Skip to main content
SpringerLink
Log in

Unique Profiles of Postpartum Family Needs and Evidence of Racial and Ethnic Disparities: Insights from Community Implementation of Family Connects

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Objectives

To delineate specific family needs during the postpartum period using data from Family Connects (FC), a universal home-visiting initiative, and to scrutinize potential racial and ethnic disparities in these needs.

Method

FC implementation data spanned from July 1, 2009, to August 31, 2021, in seven counties across the USA. Data encompassed nurse-led in-home assessments for 34,119 families. Nurses evaluated needs across four domains (healthcare, parenting/childcare, safe home, and parent support) comprising 12 risk factors.

Findings

Overall, families reported high levels of need, and community connections were facilitated for 57% of visited families. Significant differences in need profiles between whites and minority groups were revealed, reflecting both disparity and uniqueness. Employing the Oaxaca decomposition approach, we found that racial/ethnic disparities in socioeconomic attributes were associated with racial/ethnic gaps in the need profiles.

Conclusions

The event of giving birth is both high risk and high opportunity for preventive intervention. Home-visiting programs, as an evidence-based approach, must address the diverse spectrum of familial needs comprehensively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available from Family Connects, but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available. The data are, however, available from the authors (Dr. Yu Bai or Dr. Benjamin Goodman) upon reasonable request and with the permission of Family Connects.

Code Availability

The availability of the code that supports the findings of this study is restricted under license for the current study and so is not publicly available. The code is, however, available from Dr. Yu Bai upon reasonable request and with the permission of Family Connects.

References

  1. Kanotra S, et al. Challenges faced by new mothers in the early postpartum period: an analysis of comment data from the 2000 Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Matern Child Health J. 2007;11:549–58.

    Article  PubMed  Google Scholar 

  2. Fahey JO, Shenassa E. Understanding and meeting the needs of women in the postpartum period: the perinatal maternal health promotion model. J Midwifery Womens Health. 2013;58(6):613–21.

    Article  PubMed  Google Scholar 

  3. Gazmararian JA, et al. What new mothers need to know: perspectives from women and providers in Georgia. Matern Child Health J. 2014;18:839–51.

    Article  PubMed  Google Scholar 

  4. Hoyert DL. Maternal mortality rates in the United States, 2020. NCHS Health E-Stats. 2022. https://doi.org/10.15620/cdc:113967.

  5. Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666.

    PubMed  PubMed Central  Google Scholar 

  6. Williams DR, et al. Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci. 2010;1186(1):69–101.

    Article  PubMed  PubMed Central  Google Scholar 

  7. U.S. Department of Health & Human Services and Administration for Children and Families Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program 2021.

  8. Martin JA, Hamilton B, Osterman M, Driscoll AK. Births: Final Data for 2019. Natl Vital Stat Rep. 2021;70(2):1–51. 

  9. Ronsaville DS, Hakim RB. Well child care in the United States: racial differences in compliance with guidelines. Am J Public Health. 2000;90(9):1436.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Wang L, et al. Prevalence and risk factors of maternal depression during the first three years of child rearing. J Womens Health. 2011;20(5):711–8.

    Article  Google Scholar 

  11. Rowe ML, et al. The role of parent education and parenting knowledge in children’s language and literacy skills among White, Black, and Latino families. Infant Child Dev. 2016;25(2):198–220.

    Article  Google Scholar 

  12. Singh GK, Stella MY. Infant mortality in the United States, 1915–2017: large social inequalities have persisted for over a century. Int J MCH AIDS. 2019;8(1):19.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Olausson PO, Cnattingius S, Haglund B. Teenage pregnancies and risk of late fetal death and infant mortality. BJOG Int J Obstet Gynaecol. 1999;106(2):116–21.

    Article  CAS  Google Scholar 

  14. Izugbara C. Single motherhood and neonatal and infant mortality in Sierra Leone, Burkina Faso and Burundi. Public Health. 2016;135:122–30.

    Article  CAS  PubMed  Google Scholar 

  15. Hanson JL, et al. Family poverty affects the rate of human infant brain growth. PLoS ONE. 2013;8(12):e80954.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Korenman S, Miller JE, Sjaastad JE. Long-term poverty and child development in the United States: results from the NLSY. Child Youth Serv Rev. 1995;17(1–2):127–55.

    Article  Google Scholar 

  17. Frost MB, Forste R, Haas DW. Maternal education and child nutritional status in Bolivia: finding the links. Soc Sci Med. 2005;60(2):395–407.

    Article  PubMed  Google Scholar 

  18. Cunradi CB, et al. Neighborhood poverty as a predictor of intimate partner violence among White, Black, and Hispanic couples in the United States: a multilevel analysis. Ann Epidemiol. 2000;10(5):297–308.

    Article  CAS  PubMed  Google Scholar 

  19. Jones DJ, et al. A review of childrearing in African American single mother families: the relevance of a coparenting framework. J Child Fam Stud. 2007;16:671–83.

