JMIR Res Protoc. 2025 Jun 16;14:e70076. doi: 10.2196/70076.
ABSTRACT
BACKGROUND: Maternal mental health disorders are associated with adverse maternal and infant health outcomes. Despite advances in screening and treatment, disparities in maternal mental health disorders continue to disproportionately affect Black mothers and birthing persons. While there are studies that have examined maternal mental health, a gap in research remains in understanding the protective and risk factors of Black maternal mental health in Canada. Identifying the risks and protective factors is critical for advancing equitable and inclusive policies and practices that promote maternal well-being and optimal outcomes for Black perinatal populations.
OBJECTIVE: This paper presents an outline of a study protocol that seeks to identify the protective and risk factors of Black maternal mental health and to engage Black mothers and birthing persons from the Greater Toronto Area in codesigning a culturally safe and inclusive best practices model to inform policy and interventions.
METHODS: The proposed study will use an exploratory 3-phase sequential mixed methods approach underpinned by the principles of health equity and community-based participatory research. Phase 1 will involve engaging Black mothers and birth persons (n=300) in a survey to examine the psychosocial determinants of Black maternal mental health, including depression, anxiety, discrimination, strong Black women trope, attitude toward seeking mental health, support, and stigma. In phase 2, we will conduct 6 focus groups and individual interviews (n=60) to explore the stressors in the context of Black mothers and birth persons' everyday lives, psychosocial and support needs, and conditions that promote their resilience. Finally, phase 3 will engage Black women and birthing persons (n=30) in a codesign session using the concept mapping method to identify priority areas for action to inform policy and programming. We will use SPSS version 26 (IBM Corp) to analyze the survey data, drawing on both descriptive and inferential statistics. NVivo (Lumivero), a qualitative data analysis software, will be used to organize the data from phase 2 into meaningful themes informed by Braun and Clarke's thematic analysis approach.
RESULTS: Ethics approval was granted in July 2024. Data collection for phase 1 started in December 2024 and will be completed in April 2025. Findings from phase 1 will inform phases 2 and 3 of this study, which will be conducted in the third quarter of 2025. We will disseminate the results of this study in the second and third quarters of 2025.
CONCLUSIONS: The findings will generate the much-needed knowledge to shift policy, practice, and research and support capacity building among Black mothers and birthing persons. In addition, the proposed study will contribute to informing policy initiatives and interventions at the health system and community level to advance mental health equity and build capacity among service providers to provide culturally safe and equitable mental health care.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/70076.
PMID:40523275 | PMC:PMC12209720 | DOI:10.2196/70076
J Womens Health (Larchmt). 2025 Jun;34(6):843-854. doi: 10.1089/jwh.2024.0544.
ABSTRACT
Abortion bans may exacerbate high maternal mortality and severe maternal morbidity (SMM) in the United States. We estimate the expected increase in maternal deaths and SMM arising from banning abortion and continuing pregnancy in 14 states with bans (or no providers). Compiling national, state, and race/ethnicity-specific data on abortion, maternal mortality rate (MMR), and SMM, we conduct a cross-sectional prediction of additional maternal deaths and SMM overall and by race/ethnicity over a 4-year period, beginning 1 year after a state enforced an abortion ban. Our main prediction assumes all wanted abortions are denied in-state, each abortion denied leads to 0.336 births, and a respective increase in exposure to maternal mortality and SMM occurs. We conduct sensitivity analyses to estimate additional deaths and SMM under various travel and self-managed abortion scenarios. Using state-specific MMRs, we predict 42.0 (95% confidence interval [CI]: 33.5, 51.7) additional maternal deaths over 4 years in the 14 states (sensitivity range: 17.0-66.9) compared with 31.7 (95% CI: 30.4, 33.0) using the national MMR (sensitivity range: 12.9-50.64). Applying 2016-2017 national and region-specific SMM rates, we estimate 2,174 and 2,241 new SMM, respectively. Applying 2018-2021 national SMM rates, we predict 2,693 additional SMM. Among 10 states, we predict 29.6 more maternal deaths, with Black women representing 63%. Racial inequities in maternal deaths are pronounced in certain states. Despite innovative efforts to expand abortion access, not all the harms of Dobbs will be ameliorated. State-level policymakers and practitioners must improve maternal health care to mitigate geographic and racial disparities.
PMID:40499067 | DOI:10.1089/jwh.2024.0544
Womens Health (Lond). 2025 Jan-Dec;21:17455057251338929. doi: 10.1177/17455057251338929. Epub 2025 Jun 6.
ABSTRACT
Racial and ethnic disparities in maternal health persist in the United States despite continued efforts to make healthcare more equitable. The COVID-19 pandemic and overturning of Roe v Wade have further widened existing disparities in maternal healthcare. In this era of advanced technology, innovative tools like health information technology (IT) should be leveraged to address and reduce disparities in maternal health outcomes. Ongoing projects have demonstrated the potential for collaboration to prioritize patient autonomy in improving maternal health. However, further research is necessary to evaluate the effectiveness of these interventions in achieving equitable outcomes.
PMID:40478529 | PMC:PMC12144377 | DOI:10.1177/17455057251338929
JAMA Netw Open. 2025 Jun 2;8(6):e2513578. doi: 10.1001/jamanetworkopen.2025.13578.
