Meeting people's pregnancy prevention needs: Let's not force people to state an "Intention".

Pregnancy intention screening does not identify need for pregnancy prevention and ignores the nuances of lived experiences while reinforcing white middle-class normative expectations. Asking about desire for contraception is a patient-centered approach to meeting people's needs.

US county-level prevalence and spatial distribution of optimal birth outcomes 2018-2019.

A shift in focus towards healthy reproductive outcomes may reveal opportunities for novel interventions and strategies to promote optimal health. Using variables from the National Center for Health Statistics restricted use natality files, we calculated Empirical Bayes smoothed (EBS) rates of optimal birth for the all live births-both overall and by maternal race/ethnicity-by applying the smoothing tool in GeoDa version 1.18.

Centering equity: Addressing structural and social determinants of health to improve maternal and infant health outcomes.

Despite decades of investment and improvements in infant health in the United States, efforts to ensure the health and well-being of birthing people, especially those from racialized and minoritized communities, have been underfunded and neglected. As a result, many birthing people do not have access to the quality care they deserve and suffer disproportionately from adverse health outcomes such as severe maternal morbidity and maternal mortality. Through a Reproductive Justice lens, this paper will discuss structural causes for maternal health disparities as well as some of the structural solutions necessary to support the correction of centuries of discrimination on the basis of race, sex, gender, and other minoritized identities.

Black Perinatal Mental Health: Prioritizing Maternal Mental Health to Optimize Infant Health and Wellness.

Infant mental health is interconnected with and affected by maternal mental health. A mother or birthing person's mental health before and during pregnancy and the postpartum period is essential for a child's development. During the first year of life, infants require emotional attachment and bonding to strive.

Developing Tools to Report Racism in Maternal Health for the CDC Maternal Mortality Review Information Application (MMRIA): Findings from the MMRIA Racism & Discrimination Working Group.

Purpose: The purpose of this report from the field is to describe the process by which an multidisciplinary workgroup, selected by the CDC Foundation in partnership with maternal health experts, developed a definition of racism that would be specifically appropriate for inclusion on the Maternal Mortality Review Information Application (MMRIA) form.

Description: In the United States Black women are nearly 4 times more likely to experience a pregnancy-related death. Recent evidence points to racism as a fundamental cause of this inequity.

Pathways To Equitable And Antiracist Maternal Mental Health Care: Insights From Black Women Stakeholders.

Structural racism causes significant inequities in the diagnosis of perinatal and maternal mental health disorders and access to perinatal and maternal mental health treatment. Black birthing populations are particularly burdened by disjointed systems of care for mental health. To identify strategies to address racism and inequities in maternal and infant mental health care, we interviewed ten Black women who support Black birthing people, including mental health practitioners, researchers, and activists, in February 2021.

The Index of Concentration at the Extremes (ICE) and Pregnancy-Associated Mortality in Louisiana, 2016-2017.

Objectives: Social and contextual factors underlying the continually disproportionate and burdensome risk of adverse health outcomes experienced by Black women in the US are underexplored in the literature. The aim of this study was to use an index based on area-level population distributions of race and income to predict risk of death during pregnancy and up to 1 year postpartum among women in Louisiana.

Methods: Using vital records data provided by the Louisiana Department of Health 2016-2017 (n = 125,537), a modified Poisson model was fit with generalized estimating equations to examine the risk of pregnancy-associated death associated with census tract-level values of the Index of Concentration at the Extremes (ICE)-grouped by tertile-while adjusting for both individual and tract-level confounders.

The Cycle to Respectful Care: A Qualitative Approach to the Creation of an Actionable Framework to Address Maternal Outcome Disparities.

Despite persistent disparities in maternity care outcomes, there are limited resources to guide clinical practice and clinician behavior to dismantle biased practices and beliefs, structural and institutional racism, and the policies that perpetuate racism. Focus groups and interviews were held in communities in the United States identified as having higher density of Black births. Focus group and interview themes and codes illuminated Black birthing individual's experience with labor and delivery in the hospital setting.

Bridging the Chasm between Pregnancy and Health over the Life Course: A National Agenda for Research and Action.

Background: Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care.

