Perinatal healthcare access, perceived quality, and preferences among historically underrepresented mother-infant dyads: a mixed methods study.

backgroundTimely and accessible prenatal and postpartum healthcare supports the health and well-being of the mother-infant dyad, enabling detection and prevention of pregnancy-related complications and chronic conditions. In the U.S., maternal mortality and morbidity are disproportionately higher in Black and Hispanic/Latina women. Focused, intentional dyadic care informed by patient perspectives can improve healthcare access and mitigate inequities.

aimTo understand factors influencing access to and perceived effectiveness of perinatal healthcare for mother-infant dyads by exploring perspectives, preferences, perinatal health knowledge, and opportunities to empower mothers from historically marginalized or underrepresented backgrounds, to promote health advocacy.

methodsIn this mixed-methods study, our interdisciplinary team administered an iteratively developed interview guide and survey with purposively sampled English/Spanish-speaking women who received care at a maternal-infant mobile medical clinic or a postpartum heart health program, settings where patients are primarily covered by Medicaid insurance. Phone interviews were recorded via a videoconferencing app, transcribed with automated software, and edited by research team members. A four-person coding team (two of whom speak Spanish) coded transcripts in original languages in Dedoose. Discrepancies were resolved by consensus, and the constant comparative method was applied to identify emerging themes. Descriptive statistics were applied to quantitative data, which consisted of a brief survey of participant demographics, health problems, and preferences for perinatal care.

resultsOf the 22 in-depth interviews (9 Spanish,13 English), half chose either a home or mobile medical clinic visit as their preferred care setting, and half reported a missed clinic-based appointment due to lack of transportation. Key themes reflected postpartum healthcare priorities: (1) multi-level support centered around mother-infant dyad preference (cross-cutting theme); (2) collective well-being (fostering connection and communal experience); (3) improved provider communication and education (to empower self-care and health knowledge); and (4) responsive and personalized perinatal care (meeting women where they are at).

conclusionWomen's perspectives reflected the need for multilevel support with specific attention to community and relationship strengthening, provider engagement, and policy reforms around social support (e.g., benefits and insurance). Findings suggested that prioritizing holistic, patient-centered perspectives may enhance interactions with healthcare systems and contribute to improving perinatal health equity.