Black women are three times more likely to die from pregnancy-related causes than white women in the United States. This racial disparity is particularly stark in Pittsburgh, PA, where Black women are more likely to die from pregnancy-related causes than in 97% of comparable cities due to structural and interpersonal racism, social determinants of health and inadequate health care delivery. Notably, 80% of all maternal mortality can be prevented, and 65% of maternal deaths occur after delivery. These data underscore a critical need to create novel and equity-centered postpartum care delivery models to reduce maternal mortality and severe maternal morbidity among Black birthing people. 

Physician-led postpartum care models traditionally engage people with a single visit at 6-8 weeks post- delivery, however, as most severe maternal morbidity and 21% of maternal mortality occur within the first two weeks post-delivery, this is too late to prevent many maternal deaths. Furthermore, 40% of postpartum people receive no postpartum visit, with Black birthing people 3.5 times less likely to receive postpartum visits than White people. In contrast, 90% of postpartum people attend their infants’ well-child visits. The interconception care model was developed to screen postpartum people for behavioral health and other risk factors at infant well child visits from 1 to 24 months. For 15 years, eight Pittsburgh sites have provided interconception care to postpartum people as part of the IMPLICIT Network, a national consortium of 38 family medicine residencies. In 2020-21, Pittsburgh IMPLICIT piloted “ 4th Trimester” physician-led postpartum at two sites. The 4th Trimester model recommends clinic visits at 3 and 8 weeks post-delivery and was endorsed by the American College of Obstetricians and Gynecologists, building on initial work by the American College of Nurse-Midwifery. Both interconception care and 4th Trimester model are physician-centered models, and they do not address core issues that undermine physician-led postpartum uptake among Black people, including barriers related to medical mistrust and logistical barriers associated with acute financial stressors. Despite rapidly emerging evidence about the negative effects of structural racism and structural barriers on Black women’s reproductive health and wellbeing, interventions remain focused on individual behaviors. Research is urgently needed to fill knowledge gaps about barriers to PPC facing Black birthing people, at the individual, health-system and structural levels. 

Our multidisciplinary team will use a mixed methods approach to evaluate the effects of the current interconception care and/or 4th Trimester model on perinatal health outcomes among Black birthing people, compared to White birthing people, and we will leverage resources from the Community and Training Components of the Equity in Birth Outcomes and Reproductive Health Through Community Engagement Center (EMBRACE) to develop and implement a new, integrative model of PPC that is culturally and community-informed. We will apply the locally and collaboratively developed Allegheny County BIRTH Plan framework, which draws on the theoretical framework of ROOTT, (Restoring Our Own Through Transformation), approaching maternal health inequities as consequences of structural and institutional racism. Informed by our team’s robust experience implementing the IMPLICIT interconception care model at multiple sites and our recent piloting of 4th Trimester model at 2 sites, we will implement and assess the new model at five interconception care sites. The overarching goal of this proposal is to develop a model of actionable postpartum care strategies to improve postpartum health and well-being of Black birthing people.