Exploring Clinic Readiness to Engage in Systems Change Work

Systems-level interventions in hospital care are effective in advancing Black perinatal equity, but these interventions are often limited to care that is provided during labor, birth, and the initial post-partum period only. Outpatient clinics provide long-term perinatal care, often from the first trimester of pregnancy through 6 weeks postpartum. Therefore, it is crucial to include pediatric ambulatory care services in intervention strategies, as this is where infants receive care from birth through age 18—including the critical first year of life, during which Black infants are 3-4 times more likely to experience mortality than white infants (March of Dimes).

Birth equity efforts have historically centered on the hospital experience—understandably so, as most births in California take place in hospitals. However, the Coalition recognizes that hospitals account for only a small portion of the time patients and families spend during pregnancy and postpartum. To advance birth equity, outpatient clinics providing prenatal, postpartum, and pediatric care must also be included. 

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Approach

The Coalition conducted two observational clinic site visits in Los Angeles County and hosted a virtual clinic roundtable in the Fall of 2024 in order to explore approaches that increase clinic readiness to participate in systems change efforts to advance birth equity for Black families. During the site visits and roundtable discussion, the Coalition assessed current equity practices and opportunities for improvement by directly speaking with Black patients, Federally Qualified Health Centers (FQHC), Comprehensive Perinatal Services Program (CPSP), state-agency and other ambulatory care clinic staff. The following patient feedback and experiences were incredibly eye opening and aligned with what is well known about Black patient experiences in maternal healthcare. 

Key Take-Aways
From requiring clinics to participate in birth equity quality improvement efforts, to streamlining appointment and referral processes, removing insurance barriers to medical and community-based holistic care, and strengthening responses to patient grievances, there are numerous opportunities to advance birth equity for Black families within the outpatient clinic setting.

Continued birth equity work requires the addition of meaningful and direct engagement with outpatient clinics for assessment, education, training, and quality improvement opportunities designed to advance birth equity for Black families during all aspects of their clinic care, not isolated to the hospital experience. An additional key and often missing component of engagement in birth equity advancement includes insurance payers and managed care plans.

Both entities play a pivotal role in birth equity, but often are not included in conversations on how to improve access to care that families desire. The Coalition has identified the need for continued engagement with not only hospitals, but also outpatient clinics and insurance payers to determine the most effective ways to collaborate with all entities providing care for Black families during prenatal, hospital, postpartum, and pediatric care. Ultimately, the goal is to catalyze sustainable support structures to advance birth equity for Black families.