ABSTRACT
IMPORTANCE: Given that nearly one-third of US births are cesarean deliveries, subsequent births after a cesarean delivery are common. Racial and ethnic disparities in severe maternal morbidity (SMM) have been well-documented, and prior studies have identified differences in birth mode after prior cesarean delivery by race and ethnicity.
OBJECTIVE: To examine variation by race and ethnicity in the association between SMM and birth mode for individuals with a prior cesarean delivery.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Massachusetts linked birth certificate and hospital discharge data from 2012 to 2021. The analytic sample was limited to births to individuals with 1 prior cesarean delivery. Data were analyzed from August 23, 2024, to March 31, 2025.
EXPOSURES: Race and ethnicity and birth mode (vaginal birth after cesarean delivery, planned repeat cesarean delivery, and unplanned repeat cesarean delivery).
MAIN OUTCOME AND MEASURES: SMM was measured using Centers for Disease Control and Prevention indicators. Associations of race and ethnicity and birth mode with SMM were calculated using logistic regression, then an interaction term was added between race and ethnicity and birth mode. Models controlled for covariates.
RESULTS: The study population included 72 836 individuals (mean [SD] age, 32.40, [5.03] years), of whom 8022 (11.0%) were Black, 14 664 (20.1%) were Latinx, and 41 350 (56.8%) were White. Approximately one-third of individuals were born outside the US (25 119 individuals [34.5%]). In adjusted analyses, Black individuals had higher odds of SMM compared with White individuals (adjusted odds ratio [AOR], 1.60; 95% CI, 1.25-2.05). Odds of SMM were higher for unplanned repeat cesarean birth (AOR, 3.05; 95% CI, 2.23-4.18) compared with vaginal birth after cesarean delivery, and higher for planned repeat cesarean birth compared with vaginal birth after cesarean delivery (AOR, 1.57; 95% CI, 1.20-2.06). Including an interaction term identified variation in the association between birth mode and SMM by race and ethnicity. Planned repeat cesarean birth vs VBAC was associated with an increase in the likelihood of SMM of 0.56 (95% CI, 0.21-0.90) percentage points (P = .001) among Black birthing people and 0.46 (95% CI, 0.16-0.76) percentage points (P = .003) among Latinx birthing people, while among White individuals, the likelihood of SMM did not differ between planned repeat cesarean birth and VBAC.
CONCLUSIONS AND RELEVANCE: In this cross-sectional study of births among individuals with a prior cesarean birth, patterns of SMM by birth mode varied by race and ethnicity, with elevated rates of SMM among those from marginalized racial and ethnic groups with planned cesarean births. Future work should identify interventions to improve quality of care and promote equity for this population.
PMID:40459888 | PMC:PMC12134949 | DOI:10.1001/jamanetworkopen.2025.13578
Int J Equity Health. 2025 Jun 2;24(1):160. doi: 10.1186/s12939-025-02506-2.
ABSTRACT
OBJECTIVE: In this meta-analysis we explore significant health disparities in maternal and newborn health among Syrian refugees residing in Turkey.
METHOD: The study protocol was registered in PROSPERO. We conducted a comprehensive literature search across six databases, including sources in English and Turkish, as well as relevant UN agencies, covering the period from 2011 (the onset of the Syrian conflict) to September 2024. This research specifically targets Syrian mothers aged 15 to 49 who were either pregnant or had recently given birth in Turkey, including studies with observational cross-sectional or retrospective designs. The quality of the included studies was evaluated using the JBI Critical Appraisal Checklist. Statistical analyses were performed using R version 4.4.1.
RESULT: Of 382 studies in English and Turkish, 29 papers, 2 reports and 1 postgraduate thesis were selected for full-text evaluation. Syrian migrants were more at risk of anemia in the third trimester of pregnancy [RR: 2.27 (95% CI: 1.57 to 3.32)], and had less access to antenatal care [RR: 0.39 (95% CI: 0.26 to 0.58)] and iron supplementation during pregnancy [RR: 0.69 (95% CI: 0.46 to 0.96)] compared to the native population. The risks of adolescent pregnancy [RR: 3.78 (95% CI: (3.06 to 4.88)] and home birth [RR: 3.68 (95% CI: (2.53 to 5.27)] were higher among migrants [RR: 3.78 (95% CI: (3.06to 4.88)]. Conversely, migration was an important factor in gestational diabetes [RR: 0.44 (95% CI: (0.21 to 0.90)] and newborn macrosomia [RR: 0.54 (95% CI: (0.50 to 0.58)] as well as preeclampsia [RR: 0.56 (95% CI: (0.32 to 0.98)].
CONCLUSION: Our data revealed that Syrian migrant mothers face a higher risk of anemia, limited access to antenatal care and iron supplements, and higher rates of adolescent pregnancies and home births compared to their native counterparts. However, migration appears to have a protective effect on gestational diabetes and preeclampsia. The results underscore the need for targeted health interventions and policies that address access to maternal healthcare services.
PMID:40457273 | PMC:PMC12128300 | DOI:10.1186/s12939-025-02506-2