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Addressing Reproductive and Maternal Health Disparities: Identification, Measurement, and Solutions
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Addressing Reproductive and Maternal Health Disparities: Identification, Measurement, and Solutions

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (29 February 2024) | Viewed by 10907

Special Issue Editors

Dr. Joan Combellick

E-Mail Website
Guest Editor
School of Nursing, Yale University, Orange, CT 0647, USA
Interests: women’s health; high quality maternity care; reproductive health disparities; mental health conditions and reproductive health outcomes; practice-based research; birth and microbiome outcomes; the midwifery model of care
Dr. Bridget Basile Ibrahim

E-Mail Website
Guest Editor
School of Nursing, Yale University, Orange, CT 0647, USA
Interests: maternal health equity; respectful maternity care; high quality maternity care; social determinants of health; physiologic birth

Special Issue Information

Dear Colleagues, 

Global disparities in reproductive and maternal health outcomes are pervasive, whether between and within countries, or across communities. These disparities are stubbornly persistent and follow lines of race and ethnicity, socioeconomic level, immigration and language status, health conditions, and geography. The dire outcomes of sub-populations, such as racialized and other marginalized individuals in high-income countries, are often obscured by reporting that does not disaggregate marginalized groups from the majority population or otherwise face their situation being overly simplified because of a lack of validated instruments to measure structural racism. Entrenched differences, such as those between maternal outcomes in the global North and South, can be overlooked due to complacency about the status quo. Health conditions that are exacerbated by pregnancy but manifest in the late postpartum period, such as mental health conditions leading to suicide, homicide and overdose, may remain unseen and uncounted because they occur beyond standard reporting periods. 

In this Special Issue, we seek to focus on populations who suffer a disproportionate burden of reproductive and maternal morbidity and mortality, but who often remain unseen. We intend to represent the entire reproductive span, as well as broad and long-term maternal health outcomes such as mental health, birth trauma, and health care utilization. We hope to dialog across communities, countries, and regional boundaries to describe new approaches to identifying and measuring the needs of these populations. We especially endeavor to bring forward ‘lessons learned’ from novel interventions. We invite the submission of your current research, review articles, or commentary.

Dr. Joan Combellick
Dr. Bridget Basile Ibrahim
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • health equity
  • maternal mortality
  • maternal morbidity
  • infant mortality
  • racial/ethnic
  • rural
  • disability
  • maternal mental health
  • respectful maternity care
  • reproductive health
  • reproductive health justice

Published Papers (7 papers)

