Reducing Racial and Economic Inequality through Community-Based Birthwork

Background and Purpose

Despite being home to several world-class medical institutions, the infant mortality rate for African American infants in Cleveland, Ohio is more than double that of white infants. Initiatives addressing infant mortality in Ohio have improved only white infant mortality rates. An innovative community-based perinatal support and workforce development program, Birthing Beautiful Communities (BBC) seeks to change this. BBC serves African American families, applying a person-in-environment framework, and employing women from predominately African American Cleveland communities to provide services for pregnant women and their families before, during, and after their babies’ births. BBC’s approach aims to achieve its outcomes by ameliorating the effects of toxic stress and systemic racism. This study examines program impacts and outcomes using mixed methods, including quantitative client data integrated with in-depth perspectives and experiences of staff and clients.

Methods

Participants were African American women who were either BBC staff or clients. Mixed methods approaches were taken to collecting, analyzing, and interpreting the data, providing multiple perspectives on BBC’s work and impact. Data sources included quantitative administrative data (one year’s worth of agency administrative data on 216 clients) and qualitative interview data (semi-structured focus group with program staff (N=14), and individual in-depth client interviews (N=25)). Administrative data included, from intake (e.g., demographics, background information) and birth outcomes (e.g., infant survival, prematurity, low birth weight, cesarean sections, and breastfeeding rates). The qualitative data explored program experiences, which helped contextualize and explain the quantitative findings.

Community-based participatory approaches were embedded in the study design, with BBC staff helping design the study, refine the questions, and recruit participants for the qualitative interviews. Administrative data were collected by PSPs as a part of the agency’s service records, and clients and PSPs were recruited separately for the qualitative interviews. Descriptive analyses of the quantitative administrative data were performed. Qualitative data analysis was systematic and rigorous, employing safeguards to ensure the data trustworthiness and credibility, including member checks, peer debriefing, and (data and analyst) triangulation.

Results

Client characteristics and birth outcomes with regard to infant mortality rates, prematurity, low birth weight, and breastfeeding rates are reported. Findings indicate more positive outcomes as compared to rates for African Americans locally, within the city, the county, the state, and nationally. Qualitative findings indicated both PSPs’ and clients’ rich experiences, with four key themes expressed, including (1) the importance of culturally matched services; (2) intense emotional, instrumental, and informational support delivered individually and in group interventions; (3) PSPs as professionals but also as friends/family; and (4) clients becoming empowered around self-care.

Implications

While perinatal support is increasingly being understood to be a key factor in improving birth outcomes, BBC takes this a step further, basing its programming on the framework of person-in-environment, explicitly recognizing the impact of structural inequities, tackling issues of social justice and equity, while providing direct practice and rigorously documenting client outcomes. Social work can use this organization’s work as a model and inspiration for improving practice with pregnant African American clients and working to achieve equity in birth outcomes.