Community Recommendations for Hospital-Based Maternity Care: Insights from Black and Pacific Islander Mothers in San Francisco.

INTRODUCTION

Hospitals in the United States are increasingly working to advance maternal health (MH) equity. To succeed, these efforts must be community-driven, centering voices of those with experience of health inequities, suboptimal care, and the impacts of structural racism. However, robust hospital engagement with such guidance remains rare. We documented community-driven strategies for advancing MH equity.

METHODS

Using a community-based participatory research approach, we conducted longitudinal in-person strategy sessions with individuals from communities disproportionately burdened by MH inequities: Black and/or Pacific Islander individuals who had recently delivered or considered delivering in San Francisco hospitals. Two 2.5-h discussion-intensive meetings focused on generating and refining recommendations for improving hospital maternity care. Participants then selected their top 15 recommendations. Experienced community-based team members led recruitment and facilitated sessions. We independently reviewed data for accuracy and conducted thematic analysis to categorize recommendations into domains.

RESULTS

Participants developed and refined 48 unique recommendations to improve hospital maternity care for their communities, categorized into seven domains. Top-rated recommendations included: Respecting patient preferences/requests.Trainings to educate and un-bias clinicians.Engaging patients and clinical teams with the "Black Birthing Bill of Rights."Racially-, culturally-, and/or community-concordant programs and care teams.Hospital-based community task forces.Collecting patient feedback at discharge using tablets with clinician photos.

DISCUSSION: The recommendations affirm guidance from other realms of reproductive care and reveal new strategies for hospitals to better serve affected communities.

HEALTH EQUITY IMPLICATIONS: Community-generated recommendations offer actionable and responsive ways for hospitals to improve maternal health care. These strategies are likely transferable across diverse hospital settings.