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Research

15 pages, 459 KiB  
Article
Addressing the Rehabilitation Needs of Women Experiencing Infertility in Ethiopia: Time for Action
by Bilen Mekonnen Araya, Maria P. Velez, Kassahun Alemu Gelaye, Silke Dyer and Heather M. Aldersey
Int. J. Environ. Res. Public Health 2024, 21(4), 475; https://doi.org/10.3390/ijerph21040475 - 13 Apr 2024
Viewed by 915
Abstract
The psychological, social, and financial disabilities caused by infertility are significant for women, particularly those living in low- and middle-income countries such as Ethiopia. Although rehabilitation can be an important form of support for such women, infertility is frequently overlooked as a disability [...] Read more.
The psychological, social, and financial disabilities caused by infertility are significant for women, particularly those living in low- and middle-income countries such as Ethiopia. Although rehabilitation can be an important form of support for such women, infertility is frequently overlooked as a disability or potential target of rehabilitation interventions. This study aimed to determine what rehabilitation-related services and supports are available for women experiencing infertility in Ethiopia. We used an Interpretive Description design. We purposefully selected fourteen rehabilitation, medical, and policy service providers from diverse institutions across three geographical locations. We used semi-structured questions during our in-person and telephone interviews. The data were analyzed using reflexive thematic analysis with the assistance of NVivo. We identified five main themes, including (a) policies related to infertility, (b) the concept that disabilities are physically visible fails to recognize infertility, (c) the need for rehabilitation services for women with infertility, (d) the importance of wellness services for women experiencing infertility, and (e) the role of religion in rehabilitation services. In conclusion, it is essential to strengthen the policies around infertility, incorporate rehabilitation services in fertility care, and view infertility as a disabling condition for women who experience it in Ethiopia. Full article
(This article belongs to the Special Issue Addressing Reproductive and Maternal Health Disparities: Identification, Measurement, and Solutions)
16 pages, 637 KiB  
Article
Supporting the Development of Grassroots Maternal and Childhood Health Leaders through a Public-Health-Informed Training Program
by Kenzie Latham-Mintus, Brittney Ortiz, Ashley Irby and Jack Turman, Jr.
Int. J. Environ. Res. Public Health 2024, 21(4), 460; https://doi.org/10.3390/ijerph21040460 - 9 Apr 2024
Viewed by 863
Abstract
The purpose of this research was to assess leadership growth (i.e., changes in personal capacity and social capital) among women living in high-risk infant mortality zip codes who completed a grassroots maternal and childhood health leadership (GMCHL) training program. We used semi-structured qualitative [...] Read more.
The purpose of this research was to assess leadership growth (i.e., changes in personal capacity and social capital) among women living in high-risk infant mortality zip codes who completed a grassroots maternal and childhood health leadership (GMCHL) training program. We used semi-structured qualitative interviews and thematic analysis. Three major themes associated with the training program experience were identified: (1) building personal capacity and becoming community brokers; (2) linking and leveraging through formal organizations; and (3) how individual change becomes community change. Although many of the grassroots leaders were already brokers (i.e., connecting individuals to information/services), they were able to become community brokers by gaining new skills and knowledge about strategies to reduce adverse birth outcomes in their community. In particular, joining and participation in formal organizations aimed at improving community health led to the development of linking or vertical ties (e.g., “people in high places”). The grassroots leaders gained access to people in power, such as policymakers, which enabled leaders to access more resources and opportunities for themselves and their social networks. We outline the building blocks for supporting potential grassroots leaders by enhancing personal capacity and social capital, thus leading to increases in collective efficacy and collective action. Full article
(This article belongs to the Special Issue Addressing Reproductive and Maternal Health Disparities: Identification, Measurement, and Solutions)
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11 pages, 705 KiB  
Article
Improving the Maternity Care Safety Net: Establishing Maternal Mortality Surveillance for Non-Obstetric Providers and Institutions
by Joan L. Combellick, Bridget Basile Ibrahim, Aryan Esmaeili, Ciaran S. Phibbs, Amanda M. Johnson, Elizabeth Winston Patton, Laura Manzo and Sally G. Haskell
Int. J. Environ. Res. Public Health 2024, 21(1), 37; https://doi.org/10.3390/ijerph21010037 - 27 Dec 2023
Viewed by 1898
Abstract
The siloed nature of maternity care has been noted as a system-level factor negatively impacting maternal outcomes. Veterans Health Administration (VA) provides multi-specialty healthcare before, during, and after pregnancy but purchases obstetric care from community providers. VA providers may be unaware of perinatal [...] Read more.
