PROJECT SUMMARY
The United States is facing a Black birthing crisis. Birth inequities disproportionately impact Black birthing patients, families, and communities. Disparities exist regardless of income-level or education, and black birthing patients are more than three times as likely to die from perinatal complications than White birthing patients, and experience morbidity at more than twice the rate of White birthing patients. Ripple effects of this grim reality reach Orange County (OC), California as well. Although only 2.3% of over 3 million residents living in OC identify as African-American or Black (72,477 residents), Black birthing people disproportionately are at highest risk of preterm delivery (12.3% vs. 6.8% for White birthing patients), and Black infants have the highest prevalence of low birth weight (9.8% vs. 5% for White infants). The Black PEARL (Promoting Equity Anti-Racism and Love) Model for systemic integration of community maternal support services (COMSS) was created to address the need for integrated care systems supporting a BIPOC community-based doula (CBD) workforce in OC and establish systemic integrated care with the only academic health center in the county, UCI Health. Through established community-academic partnerships between HERstory, Inc., UCI Health Douglas Hospital (providing level III maternal care services), the UCI School of Medicine (UCI SOM) Departments of Obstetrics and Gynecology, Pediatrics, and Family Medicine, the UCI Sue & Bill Gross School of Nursing (UCI SON), and the UCI SOM Program in Medical Education, Leadership Education to Advance Diversity–African, Black and Caribbean (PRIME LEAD-ABC) the Black PEARL project team will: 1) Establish the Black PEARL Community Advisory Board, which will provide council to support accountability and optimal care for BIPOC birthing families and provide guidance in the development of educational trainings for healthcare providers and trainees fostering awareness of implicit bias, birth ine
quities, cultural humility, and doula-partnered care; 2) Grow regional capacity to realize birthing equity and joy in OC by increasing the number of HERstory, Inc. BIPOC CBDs in the region from 7 to 14, training 40 CBDs, and supporting CBD integration into perinatal care at an academic medical center; and 3) Develop Black PEARL community outreach volunteer programs that screen for psychosocial and health needs and connect BIPOC birthing families with local resources to support BIPOC families’ well-being and encourage any breastfeeding through 3 months, while also supporting experiential learning opportunities for a future workforce of culturally humble healthcare providers who are skilled in advocating for birthing equity. Mixed methodology, using questionnaires, chart review, and community-based focus groups, will be utilized to assess patient and process outcomes, as well as doula and healthcare provider confidence, self-efficacy, and well-being. Project results are anticipated to realize birthing equity for Black birthing patients by reducing the frequency of cesarean sections (from 44.6% to 34%) and preterm deliveries (from 30% to 23%) to achieve birthing equity with White birthing patients, establishing baseline data for the prevalence of experiences with discrimination and perinatal mood and anxiety disorders (PMADs) among BIPOC birthing patients, and increasing any breastfeeding by BIPOC birthing patients to 80 % in comparison to the Orange County average of 74.1% at infant age three months. The Black PEARL model for COMSS integration is anticipated to be generalizable to diverse settings and have a replicable impact on reducing Black birth inequities.
