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Edition 34 – Lessons Learned From a Maternal Health-Focused Podcast Mini-Series Created for Pregnant and Postpartum Black, Indigenous, and People of Color


34 – MCH

Lessons Learned From a Maternal Health-Focused Podcast Mini-Series Created for Pregnant and Postpartum Black, Indigenous, and People of Color

By Kai Holder, BA,
Rabih Dahdouh, MS,
Cassandra A. A. Osei, MPH,
Nihmotallahi A. Adebayo, BS,
Laura Tom, MS,
Dr. Catherine O’Brian, MS, PhD,
Ivy Leung, MS,
Araceli Estrada, BS,
Dr. Melissa Simon, MD, MPH,

Citation

Holder K. Dahdouh R. Osei C. Adebayo N. Tom L. O’Brian C. Leung I. Estrada A. Simon M. Lessons learned from a maternal health focused podcast mini-series created for pregnant and postpartum black, indigenous, and people of color. HPHR. 2021;34

Lessons learned from a maternal health-focused podcast mini-series created for pregnant and postpartum Black, Indigenous, and People of Color

Abstract

Background: Black, Indigenous, and People of Color (BIPOC) face complex and unique healthcare barriers, which are especially significant in the context of prenatal and postpartum care. Unfortunately, there are few educational resources that are tailored for BIPOC pregnant and birthing persons. Podcasting is a nontraditional media format that has emerged as an effective communication tool to reach BIPOC patients and has the potential to enhance patient engagement on healthcare topics. Our team utilized podcasts in the form of a Maternal Health-focused limited series as an innovative form of media to detail inequities within the current healthcare system that affect BIPOC pregnant and birthing individuals and to also provide information about resource referrals, advocacy, and methods for birthing individuals to confront these inequities and to assist healthcare providers better address these disparities in their clinical practices.

Introduction

Black, Indigenous, and People of Color (BIPOC) face complex and unique healthcare barriers, which are especially significant in the context of prenatal and postpartum care. These barriers include, but are not limited to, racism and discrimination (implicit and explicit biases, disrespect, coercion, or intimidation from healthcare providers); various systemic and structural barriers (e.g., healthcare access, language barriers, transportation, unstable housing, and food insecurity); and psychosocial barriers (e.g., medical distrust, life stressors, and trauma.1-4

 

Due to these barriers, BIPOC pregnant and birthing persons are tasked with being their own self-advocate during their prenatal and postpartum healthcare journeys. Thus, it is crucial that BIPOC individuals, who are at higher risk of obstetric morbidity and mortality, are empowered to advocate for high quality healthcare. At the same time, it is important that patient agency is encouraged in a way that minimizes information overload. Unfortunately, many resources currently available online, including those targeting maternal mortality and morbidity, are not accessible for patients and/or are written in language riddled with hard-to-understand medical jargon and terminology. Additionally, there are very few educational resources that are tailored for BIPOC pregnant and birthing persons specifically.

 

Podcasting is a nontraditional media format that has emerged as an effective communication tool to reach patients and the public and has potential to enhance patient engagement on healthcare topics.5 Recent data show tremendous growth in podcast listeners, from 12% of US adults ten years ago to 37% in 2020 having listened to a podcast.6 New podcast listeners are 65% women and 30% people of color.7 Health, pregnancy, and parenting related podcasts have listeners in 23 million US households according to a recent Nielsen report. Our team at Northwestern University Feinberg School of Medicine’s Center for Health Equity Transformation, utilized podcasts in the form of a Maternal Health-focused limited series as an innovative form of media with the intention of building, understanding, attracting, sustaining interest, and engaging pregnant and postpartum individuals in making meaningful connections.8-10

 

Thus far six episodes of the podcast’s limited series have been recorded with experts in various fields within maternal health including two physicians with master’s degrees in public health, a breast-feeding peer support counselor, a maternal criminal justice advocate, a policy maker, and a public administrator. This podcast series details inequities within the current healthcare system that affect BIPOC pregnant and birthing individuals, and it also provides information about resource referrals, advocacy, and methods for birthing individuals to confront these inequities This podcast helps healthcare providers better address these disparities in their clinical practices. The episodes that have been recorded are as follows:

 

  • The consequences of poor Medicaid policies and reimbursement rates on maternal health
  • The Black-white maternal disparity and its impacts on Black pregnant individuals’ pre- and post-natal care experiences
  • Binary gender dynamics and its impact on maternal health
  • ACE scores, PTSD, violence, and their impact on pregnancy and birth
  • Inadequate breast-feeding support in the clinical and socio-cultural environment

 

 

Various themes have emerged from these podcast episodes, and below are some lessons learned:

Themes

Postpartum Medicaid coverage must be extended

“Right now, we have a nation that only gives [Medicaid postpartum] coverage for six weeks and we’re saying we need that coverage for a full year because maternal mortality can happen up to a year after giving birth, and so cutting off coverage at six weeks with the folks that are most vulnerable is unsound and morally unconscionable.”