The siloed nature of maternity care has been noted as a system-level factor negatively impacting maternal outcomes. Veterans Health Administration (VA) provides multi-specialty healthcare before, during, and after pregnancy but purchases obstetric care from community providers. VA providers may be unaware of perinatal complications, while community-based maternity care providers may be unaware of upstream factors affecting the pregnancy. To optimize maternal outcomes, the VA has initiated a system-level surveillance and review process designed to improve non-obstetric care for veterans experiencing a pregnancy. This quality improvement project aimed to describe the VA-based maternal mortality review process and to report maternal mortality (pregnancy-related death up to 42 days postpartum) and pregnancy-associated mortality (death from any cause up to 1 year postpartum) among veterans who use VA maternity care benefits. Pregnancies and pregnancy-associated deaths between fiscal year (FY) 2011–2020 were identified from national VA databases. All deaths underwent individual chart review and abstraction that focused on multi-specialty care received at the VA in the year prior to pregnancy until the time of death. Thirty-two pregnancy-associated deaths were confirmed among 39,720 pregnancies (PAMR = 80.6 per 100,000 live births). Fifty percent of deaths occurred among individuals who had experienced adverse social determinants of health. Mental health conditions affected 81%. Half (n = 16, 50%) of all deaths occurred in the late postpartum period (43–365 days postpartum) after maternity care had ended. More than half of these late postpartum deaths (n = 9, 56.2%) were related to suicide, homicide, or overdose. Integration of care delivered during the perinatal period (pregnancy through postpartum) from primary, mental health, emergency, and specialty care providers may be enhanced through a system-based approach to pregnancy-associated death surveillance and review. This quality improvement project has implications for all healthcare settings where coordination between obstetric and non-obstetric providers is needed. Full article
(This article belongs to the Special Issue Addressing Reproductive and Maternal Health Disparities: Identification, Measurement, and Solutions)
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12 pages, 309 KiB  
Article
The Sociocultural Influences on Breast Cancer Screening among Rural African Women in South Africa
by Nelisha Sarmah, Maureen Nokuthula Sibiya and Thandokuhle Emmanuel Khoza
Int. J. Environ. Res. Public Health 2023, 20(21), 7005; https://doi.org/10.3390/ijerph20217005 - 1 Nov 2023
Viewed by 1643
Abstract
The incidence of breast cancer in South Africa is increasing, with rural South African women presenting with advanced stages of the disease. A woman’s breasts are a symbol of her womanhood; they also constitute a social definition of her femininity. Women with breast [...] Read more.
The incidence of breast cancer in South Africa is increasing, with rural South African women presenting with advanced stages of the disease. A woman’s breasts are a symbol of her womanhood; they also constitute a social definition of her femininity. Women with breast cancer in rural South Africa are heavily stigmatized and suffer from various sociocultural interpretations of the disease. Breast cancer is frequently interpreted in rural South Africa as a symbol of witchcraft, sin, and punishment, and traditionally, it is treated by offering animal sacrifices, consumption of herbs, and prayer to ancestors. Using care-seeking behaviour theory as the theoretical framework, we intend to explore the sociocultural factors influencing breast cancer screening practices among rural South African women. A qualitative exploratory study was conducted using semi-structured interviews with 22 rural South African women selected by purposive sampling. Thematic analysis was used to analyse the data. The study identified four sociocultural factors influencing women’s practices of breast cancer screening in rural South Africa, including psychological factors, habits, beliefs, and perceptions of healthcare. Women in rural South African communities have deep-rooted traditional beliefs and practices regarding breast cancer. Consequently, this influences women’s preventative health behaviours regarding breast cancer screening. The development of culturally appropriate health education programs involving traditional healers and influential community leaders is essential to increasing the number of women being screened for breast cancer in rural South Africa. Full article
(This article belongs to the Special Issue Addressing Reproductive and Maternal Health Disparities: Identification, Measurement, and Solutions)
13 pages, 321 KiB  
Article
Experiences of Women with Disabilities in Accessing Maternal Healthcare Services: A South African Case Study
by Doreen Mheta, Maureen Nokuthula Sibiya and Pauline Busisiwe Nkosi
Int. J. Environ. Res. Public Health 2023, 20(21), 6966; https://doi.org/10.3390/ijerph20216966 - 24 Oct 2023
Viewed by 1566
Abstract
Access to maternal healthcare services is a challenge in most low- and middle-income countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions in place to improve the accessibility [...] Read more.
