abstract: 'Health inequities are not caused by personal failings or shortcomings

  within disadvantaged groups, which can be erased with behavioral

  interventions. The scope of the problem is much greater and will only

  fully be addressed with the examination of the systems, structures, and

  policies that perpetuate racism, classism, and an economic, class, race,

  or gender divide between patients and the people who care for them.

  Solution-oriented strategies to achieve health equity will remain

  elusive if researchers continue to focus on behavior modification in

  patients while failing to do harder work that includes focusing on the

  institutions, community, and societal contexts in which pregnant women

  are living; addressing social determinants of health; considering racism

  in study design, analysis, and reporting; valuing the voices of

  patients, practitioners, and researchers from historically disadvantaged

  groups; disseminating research findings back to the community; and

  developing policy and reimbursement structures to support care delivery

  change that advances equitable outcomes. A case study shows us how group

  prenatal care may be one viable vehicle through which to affect this

  change. Group prenatal care is one of the few interventions shown to

  improve pregnancy outcomes for black women. Studies of group prenatal

  care have predominantly focused on the patient, but here we propose that

  the intervention may exert its greatest impact on clinicians and the

  systems in which they work. The underlying mechanism through which group

  prenatal care works may be through increased quantity and quality of

  patient and practitioner time together and communication. We hypothesize

  that this, in turn, fosters greater opportunity for cross-cultural

  exposure and decreases clinician implicit bias, explicit bias, and

  racism, thus increasing the likelihood that practitioners advocate for

  systems-level changes that directly benefit patients and improve

  perinatal outcomes.

  taged groups, which can be erased with behavioral interventions. The

  scope of the problem is much greater and will only fully be addressed

  with the examination of the systems, structures, and policies that

  perpetuate racism, classism, and an economic, class, race, or gender

  divide between patients and the people who care for them.

  Solution-oriented strategies to achieve health equity will remain

  elusive if researchers continue to focus on behavior modification in

  patients while failing to do harder work that includes focusing on the

  institutions, community, and societal contexts in which pregnant women

  are living; addressing social determinants of health; considering racism

  in study design, analysis, and reporting; valuing the voices of

  patients, practitioners, and researchers from historically disadvantaged

  groups; disseminating research findings back to the community; and

  developing policy and reimbursement structures to support care delivery

  change that advances equitable outcomes. A case study shows us how group

  prenatal care may be one viable vehicle through which to affect this

  change. Group prenatal care is one of the few interventions shown to

  improve pregnancy outcomes for black women. Studies of group prenatal

  care have predominantly focused on the patient, but here we propose that

  the intervention may exert its greatest impact on clinicians and the

  systems in which they work. The underlying mechanism through which group

  prenatal care works may be through increased quantity and quality of

  patient and practitioner time together and communication. We hypothesize

  that this, in turn, fosters greater opportunity for cross-cultural

  exposure and decreases clinician implicit bias, explicit bias, and

  racism, thus increasing the likelihood that practitioners advocate for

  systems-level changes that directly benefit patients and improve

  perinatal outcomes. Key words: centering pregnancy, group prenatal care,

  health equity, racism'
affiliation: 'Carter, EB (Corresponding Author), Washington Univ, Sch Med, Dept Obstet
  \& Gynecol, Div Maternal Fetal Med, St Louis, MO 63110 USA.

  Carter, Ebony B., Washington Univ, Sch Med, Dept Obstet \& Gynecol, Div Maternal
  Fetal Med, St Louis, MO 63110 USA.

  EleVATE Women Collaborative, St Louis Integrated Hlth Network, St Louis, MO USA.

  Mazzoni, Sara E., Univ Washington, Sch Med, Dept Obstet \& Gynecol, Div Gen Obstet
  \& Gynecol, Seattle, WA 98195 USA.'
author: Carter, Ebony B. and Mazzoni, Sara E. and Collaborative, EleVATE Women
author-email: ebcarter@wustl.edu
author_list:
- family: Carter
  given: Ebony B.
- family: Mazzoni
  given: Sara E.
- family: Collaborative
  given: EleVATE Women
da: '2023-09-28'
doi: 10.1016/j.ajog.2020.11.040
earlyaccessdate: MAR 2021
eissn: 1097-6868
files: []
issn: 0002-9378
journal: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
keywords: centering pregnancy; group prenatal care; health equity; racism
keywords-plus: 'GROUP PRENATAL-CARE; PRETERM BIRTH; UNITED-STATES; DISPARITIES; EQUITY;

  CENTERINGPREGNANCY; STUDENTS; IMPACT; BIAS'
language: English
month: APR
number: '4'
number-of-cited-references: '29'
orcid-numbers: Carter, Ebony/0000-0002-7620-4929
pages: 359-361
papis_id: 5ac7e48161aade1390dfceafe6dab3fd
ref: Carter2021paradigmshift
times-cited: '17'
title: A paradigm shift to address racial inequities in perinatal healthcare
type: Article
unique-id: WOS:000637866800003
usage-count-last-180-days: '0'
usage-count-since-2013: '15'
volume: '224'
web-of-science-categories: Obstetrics \& Gynecology
year: '2021'