Patient self-agency is crucial to navigate the socio-cultural environment during pregnancy and post-partum

“I teach the importance of a paper trail, and that everyone that works in healthcare knows if it isn’t in writing, then it didn’t happen…It’s very important for [patients] to write it down as well. Especially now that a lot of hospitals are creating birth equity committees. This type of correspondence can help hospital committees understand the experiences of women and thus work on ways of preventing these situations from happening.”

 

Obstetric providers have an important role in advocating for marginalized patients

“As a physician, you have an ethical duty to speak up about social inequity because we know it basically causes all the issues I’m dealing with every single day as a clinician. I [also] tell my patients that a door is always open. So, you do not have to sit at home and worry that I’m bothering some doctor, or that I am overreacting.”

Maternal Health disparities exist not due to a “natural” biological cause but rather reflect the impacts of structural racism

“There’s nothing wrong with Black women, there’s nothing wrong with Black people experiencing pregnancy and how they take care of themselves or their mothering.

What’s wrong is society. When we look at why Black women are two to three times more likely to die as a result of pregnancy-related complications, the answers are the root causes: structural racism and gender oppression. Both converge to create this disparity and happen over the course of Black people’s lives. Those stressors erode our sense of safety and have an actual biological impact on our health and well-being. And on top of those stresses, we put the stress of pregnancy. This is why we wind up dying. Race is not the problem, racism is.”

Conclusion

 

This maternal health focused podcast series further highlighted that the prenatal and postpartum healthcare system is exceedingly difficult to navigate as a BIPOC pregnant individual. It conveyed that the disparities in healthcare outcomes seen in this population are the culmination of life-long stressors that are exacerbated during the perinatal period. Since several of the podcast guests discussed the significance of patient self-advocacy and wellness as well as providers advocating for marginalized patients, we suggest that podcasts are an impactful, culturally grounded educational format with the ability to reach both patients and clinicians; can engage audiences at varying health literacy levels; and can assist in educating and supporting birthing individuals while guiding clinicians to improve their care practices.

Acknowledgements

Research reported in this publication was supported by the National Library Of Medicine of the National Institutes of Health under Award Number G08LM013188. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Disclosure Statement

The author(s) have no relevant financial disclosures or conflicts of interest.

References

[1] Heaman MI, Sword W, Elliott L, et al. Barriers and facilitators related to use of prenatal care by inner-city women: perceptions of health care providers. BMC Pregnancy Childbirth. 2015;15(1):2. doi:10.1186/s12884-015-0431-5

 

2 Mazul MC, Salm Ward TC, Ngui EM. Anatomy of Good Prenatal Care: Perspectives of Low Income African-American Women on Barriers and Facilitators to Prenatal Care. J Racial and Ethnic Health Disparities. 2017;4(1):79-86. doi:10.1007/s40615-015-0204-x

 

3 Edmonds BT, Mogul M, Shea JA. Understanding Low-Income African American Women’s Expectations, Preferences, and Priorities in Prenatal Care. Family & Community Health. 2015;38(2):149-157. doi:10.1097/FCH.0000000000000066

 

4 Lantz PM. Can Communities and Academia Work Together on Public Health Research? Evaluation Results From a Community-Based Participatory Research Partnership in Detroit. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2001;78(3):495-507. doi:10.1093/jurban/78.3.495

 

5 Nwosu AC, Monnery D, Reid VL, Chapman L. Use of podcast technology to facilitate education, communication and dissemination in palliative care: the development of the AmiPal podcast. BMJ Support Palliat Care. 2017;7(2):212-217. doi:10.1136/bmjspcare-2016-001140

 

6 Rain News. New podcast listeners and diversity U.S. 2019. Statista. Published March 16, 2020. Accessed November 15, 2021. https://www.statista.com/statistics/1122762/us-podcast-consumer-diversity/

 

7 Rain News. Podcast listeners and diversity U.S. 2019. Statista. Accessed November 15, 2021. https://www.statista.com/statistics/1122762/us-podcast-consumer-diversity/

