Some African-American Women Not Aware of Future Risk After Preterm Birth
Key findings
- In three U.S. cities, a total of 60 African-American women who had had at least one prior preterm birth (PTB) participated in focus groups about their awareness of the risk of subsequent PTB
- PTB was often incorrectly defined by women as low birthweight, which prevented many participants from identifying that they had, indeed, experienced PTB
- There was a tendency for the women to consider PTB normal or to have a fatalistic attitude about its occurrence
- Some women did not receive information about the potential long-term health and developmental consequences of PTB, and most were not counseled about risk factors for PTB
- Focus group participants expressed a desire to receive information about PTB from their obstetric care provider, preferably at the first postpartum visit
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It's well established that African-American women are at higher risk of preterm birth (PTB) in the U.S. than white women. According to the Centers for Disease Control and Prevention (CDC), the respective rates were 14% versus 9% in 2018.
In March 2016, clinicians representing the National Medical Association, the Society for Maternal-Fetal Medicine and the American College of Nurse-Midwives met to discuss health inequities related to PTB in the African-American community. One outgrowth was a series of focus groups with African-American women who had experienced PTB, whether spontaneous or medically indicated.
Allison S. Bryant, MD, MPH, specialist in the Maternal-Fetal Medicine Program at Massachusetts General Hospital, and colleagues report lessons from those discussions in the Journal of Racial and Ethnic Health Disparities.
Participants and Objectives
Two focus groups were conducted in each of three U.S. cities (Atlanta, Baltimore and Boston) between October 4 and October 12, 2016. In total, 60 African-American women participated who had experienced at least one PTB in the past five years. In each city, one group included women with annual household incomes ≤$49,999 and the other included those with income ≥$50,000.
The overarching objective of the focus groups was to gain insight into whether the participants were aware of the risk of a subsequent PTB. Several broad topics were planned for the discussions, but the findings were grouped into five key themes based on the responses:
- Lack of knowledge about the definition of PTB: About half the participants considered their child to have been preterm. PTB was often incorrectly defined as one in which the baby was born underweight. There was a tendency for the women to believe in a difference between the terms "preterm/premature/preemie," with "preemie" regarded as more serious than "preterm"
- Tendency to normalize PTB: Some women assumed that if their own mothers gave birth at <37 weeks, PTB must be normal. Moreover, many participants expressed the belief that pregnancy is different for each woman and little can be done to change outcomes
- Varying levels of information about the potential long-term health and developmental consequences of PTB: Women who had an uncomplicated pregnancy and/or delivery received very little information about the potential consequences of the PTB
- Lack of information about risk factors for PTB: Only women who had experienced severe complications recalled specific conversations with their obstetric care provider about future risk of PTB. There was a greater lack of information among lower-income women
- Desire to receive information about PTB: The women read the take-home packets they received after childbirth and said they would welcome more content about pregnancy length. They viewed their obstetric care providers as the optimal source of information. Almost unanimously, women said they would be unable to focus on information about risk of subsequent PTB during the hospital stay after PTB. The first postpartum visit would be better timing
Race Is Not a Risk Factor
The statement that African-American women are a high-risk group was largely met with resentment, a valid reaction. Evidence suggests that race itself is not the root cause of high rates of PTB, but rather factors associated with being African-American, including health care inequities, experiencing institutional racism and, perhaps, higher psychosocial stress. Educational materials and counseling must take these facts into consideration.
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