    Article  Google Scholar 

  20. Manlove J, et al. Racial and ethnic differences in the transition to a teenage birth in the United States. Perspect Sex Reprod Health. 2013;45(2):89–100.

    Article  PubMed  Google Scholar 

  21. Cajner, Tomaz, Tyler Radler, David Ratner, and Ivan Vidangos (2017). Racial gaps in labor market outcomes in the last four decades and over the business cycle. Finance and Economics Discussion Series 2017-071. Washington: Board of Governors of the Federal Reserve System. https://doi.org/10.17016/FEDS.2017.071.

  22. Murnane RJ. US high school graduation rates: patterns and explanations. J Econ Lit. 2013;51(2):370–422.

    Article  Google Scholar 

  23. Wilper AP, et al. Health insurance and mortality in US adults. Am J Public Health. 2009;99(12):2289–95.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Dodge KA, Goodman WB. Universal reach at birth. Future Child. 2019;29(1):41–60.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Goodman WB, et al. Randomized controlled trial of Family Connects: effects on child emergency medical care from birth to 24 months. Dev Psychopathol. 2019;31(5):1863–72.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Oaxaca R. Male-female wage differentials in urban labor markets. Int Econ Rev. 1973;14(3):693–709. https://doi.org/10.2307/2525981.

  27. Blinder AS. Wage discrimination: reduced form and structural estimates. J Human Resour. 1973;8(4):436–455. https://doi.org/10.2307/144855.

  28. Little RJ, Rubin DB. Statistical analysis with missing data. 3rd ed. John Wiley & Sons. 2019.

  29. Schafer J. Multiple imputation: a primer. Stat Methods Med Res. 1999;8(1):3–15.

    Article  CAS  PubMed  Google Scholar 

  30. Von Hippel PT. How many imputations do you need? A two-stage calculation using a quadratic rule. Sociol Methods Res. 2020;49(3):699–718.

    Article  Google Scholar 

  31. Dodge KA, et al. Implementation and randomized controlled trial evaluation of universal postnatal nurse home visiting. Am J Public Health. 2014;104(S1):S136–43.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Williams DR, Cooper LA. Reducing racial inequities in health: using what we already know to take action. Int J Environ Res Public Health. 2019;16(4):606.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ward E, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004;54(2):78–93.

    Article  PubMed  Google Scholar 

  34. Dodge KA, et al. Toward population impact from home visiting. Zero to Three. 2013;33(3):17.

    PubMed  PubMed Central  Google Scholar 

  35. Dodge KA, et al. Impact of a universal perinatal home-visiting program on reduction in race disparities in maternal and child health: two randomised controlled trials and a field quasi-experiment. Lancet Reg Health Am. 2022;15. https://doi.org/10.1016/j.lana.2022.100356.

  36. Wilson SJ, et al. Dropout prevention and intervention programs: effects on school completion and dropout among school-aged children and youth. Campbell Syst Rev. 2011;7(1):1–61.

    Google Scholar 

Download references

Acknowledgements

We would like to express our sincere gratitude to The Duke Endowment and the Eunice Kennedy Shiver National Institute for Child Health and Human Development, who provided financial support (R01HD069981 and R37HD069981).

Funding

Funding was provided by The Duke Endowment and the Eunice Kennedy Shiver National Institute for Child Health and Human Development (R01HD069981 and R37HD069981).

Author information

Authors and Affiliations

  1. Sanford School of Public Policy, Duke University, 201 Science Drive, Durham, NC, 27708, USA

    Yu Bai, Helen Milojevich, Kenneth A. Dodge & W. Benjamin Goodman

  2. Center for Child & Family Health, Duke University, 3518 Westgate Drive, Durham, NC, 27710, USA

    Karen O’Donnell

Authors
  1. Yu Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helen Milojevich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenneth A. Dodge
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. Benjamin Goodman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karen O’Donnell
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YB: conceptualization, methodology, data analysis, writing—original draft preparation, writing—reviewing and editing.

HM: conceptualization, methodology, data analysis, writing—original draft preparation, writing—reviewing and editing.

KD: conceptualization, methodology, writing—original draft preparation, writing—reviewing and editing.

BG: conceptualization, data collection, methodology, writing—reviewing and editing.

KO: conceptualization, writing—reviewing and editing.

Corresponding author

Correspondence to Yu Bai.

Ethics declarations

Ethics Approval

This study was approved by the Institutional Review Board of Duke University.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Consent for Publication

Not applicable.

Competing Interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 96 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bai, Y., Milojevich, H., Dodge, K.A. et al. Unique Profiles of Postpartum Family Needs and Evidence of Racial and Ethnic Disparities: Insights from Community Implementation of Family Connects. J. Racial and Ethnic Health Disparities (2024). https://doi.org/10.1007/s40615-024-02013-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40615-024-02013-0

Keywords

Search

Navigation