 

8 Loftus CT, Stewart OT, Hensley MD, Enquobahrie DA, Hawes SE. A Longitudinal Study of Changes in Prenatal Care Utilization Between First and Second Births and Low Birth Weight. Matern Child Health J. 2015;19(12):2627-2635. doi:10.1007/s10995-015-1783-1

 

9 American Academy of Pediatrics, The American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. Published online October 1, 2012. Accessed November 15, 2021. https://publications.aap.org/aapbooks/book/421/Guidelines-for-Perinatal-Care

 

10 Haigh C, Hardy P. Tell me a story — a conceptual exploration of storytelling in healthcare education. Nurse Education Today. 2011;31(4):408-411. doi:10.1016/j.nedt.2010.08.001

Acknowledgements

We express our heartfelt gratitude to Dr. K. Shreedhara Avabratha, Professor and Head of the Department of Pediatrics at Father Muller Medical College for his constant help, guidance and encouragement.

About the Authors

Kai Holder, BA

Kai Holder is a second year medical and public health dual degree student at Northwestern Feinberg School of Medicine. Prior to her graduate studies, Kai received a BA in Political Science from the University of Pennsylvania. Before entering medical school, she worked as a community health worker for BIPOC pregnant and birthing individuals. Her research interests include maternal-child health and equitable patient communication.

Rabih Dahdouh, MS

Rabih Dahdouh has an extensive background in behavioral health, technology and preventive medicine. Most recently he worked with over 40 clinical partners delivering mental health services with an integrated digital platform to underserved populations across the country. Previously he’s worked in the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine as research project manager for the Keep Your Heart Healthy (KYHH) program. He also served as Director of Communications & Engagement with the All of Us Research Program at Northwestern with a mission to enroll 1 million people to speed up health research breakthroughs to advance precision medicine. Rabih completed his BS in Child Learning & Development and MS in Psychological Sciences at the University of Texas at Dallas.

Cassandra A. A. Osei, MPH

Cassandra Osei leverages over six years of interdisciplinary research and professional experience in population health, maternal health, and public policy and administration to promote social and health equity and inclusion as the Clinical Research Project Manager at Northwestern’s Center for Health Equity Transformation. Their experience supports a passion for investing in the success and resiliency of historically underserved and underrepresented populations. Cassandra holds an MPH from Boston University School of Public health in Social Behavioral Sciences and Epidemiology. Currently, they are a Ph.D. student at KU’s School of Public Affairs and Administration with a specialization in Public Policy and the Social Determinants of Health, and a secondary focus in population health and health disparities. Their research assesses the role and impact of collaborative governance and innovation on maternal health and mortality.

Nihmotallahi, A, Adebayo, BS.

Nihmotallahi Adebayo is a Research Assistant in the Simon lab at the Center for Health Equity Transformation, Feinberg School of Medicine. She primarily works on the National Library of Medicine projects and holds both a BA in Neuroscience with a minor in Global Health and a MS in Health Communication degree from Northwestern University.

Laura Tom, MS

Laura Tom is a Clinical Research Associate at Northwestern University. Laura received her MS in social and behavioral sciences and BA in sociology from Harvard University.

Dr. Catherine O’Brian, MS, PhD

Catherine O’Brian is a scientific editor at the Center for Health Equity Transformation of Northwestern University.

Ivy Leung, MS

Ivy Leung graduated from Chinese University of Hong Kong with a Bachelor degree in Geography and obtained her M.S. in Administration of Justice from SIUC.

Araceli Estrada, BS

Araceli Estrada is a Research Project Coordinator in the Center for Health Equity Transformation (CHET).  Araceli received her B.S. in Biological Sciences from the University of Illinois at Chicago. She is a Chicago native and volunteers locally as a Spanish interpreter at CommunityHealth.

Dr. Melissa Simon, MD, MPH

Melissa Simon is an expert in implementation science, women’s health across the lifespan, minority health, community engagement and health equity. She has been recognized with numerous awards for her substantial contribution to excellence in health equity scholarship, women’s health and mentorship, including the Presidential Award in Excellence in Science Mathematics and Engineering Mentorship and a Presidential Leadership Scholar. She is a former member and current consultant to the US Preventive Services Task Force, serves on the NIH Office of Research in Women’s Health Advisory Committee, and is also a member of the National Academy of Medicine’s Roundtable on the Promotion of Health Equity.