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Full presentation descriptions:Diverse Colorado Voices: Community-based Solutions for the Perinatal Period: Feedback from 5 Statewide Listening Sessions with Community Members and Birth Equity Leaders in Colorado
The authentic and intentional incorporation of community voice and lived experiences into policy, practice, and programing has the profound potential to optimize equitable health outcomes for those in the perinatal period. Through cross-collaborating with grass roots - perinatal birth equity leaders in the state of Colorado we held 5 listening sessions to seek community defined issues and solutions in the perinatal time period in Colorado. Data gathered during community member listening sessions identified three overarching issues faced in the perinatal period: systemic racism, lack of postpartum support, and systems-level inadequacies. Policy implementations and recommendations to optimize perinatal care were drawn from community member input, and emphasize the need to examine issues as interconnected and inextricably linked to the social determinants of health.
In July 2020 the Maternal Mortality Review Committee released their report titled Maternal Mortality in Colorado, 2014 - 2016 which examines all cases of maternal death. The committee described one of the next steps in the process as identifying community-led solutions to maternal mortality. The report acknowledges that “grassroots community-based perinatal and birth providers and activists all play a unique and necessary role and will be a part of community-led solutions.”
Critically, all policies should be viewed through an anti-racist lens such that Colorado strives to attain health equity for all. Implementation, design, and development of these recommendations need to be done with the consultation of the lived expertise of families that experience challenges like those associated with experienced racism. Participants will be given the example of community engagement of listening sessions, including the importance of highlighting local community leaders in the perinatal period, opportunities for aligning advocacy efforts and tangible policy recommendations that are community driven, anti-racist, and address micro and macro systems level inadequacies in the perinatal time period.
Ethnic Disparities in the Care of Opioid Exposed Newborns in Colorado Birthing Hospitals This presentation explores the disparity in quality improvement outcomes among Hispanic versus Non-Hispanic opioid exposed newborns within a statewide collaborative. Data were collected for this initiative directly from hospitals at the mother-infant dyad level. This study found that while pre and post intervention numbers reflected positive outcomes among both groups, when we disaggregated data by maternal Hispanic ethnicity and tracked it over time, the path to these outcomes was not uniform. We discovered that the Hispanic cohort experienced one to three quarter delays in sustained improvement as compared to their Non-Hispanic counterparts, indicating some difference in how they experienced the interventions and process of the improvement efforts. We hypothesize that language barriers as well as compounding socioeconomic characteristics of Hispanic families in our state likely accounted for some of this difference. Previous research has explored the experience of pediatric parents with limited English proficiency and has found increased risk of parents misunderstanding their child’s diagnosis, inadequate use of required interpretation tools even when indicated as necessary, and fear of being a burden on providers. While we believe language barriers were likely a factor in our study, we discovered in the analysis process that many of our participants did not have a documented primary or preferred language recorded in our dataset which was based on electronic health record (EHR) data. Studies exploring the accuracy of sociodemographic data captured in electronic health records have found that when compared to self-report, the EHR underestimates Hispanic ethnicity, primary Spanish language speaking, and bi-/multi-race status. The results of this study and others indicate a need for QI efforts that explicitly focus on culturally competent approaches for the outset for mother and infants.