Access to maternal healthcare services is a challenge in most low- and middle-income countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions in place to improve the accessibility of maternal healthcare services, vulnerable women including women with disabilities are still facing numerous challenges when trying to access these services. The aim of this study was to explore the experiences of women with disabilities in the province of KwaZulu-Natal in South Africa in accessing public maternal healthcare services. The objectives of this study were to describe the experiences of women with disabilities in accessing maternal healthcare services during pregnancy, childbirth and post-partum care; explore the inhibitors of access to maternal healthcare services for women with disabilities; and explore the facilitators of access to maternal healthcare services for women with disabilities. Twelve women with disabilities (four with physical impairments, four with hearing impairments and four with visual impairments) were interviewed for this study. Data were transcribed verbatim and analysed utilising the Framework of Assessing Access to Maternal Healthcare Services by Peters et al., 2008. Our study found that narrow passages and information in inaccessible formats were a challenge for women with visual impairments. Women with hearing impairments faced communication difficulties due to the lack of sign language interpreters in most facilities. Moreover, healthcare professionals displayed unfavourable attitudes toward women with hearing impairments, and these women were often overlooked when seeking help. The women with physical impairments encountered inaccessible buildings, narrow passages, small consultation rooms and equipment that is not adjustable, such as beds and scales. Full article
(This article belongs to the Special Issue Addressing Reproductive and Maternal Health Disparities: Identification, Measurement, and Solutions)
14 pages, 1573 KiB  
Article
Preventing Perinatal Depression: Cultural Adaptation of the Mothers and Babies Course in Kenya and Tanzania
by Huynh-Nhu Le, Elena McEwan, Maureen Kapiyo, Fidelis Muthoni, Tobias Opiyo, Kantoniony M. Rabemananjara, Shannon Senefeld and John Hembling
Int. J. Environ. Res. Public Health 2023, 20(19), 6811; https://doi.org/10.3390/ijerph20196811 - 23 Sep 2023
Viewed by 1787
Abstract
Pregnant women and mothers in sub-Saharan Africa are at high risk for perinatal depression, warranting a need to develop culturally tailored interventions to prevent perinatal depression. This paper documents the process of adapting an evidence-based preventive intervention developed in the United States, the [...] Read more.
Pregnant women and mothers in sub-Saharan Africa are at high risk for perinatal depression, warranting a need to develop culturally tailored interventions to prevent perinatal depression. This paper documents the process of adapting an evidence-based preventive intervention developed in the United States, the Mothers and Babies Course (MBC), to fit the contexts of rural pregnant women and mothers of young children in Kenya and Tanzania using the updated Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). Data from informant interviews and field observations from the planning and implementation phases were used to make adaptations and modifications of the MBC for perinatal women through the eight aspects of FRAME. Follow-up field visits and reflection meetings with case managers and intervention participants indicated that the adapted version of the MBC was well accepted, but fidelity was limited due to various implementation barriers. The FRAME provided an optimal structure to outline the key adaptations and modifications of a preventive intervention intended to maximize engagement, delivery, and outcomes for high-risk perinatal women in rural settings. Full article
(This article belongs to the Special Issue Addressing Reproductive and Maternal Health Disparities: Identification, Measurement, and Solutions)
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12 pages, 328 KiB  
Article
Pregnant Women’s Views Regarding Maternity Facility-Based Delivery at Primary Health Care Facilities in the Province of KwaZulu-Natal in South Africa
by Puseletso Ruth Mlotshwa and Maureen Nokuthula Sibiya
Int. J. Environ. Res. Public Health 2023, 20(15), 6535; https://doi.org/10.3390/ijerph20156535 - 6 Aug 2023
Cited by 1 | Viewed by 1534
Abstract
For women giving birth, every moment of delay in receiving skilled care significantly increases the risks of stillbirth, neonatal and maternal death. More than half of all births in developing countries, including South Africa, take place outside a health facility and without skilled [...] Read more.
For women giving birth, every moment of delay in receiving skilled care significantly increases the risks of stillbirth, neonatal and maternal death. More than half of all births in developing countries, including South Africa, take place outside a health facility and without skilled birth attendants. Therefore, this has made it difficult to achieve the Sustainable Development Goals of global reduction in maternal mortality, which is a key health challenge globally, especially in developing countries and sub-Saharan Africa in particular. The study aimed to explore and describe the views of pregnant women regarding facility-based delivery. Focus group discussions were used to gather information from pregnant women. Information was collected from six groups of pregnant women who had delivered babies at the primary health care facilities in the past 5 years. Results showed several factors associated with the failure to use institutional delivery services, such as the lengthy distance from the health care facility, lack of transport, lack of transport fare, shortages of skilled staff, failure to disclose pregnancy, cultural and religious beliefs, and staff attitudes. Full article
(This article belongs to the Special Issue Addressing Reproductive and Maternal Health Disparities: Identification, Measurement, and Solutions)
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