Graduation Year
2023
Document Type
Dissertation
Degree
Ph.D.
Degree Name
Doctor of Philosophy (Ph.D.)
Degree Granting Department
Public Health
Major Professor
Dinorah Martinez-Tyson, Ph.D.
Co-Major Professor
Roneé Wilson, Ph.D.
Committee Member
Jason Salemi, Ph.D.
Committee Member
Jean-Paul Tanner, Ph.D.
Committee Member
Deborah Austin, Ph.D.
Keywords
birth equity, black women, father involvement, perinatal health, social support
Abstract
Background: The preventable, persistent racial inequity observed in maternal and infant death has lasting impacts on African American communities and families. Fathers, partners, and co-parents are important supports during the sensitive and vulnerable perinatal period. Emerging research has begun to demonstrate a concerted effort to move beyond the sphere of medicine and quality improvement, towards exploring and integrating social factors into targeted intervention strategies to address racial inequality in health outcomes. However, sparse literature concentrates on understanding the role of fathers and partners in peripartum care and maternal health outcomes. This study aimed to explore, understand, and describe the role of paternal involvement in the observed racial inequality in severe maternal morbidity and the navigation of systems of obstetric care in Florida.
Methods: We developed a mixed methodological study with a transformative sequential design to explore the role of paternal/partner acknowledgement, involvement, and inclusion and severe maternal morbidity in Florida. We used semi-structured, individual phenomenological interviews to explore the lived experience of Black women during pregnancy, childbirth, and postpartum, in relation to social support, the navigation of systems of obstetric care, and paternal involvement. Interviews also explored experiences with social support and paternal involvement across the lifespan. We also conducted a population-based, retrospective cohort study using birth certificate data linked to hospital discharge data via the Florida Department of Health to identify cases of severe maternal morbidity among non-Hispanic White, non-Hispanic Black, Hispanic Black, and Hispanic non-Black birthing persons in Florida. We used generalized estimating equations for logistic regression to estimate within-group and between-group estimations of risk associated with severe maternal morbidity and assessed paternal involvement as an effect modifier. Results: In this mixed methodological study, we found obstetric racism and the dehumanization of Black women in the birthing environment cultivates traumatic experiences, perpetuates harm, and facilitates adverse outcomes for Black mothers and birthing persons, as well as their infants, partners, and families. Racial inequality is likely operationalized through multi-level socio-demographic factors which shape perinatal outcomes through four main pathways: maternal health behavior, maternal psychological well-being, maternal physiological health, and provision of peripartum care. We found Black pregnant persons are at an increased risk of severe maternal morbidity in Florida, which was independent of socio-demographic factors and maternal perinatal health. Paternal involvement is an irreplaceable aspect of the pregnancy experience for Black birthing persons in Florida and operates as an effect modifier in the association between excess severe maternal morbidity and racial/ethnic background. However, the cumulative nature of racial inequality likely reduces the impact of paternal involvement on burden sharing, advocacy, and accessibility could have in mitigating the damage of racialized stress for Black birthing people. Study findings highlight the need for further investigation and the development of intervention strategies embracing and empowering fathers, partners, and co-parents, during the perinatal journey.
Conclusion: Overexposure to stressors across the lifespan and during the perinatal period differentially impacts the lived experience of Black mothers in Florida, who are uniquely vulnerable in the hospital delivery environment. Fathers, partners, and co-parents are an integral part of this journey. Multi-level, multi-pronged strategies employing family-centered, anti-racist approaches may help asymmetrically improve maternal outcomes among Black mothers.
Scholar Commons Citation
Fross, Marshara G., "Reframing Resistance, Resilience, and Racial Equity in Maternal Health: A Mixed Methods Exploration of Paternal Involvement and the Racial Disparity in Severe Maternal Morbidity" (2023). USF Tampa Graduate Theses and Dissertations.
https://digitalcommons.usf.edu/etd/10112
