Addressing Maternal Health Disparities: Investigating the Role of Social Support on Maternal Health Outcomes and Community-Based Organizations that Provide Support to Pregnant and Postpartum Women of Color in the Greater Boston Area.

Abstract

Women from communities of color (WOC) in the United States are more likely to die from childbirth or pregnancy-related causes or experience severe maternal morbidity (SMM). The disparities faced by these WOC are driven by race/ethnicity, socioeconomic status, and environmental disadvantages. Social support can help women navigate the physiological, psychosocial, and environmental stressors that may arise during pregnancy and postpartum. With a goal to improve maternal health outcomes and reduce the disparities between WOC and their counterparts in other racial and ethnic groups, this thesis generates evidence on the effect of social support on maternal health outcomes, assesses the capacity and resources of Community-Based Organizations (CBOs) to provide social support services, and identifies the gaps faced in supporting WOC during pregnancy up to one year postpartum. A conceptual framework illustrates the determinants of maternal health outcomes and potential pathways of influence for social support. An analytical framework examines the effect of social support on SMM and pregnancy-related rehospitalizations. Surveys and semi-structured interviews conducted in 20 CBOs identify the gaps in social support provision. Findings show a 78% decrease in the adjusted odds of SMM in hospital encounters for women with partner support (adjusted odds ratio [AOR] = 0.215; P .001) compared to encounters without support. In addition, ten support service gaps were identified among CBOs, along with gaps in implicit bias training programs, employee diversity, and community involvement. Informed by the gaps, recommendations call for significant investments in additional social support services, partnerships with public, private, academic and community stakeholders, and prototyping alternative delivery methods, including task shifting and technology platforms.