The roles of community health workers in understanding COVID-19-related inequities among Black pregnant women

Abstract Background US Black pregnant women have worse birth and maternal outcomes than their White counterparts, and these disparities were exacerbated by the COVID-19 pandemic. We sought to examine community health workers’ roles in shaping low-income Black pregnant women’s experiences and perspectives on public health guidance during COVID-19. Methods Between December 2020 and September 2021, we conducted two to four semi-structured interviews and feedback sessions with each participant: community health workers or pregnant/postpartum women who self-identified as Black (thirty-five total interviews and twelve feedback sessions). Using a Longitudinal Qualitative Research approach, we looked at themes over time in perceptions of COVID-19 public health guidance, specifically related to vaccination, throughout pregnancy and the postpartum period. Results Community health workers were essential sources of information about the COVID-19 vaccine, risk and safety, and other related challenges. However, there was extensive distrust of science and of health providers. This was traced to historical and modern cases of medical and scientific abuse of Black Americans. Community health workers experienced much of the same distrust of public health guidance related to the pandemic as their clients. Conclusions Community health workers represent an important group for influencing perspectives of COVID-19 health and vaccine guidance among Black pregnant and postpartum women. Both groups’ views on public health guidance during the pandemic were shaped by complex historical, economic and cultural systems. To support trust- and rapport-building, healthcare providers should take an educated, empathetic approach to working with community health workers and understanding their patients’ histories and experiences.