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Women’s Perspectives of Needs Surrounding Adverse Birth Outcomes: A Qualitative Assessment of the Neighborhood Impact of Adverse Birth Outcomes


Objectives African Americans are two times more likely to suffer adverse birth outcomes (i.e., low birth weight, preterm birth, and infant mortality) when compared to all other ethnic groups and this pattern is no different for Douglas County, Nebraska, where the majority of African Americans in Nebraska reside. Our goal was to identify factors, as described by local women, that contribute to adverse birth outcomes in the predominantly African American community of Northeast Douglas County in Omaha, NE, to ensure that these women’s voices were included in the development of interventions to improve their neighborhood’s birth outcomes. The paper describes the results of a qualitative needs assessment of these women which will aid in the design and implementation of neighborhood-based solutions. Methods We brought together a group of women with varying levels of birthing experience, time spent living in the neighborhood, and overall community involvement. Individual in-depth, in person, and telephone interviews were used to collect participants’ perceptions of birth outcomes, neighborhood resources for pregnant women, and neighborhood strengths and weaknesses. Results The needs assessment identified that, although women in this neighborhood have experience with adverse birth outcomes, these experiences are not discussed resulting in a lack of awareness of the wide spread racial disparities in birth outcomes and the efforts and resources to address this public health problem. Conclusions for Practice This study reveals the power of direct conversations with women impacted by adverse birth outcomes, as they must be primary partners in any efforts to improve birth outcomes.

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  • Blumenshine, P., et al. (2010). Socioeconomic disparities in adverse birth outcomes: A systematic review. American Journal of Preventative Medicine, 39(3), 263–272.

    Article  Google Scholar 

  • Bryant, A. S., et al. (2010). Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. American Journal of Obstetrics and Gynecology, 202(4), 335–342.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chung, B., et al. (2010). Story of Stone Soup: A recipe to improve health disparities. Ethnicity and Disease, 20(1 Suppl 2), S2-9-14.

    PubMed  PubMed Central  Google Scholar 

  • Collins, J. W. Jr.., et al. (2009). Women’s lifelong exposure to neighborhood poverty and low birth weight: A population-based study. Maternal and Child Health Journal, 13(3), 326–333.

    Article  PubMed  Google Scholar 

  • Collins, N. L., et al. (1993). Social support in pregnancy: Psychosocial correlates of birth outcomes and postpartum depression. Journal of Personality and Social Psychology, 65(6), 1243–1258.

    CAS  Article  PubMed  Google Scholar 

  • Crabtree, B. F. & Miller W. L. (1999). Doing qualitative research (2nd ed.). Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Da Costa, D., et al. (2000). Psychosocial correlates of prepartum and postpartum depressed mood. Journal of Affective Disorders, 59(1), 31–40.

    CAS  Article  PubMed  Google Scholar 

  • Da Costa, D., et al. (2000). Psychosocial predictors of labor/delivery complications and infant birth weight: a prospective multivariate study. Journal of Psychosomatic Obstetrics and Gynaecology, 21(3), 137–148.

    CAS  Article  PubMed  Google Scholar 

  • Department of Health and Human Services Profile of the Minority Popluation in Nebraska. (2015)

  • Elsenbruch, S., et al. (2007). Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome. Human Reproduction, 22(3), 869–877.

    CAS  Article  PubMed  Google Scholar 

  • Federally Designated Primary Care Medically Underserved Areas/Populations. (2012). Nebraska, U.S.D.o.H.a.H. Services, Editor. 2012: Office of Shortage Designations.

  • Feldman, P. J., et al. (2000). Maternal social support predicts birth weight and fetal growth in human pregnancy. Psychosomatic Medicine, 62(5), 715–725.

    CAS  Article  PubMed  Google Scholar 

  • Healthy People (2020). Maternal, infant, and child health. (2010).

  • Hodnett, E. D. & Fredericks, S. (2003). Support during pregnancy for women at increased risk of low birthweight babies. Cochrane Database of Systematic Reviews, 3(3), CD000198.

    Google Scholar 

  • Israel, B. A., et al. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173–202.

    CAS  Article  PubMed  Google Scholar 

  • Kaunonen, M., Hannula, L., & Tarkka, M. T. (2012). A systematic review of peer support interventions for breastfeeding. Journal of Clinical Nursing, 21(13–14), 1943–1954.

