Community-informed models of perinatal and reproductive health services provision: A justice-centered paradigm toward equity among Black birthing communities

Semin Perinatol. 2020 Aug;44(5):151267. doi: 10.1016/j.semperi.2020.151267. Epub 2020 Jun 19.


Perinatal health outcomes in the United States continue to worsen, with the greatest burden of inequity falling on Black birthing communities. Despite transdisciplinary literature citing structural racism as a root cause of inequity, interventions continue to be mostly physician-centered models of perinatal and reproductive healthcare (PRH). These models prioritize individual, biomedical risk identification and stratification as solutions to achieving equity, without adequately addressing the social and structural determinants of health. The objective of this review is to: (1) examine the association between the impact of structural and obstetric racism and patient-centered access to PRH, (2) define and apply reproductive justice (RJ) as a framework to combat structural and obstetric racism in PRH, and (3) describe and demonstrate how to use an RJ lens to critically analyze physician-led and community-informed PRH models. We conclude with recommendations for building a PRH workforce whose capacity is aligned with racial equity. Institutional alignment with a RJ praxis creates opportunities for advancing PRH workforce diversification and development and improving PRH experiences and outcomes for our patients, communities, and workforce.

Publication types

  • Review

MeSH terms

  • Black or African American
  • Community Participation
  • Female
  • Health Equity*
  • Health Services Accessibility
  • Health Status Disparities
  • Healthcare Disparities / ethnology
  • Humans
  • Maternal Health Services
  • Patient-Centered Care
  • Pregnancy
  • Racism*
  • Reproductive Health Services*
  • Reproductive Rights*
  • Risk Assessment
  • Social Determinants of Health*
  • Social Justice*
  • Stakeholder Participation