Culturally-centered care increases feelings of respect, autonomy for birthing people of color

Black and Indigenous birthing people die up to three times as often from pregnancy-related complications than their white counterparts. University of Minnesota (U of M) researchers partnering with Roots Community Birth Clinic (Roots) in Minneapolis found that alternative care models centering the birthing person’s culture and relationships may be able to improve their experiences and health during pregnancy. 

The study, published in the Maternal and Child Health Journal, was led by former University of Minnesota Medical School researcher Jennifer Almanza and drew data from a larger project with Roots headed by senior author, School of Public Health Associate Professor, and Blue Cross Endowed Professor of Health and Racial Equity Rachel Hardeman, and predoctoral trainee J’Mag Karbeah. 

“The findings of this study strongly suggest that investment in culturally-centered approaches such as those used at Roots Community Birth Center could yield improved outcomes for BIPOC birthing people,” said Karbeah.

One factor in reproductive health disparities among birthing people may be mistreatment in health care settings, with Black, Indigenous and people of color (BIPOC) people reporting experiences of mistreatment in hospitals two to three times as often as white counterparts. More than 98% of births in the United States occur in hospital settings, but Roots shows community clinics can be a beneficial alternative for birth outcomes. 

“This study takes previous findings that have shown community birth center care offers better experiences in autonomy and respect and furthers it by saying when that care is provided with a culturally-centered approach, BIPOC experiences are even further improved,” said Almanza. “Additionally, it shows that overall, regardless of race, birthing people have higher levels of autonomy and respect when provided care that centers on what is most important to them culturally."

The study examined the value of culturally-centered care by comparing feelings of autonomy and respect during birthing experiences from people who received care from Roots versus the national Giving Voice to Mothers study, which largely surveys women giving birth at hospitals where this type of care is not emphasized. 

The study found that:

• BIPOC clients reported feeling more autonomy and respect when they received culturally-centered care at the Roots clinic compared to participants in the national survey.
• Decreasing the variance in how BIPOC clients feel in terms of autonomy and respect might enhance their overall experience of perinatal care. 
• The findings confirm of previous study results suggesting that giving birth at a community birth center is protective against experiences of discrimination when compared to care in the dominant, hospital-based system.

"The big deal about this study is that it confirms what those of us working in reproductive, sexual health already know: culture is curative and not an added risk factor to poor health outcomes,” said Almanza. “As we re-align medical practices with the understanding that race should not be incorporated into risk-factor algorithms — and that employment of modern epidemiology and public health can offer a more comprehensive understanding of disparate outcomes — we also need to amplify solutions that are rooted in culture and created by those most impacted.”

The researchers recommend that policies on maternal health care reimbursement should be designed to add focus on making community birth sustainable, especially for BIPOC provider-owners offering culturally-centered care. They also think that future testing of culturally-matched care as an intervention to improve client experiences and perinatal outcomes should control for baseline differences of childbearing people who receive culturally-matched care versus those who do not. 

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Support for the Roots Birth Center study was provided by a grant from the Robert Wood Johnson Foundation’s Interdisciplinary Research Leaders Program; by the NIH grant-funded Biostatistics and Bioinformatics Core of the Masonic Cancer Center; by the National Center for Advancing Translational Sciences; and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). This project also benefited from support provided by the Minnesota Population Center. 

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