Maternal Perceptions and Solutions to Perinatal Health Issues in Alabama

Abstract

Despite recent efforts to improve poor perinatal and infant health outcomes in Alabama, the state is the second-worst in the nation to give birth, with a rising maternal mortality rate, and high rates of infant mortality and babies born too small and too early. Ethnographic research methods were employed to identify the greatest perinatal health issues and strengths as experienced by perinatal providers and professionals (n=25), and mothers/birth parents (n=33) in each of the five perinatal health regions in the state. Here, we center on maternal/birth parents’ experiences shared in six focus groups. Consensus coding and thematic analysis revealed five themes: 1) Lack of Evidence Based Care; 2) Availability & Access; 3) Social Determinants of Health; 4) Bias in Healthcare; and 5) Community Building and Desire for Change. Maternal and birth parent experiences demonstrate the widespread impact of structural violence within the perinatal care system, particularly in the form of obstetric violence, racism, gender-based violence, and authoritative knowledge. Strengths and subsequently the gaps in the perinatal care system that impact both marginalized and relatively privileged communities were identified in the study. These experiences also highlight the death of care after birth that we believe is driving maternal and infant mortality rates in the state. Maternal/birth parent narratives illustrate the negative outcomes of a fetocentric society while also highlighting the sites in which systemic changes could enhance efforts to improve poor outcomes in the state.