Methods: We launched the initiative "Bridging the Chasm between Pregnancy and Health across the Life Course" in 2018, bringing together patients, advocates, providers, researchers, policymakers, and systems innovators to create a National Agenda for Research and Action.

Ensuring Equitable Implementation of Telemedicine in Perinatal Care.

The use of telemedicine in U.S. perinatal care has drastically increased during the coronavirus disease 2019 (COVID-19) pandemic, and will likely continue given the national focus on high-value, patient-centered care.

Evolving the Preconception Health Framework: A Call for Reproductive and Sexual Health Equity.

Over the past decade, increasing attention has been paid to intervening in individuals' health in the "preconception" period as an approach to optimizing pregnancy outcomes. Increasing attention to the structural and social determinants of health and to the need to prioritize reproductive autonomy has underscored the need to evolve the preconception health framework to center race equity and to engage with the historical and social context in which reproduction and reproductive health care occur. In this commentary, we describe the results of a meeting with a multidisciplinary group of maternal and child health experts, reproductive health researchers and practitioners, and Reproductive Justice leaders to define a new approach for clinical and public health systems to engage with the health of nonpregnant people.

Social and Structural Determinants of Health Inequities in Maternal Health.

Since the World Health Organization launched its commission on the social determinants of health (SDOH) over a decade ago, a large body of research has proven that social determinants-defined as the conditions in which people are born, grow, live, work, and age-are significant drivers of disease risk and susceptibility within clinical care and public health systems. Unfortunately, the term has lost meaning within systems of care because of misuse and lack of context. As many disparate health outcomes remain, including higher risk of maternal mortality among Black women, a deeper understanding of the SDOH-and what forces underlie their distribution-is needed.

Infant Outcomes Following Maternal Infection With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): First Report From the Pregnancy Coronavirus Outcomes Registry (PRIORITY) Study.

Infant outcomes after maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not well described. In a prospective US registry of 263 infants, maternal SARS-CoV-2 status was not associated with birth weight, difficulty breathing, apnea, or upper or lower respiratory infection through 8 weeks of age.

Reflecting on Equity in Perinatal Care During a Pandemic.

Growing discourse around maternity care during the pandemic offers an opportunity to reflect on how this crisis has amplified inequities in health care. We argue that policies upholding the rights of birthing people, and policies decreasing the risk of COVID-19 transmission are not mutually exclusive. The explicit lack of standardization of evidence-based maternity care, whether expressed in clinical protocols or institutional policy, has disproportionately impacted marginalized communities.

Homicide During Pregnancy and the Postpartum Period in Louisiana, 2016-2017.

This study examines the incidence of homicide as the cause of mortality in women who are pregnant or post partum in Louisiana in 2016 through 2017, comparing this with other causes of maternal mortality.

Beyond same-day long-acting reversible contraceptive access: a person-centered framework for advancing high-quality, equitable contraceptive care.

In the last decade-plus, there has been growing enthusiasm for long-acting reversible contraceptive methods as the solution to unintended pregnancy in the United States. Contraceptive access efforts have primarily focused on addressing provider and policy barriers to long-acting reversible contraception and have promoted long-acting reversible contraception as first-line methods through marketing and tiered-effectiveness counseling. A next generation of contraceptive access efforts has the opportunity to move beyond this siloed focus on long-acting reversible contraception toward a focus on equity and person-centeredness.

Privilege and deprivation in Detroit: infant mortality and the Index of Concentration at the Extremes.

Background: Enhanced understanding of spatial social polarization as a determinant of infant mortality is critical to efforts aimed at advancing health equity. Our objective was to identify associations between spatial social polarization and risk of infant death.

Methods: We conducted a cross-sectional analysis of all birth records issued to non-Hispanic (NH) Black and White women in Wayne County, MI, from 2010 to 2013 (n = 84 159), including linked death records for deaths occurring at less than 1 year of age.

"Look at the Whole Me": A Mixed-Methods Examination of Black Infant Mortality in the US through Women's Lived Experiences and Community Context.

In the US, the non-Hispanic Black infant mortality rate exceeds the rate among non-Hispanic Whites by more than two-fold. To explore factors underlying this persistent disparity, we employed a mixed methods approach with concurrent quantitative and qualitative data collection and analysis. Eighteen women participated in interviews about their experience of infant loss.