The Urban Perinatal Education Center services would build capacity for multicultural and multilingual providers to adequately educate and support diverse clients towards having a physically, mentally, and emotionally healthy pregnancy and addressing any risks that materialize. The aim is to create an atmosphere where these providers can holistically plan out culturally and socio-economically congruent pregnancy goals, healthy activities, diets, and support structures that will allow the birthing parent to thrive. This wrap around care, especially for historically marginalized communities, aims to reduce the above disparities.

The most common request for doula services in RI, as a Black doula, is "I don't want to die."

Disparaging Data of Black Maternal Health Crisis in RI

Non-Hispanic (NH) Whites (33.1%) have a lower rate of unintended pregnancies compared to Hispanics (45.6%), and NH Blacks (61.9%).  The percentage of short interpregnancy interval (< 18 months) among  RI resident women in 2018 was 26.1%, which is a slight decrease from 26.8% in 2017.  But in 2018, Hispanic women were 40% more likely to have a short interpregnancy interval than NH White women.  Moreover, the disparity between both groups has increased from 2014 to 2018.

NH Black (22%), Hispanic (18%), and NH Asian (16%) women are more likely to receive delayed prenatal care than NH White women (13%). During pregnancy, NH Black women are almost two times as likely to experience serious pregnancy-related health complications (preeclampsia, eclampsia, gestational diabetes, etc.) compared to NH White women.  Additionally, low income and NH Black women were most likely to experience depression during pregnancy.

A community survey reports that participants chose mental health (e.g., postnatal depression or anxiety (29%) and culturally responsive pregnancy/postpartum education and care (12%) as the top issue related to pregnancy and birth. Similarly, collaborative partner SISTA FIRE, 2020 survey found that participants ranked the following as the three most important topics to be addressed by perinatal care providers to improve the health and wellbeing of parents/caregivers: 1)Mental health (68%), 2) Pregnancy/Postpartum Education & Care (41%), and 3) Violence & Abuse in Relationships (40%). For reference, there are a variety of social determinants of health, such as housing and food insecurity, structural racism, etc., that contribute to mental, emotional and toxic stress.

 The 2019 maternal morbidity rate (including blood transfusions) was 271.4 per 10,000 delivery hospitalizations, which is an increase from 242.0 per 10,000. In 2018, Black women (382.7 per 10,000 delivery hospitalizations) had a higher maternal morbidity rate than White women (224.8 per 10,000). Racial/ethnic disparities can also be seen among delivery hospitalizations regarding blood transfusions (Black women: 293.9 per 10,000; White women: 141.2 per 10,000) and hypertensive disorders (Black women: 520.4 per 10,000; White women: 288.7 per 10,000).  PRAMS data show that the percentage of women reporting symptoms of postpartum depression was 12.3% in 2018, a slight increase from 10.9% in 2014.  In 2018, women who identified as Other reported 17.5% reporting postpartum depressive symptoms compared to NH White women with 11.0%.

In RI in 2019, there were 786 infants who were born with low birth weight (< 2,500 grams), this represents 7.7% of all infant born. Racial disparities are also observed in low birth weight babies. In 2019, the preterm birth (< 37 weeks gestation) rate in Rhode Island was 9.4%. This represents an increase from the preterm birth rate of 8.2% in 2017. The risk difference between NH White (8.0%) and NH Black (11.1%) preterm births is 3.1%.  Provisional data for 2019 indicate that the infant mortality rate in RI is 5.5 deaths per 1,000 live births. The Black/White infant mortality ratio for 2017-2019 is 4.2, with NH Blacks having an infant mortality rate of 13.0 per 1,000 live births compared to that of NH White infants with 3.1 per 1,000 live births.    

Additionally, AP News reports that "despite federal assistance, 25% of households in the state were worried about having adequate food, up from 9.1% last year and the highest level of food insecurity in Rhode Island in 20 years." 36 percent of Black households and 40 percent of Latinx households are food insecure according to the Rhode Island Community Food Bank’s annual Status Report on Hunger."

Leading with an impact led by the community

The core of Urban Perinatal Education Center’s mission is founded on addressing maternal care and outcome disparities. With the help of the community we will build this new initiative that aims to shift the dynamics of a healthcare system unable to meet the needs of a historically intentionally underserved and racially marginalized population. Urban Perinatal Education Center providers pride themselves on being trauma informed, culturally responsive, respectful, and wrap around care practitioners. They understand medical vernacular isn't necessarily understood by patients and will take the necessary time to explain procedures, illnesses, and associated next steps. A patient is to leave their care facility feeling empowered in their own health and healthcare. Urban Perinatal Education Center understands that this type of wrap around care will take time and energy out of their providers. Hence, Urban Perinatal Education Center managers will convene weekly all-staff check-ins and mentoring sessions in order to work through any issues and offer staff support, assistance, and guidance. Teamwork, communication, and collaboration is truly the only way that a comprehensive perinatal care clinic can thrive.  

What we know: In a recent study it was found that Black infants cared for by Black doctors were more often to survive to their first birthday than Black infants cared for by white doctors. Additionally, the infant mortality rate is reduced for white infants when the attending physician was Black compared to when the attending physician was white. This provides data that is not only compelling but it supports the need for diversifying the health care workforce in cultural representation (including linguistically) and specifically supporting pathways for clinical training pipeline programs for future Black providers and other providers of color.

We know the JJway mode, which is the foundational blue print of the Urban Perinatal Education Center Easy Access Clinic, l has been successful, and is attributed to a culturally representative staff and the four key tenets. That work now moving forward with the National Perinatal Taskforce model to address materno-toxic stress and developing perinatal safe spots to address these issues. The Urban Perinatal Education Center will become a perinatal safe zone providing a network of care to directly address these inequities, injustice and disparities in care.

Resources to Support our Work

Rethinking Bias to Achieve Maternal Health Equity: Changing Organizations, Not Just Individuals
The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States
Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth
Information and power: Women of color's experiences interacting with health care providers in pregnancy and birth
Social and Structural Determinants of Health Inequities in Maternal Health
The Ethics of Perinatal Care for Black Women
Dismantling the Structural Racism in “Mother Blame” Narratives
Listening to Women: Recommendations from Women of Color to Improve Experiences in Pregnancy and Birth Care

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