    Article  PubMed  Google Scholar 

  • Lu, M. C., & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: A life-course perspective. Maternal Child Health Journal, 7(1), 13–30.

    Article  PubMed  Google Scholar 

  • Malterud, K. (2001). Qualitative research: Standards, challenges, and guidelines. Lancet, 358(8), 483–488.

    CAS  Article  PubMed  Google Scholar 

  • Medically Underserved Areas/Populations. (1976). Guidelines for Medically Underserved Areas and Populations, U.S.D.o.H.a.H.S.-H.R.a.S. Administration, Editor. Federal Register.

  • Meier, E. R., et al. (2007). A qualitative evaluation of a breastfeeding peer counselor program. Journal of Human Lactation, 23(3), 262–268.

    Article  PubMed  Google Scholar 

  • Mickens, A. D., et al. (2009). Peer support and breastfeeding intentions among black WIC participants. Journal of Human Lactation, 25(2), 157–162.

    Article  PubMed  Google Scholar 

  • Minkler, M. & Wallerstein, N. (2008) Community-based participatory research for health: From process to outcomes (2nd ed.). San Francisco, CA: Jossey-Bass.

    Google Scholar 

  • Nebraska Census Viewer. (2016).

  • Noel-Weiss, J., & Hebert, D. (2004). Breastfeeding peer support programs. The Canadian Nurse, 100(8), 29–33.

    PubMed  Google Scholar 

  • O’Campo, P., et al. (1993). Needs assessment for reducing infant mortality in Baltimore City: The Healthy Start Program. Southern Medical Journal, 86(12), 1342.

    Article  PubMed  Google Scholar 

  • Pestronk, R. M., et al. (2003). A partnership to reduce African American infant mortality in Genesee County, Michigan. Public Health Reports, 118(4), 324–335.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pinto, R. M., McKay, M. M., & Escobar, C. (2008). “You’ve gotta know the community”: Minority women make recommendations about community-focused health research. Women and Health, 47(1), 83–104.

    Article  PubMed  PubMed Central  Google Scholar 

  • Region Population Summary by Race Ethnicity. (2010). D.C.H. Department, Editor. 2011.

  • Schafer, E., et al. (1998). Volunteer peer counselors increase breastfeeding duration among rural low-income women. Birth, 25(2), 101–106.

    CAS  Article  PubMed  Google Scholar 

  • Turman, J. (2010). The Connections Project: Community-Based Solutions to Improve Birth Outcomes in Nebraska’s African American Communities 1–20

  • Wong, L. (2008). Data analysis in qualitative research: A brief guide to using NVivo. Malaysian Family Physician, 3(1), 14–20.

    PubMed  PubMed Central  Google Scholar 

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This research was completed by the authors during their employment at the University of Nebraska Medical Center.

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Correspondence to K. Harper-Hanigan.

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No competing financial interests exist.



Birth Outcomes

  1. 1.

    Do you know people in your community that have experienced adverse birth outcomes? (Infant mortality; preterm birth; low birth rate; still born; miscarriage)

  2. 2.

    How do these adverse birth outcomes impact your neighborhood or community?

  3. 3.

    What do you think contributes to these adverse birth outcomes?

These questions intended to assess perceived susceptibility and severity of adverse birth outcomes within the community and investigate thoughts on contributing factors as identified by the neighborhood.

Community Resources for Pregnant Women

  1. 4.

    What services are available in your community to help with these problems?

  2. 5.

    What gets in your way to accessing these services?

  3. 6.

    What is needed in your community to resolve these access problems?

These questions intended to assess perceived barriers and cues to action.

Community Strengths and Areas of Improvement

  1. 7.

    What concerns you most about your community?

  2. 8.

    What do you think are the biggest health problems in your community?

  3. 9.

    What are your community’s strengths and assets?

These questions intended to assess perceived barriers, cues to action, and self-efficacy.

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Harper-Hanigan, K., Ross, G., Sims, T. et al. Women’s Perspectives of Needs Surrounding Adverse Birth Outcomes: A Qualitative Assessment of the Neighborhood Impact of Adverse Birth Outcomes. Matern Child Health J 21, 2219–2228 (2017).

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  • Birth outcomes
  • African American
  • Needs assessment