"To me, it was overwhelming": a mixed methods study of maternal healthcare in a marginalised community in New York City, guided by the person-centered care framework for reproductive health equity.

Abstract

The Person-Centered Care Framework for Reproductive Health Equity (PCC) elucidates drivers of health disparities: community determinants, health-seeking behaviours and quality of care. Limited studies assess person-centered maternal healthcare in underserved populations. Racial and ethnic disparities in maternal health were exacerbated by the COVID-19 pandemic. We applied PCC to evaluate factors influencing maternal healthcare at two public hospitals in NYC before and during the pandemic. We conducted mixed-method, community-engaged research using PCC. A cross-sectional study using EHR data from 5330 pregnant individuals in 2019 assessed factors related to inadequate maternity care utilisation. Qualitative research in 2020 explored perceptions of maternal health equity, barriers, and healthcare quality through 17 in-depth interviews and five focus group discussions with postpartum women, clinicians, and community-organisation staff. Among 3181 women, 90% had public insurance, and 95% were people of colour. Using the Adequacy of Prenatal Care Utilisation index, 1648 (51.8%) received no or inadequate prenatal care and 1267 (40%) lacked postpartum care. Women aged 18-24, Black women, Arabic-speaking women and those who used tobacco during pregnancy appeared more likely to experience inadequate care. Qualitative data identified community-level determinants, namely health literacy and economic status. Health-seeking barriers included social distancing, telehealth and immigration status. Quality of care issues included disruptions in healthcare delivery, patient-provider experience and continuity of care. Findings indicate disparities in maternal healthcare utilisation, which are likely downstream effects of broader social inequities. Addressing these disparities requires rights-based, community-informed policies that guarantee equitable, respectful and accessible maternal care for all.