The CARE (Centering Anti Racist Education) Pregnancy Tool
We have developed the Tool in a series of steps. Step 1 began by defining the scope, purpose and intended audience of the Tool; Step 2 included a literature review of topics in pregnancy care affected by racism and communication tool development, Step 3 included development of first iteration of the Anti-Racist Pregnancy Tool by Erica Chidi and Dr. Erica Cahill, with review by a small group of stakeholders including medical journalists, community advocates, and reproductive health educators. Steps 1-3 were completed from Oct 2019 to October 2020, culminating in publication of the Anti-Racist Pregnancy Tool within an article in the New York Times by Ms Chidi and Dr Cahill. Step 4 included creating a research advisory committee with experts in Perinatal epidemiology, biostatistics, qualitative research, as well as community partners including Chanel Porshia-Albert from Ancientsong, Kimberly Allers Seals from Irth, and Kathryn Davis from Loom. This Committee has met several times to make revisions to the Tool and research process from Oct 2020 through June 2021.
For our next steps, including this project we will perform structured qualitative interviews with community stakeholders, Black women who provide pregnancy care in current care systems, to evaluate the Tool content and design (Step 5), currently planned for July 2021 through September 2021. This will be followed by Step 6, revising the Tool to reflect the themes and suggestions from this study. Finally, Step 7 is to evaluate Tool by intended users (patients and providers) and Step 8 is to revise Tool based on these findings. We plan to repeat Steps 7-8 with input from research advisory committee, specifically Community Partners, as needed.
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Questions to ask when doing trauma-informed research
- How might the approach minimize re-traumatization of a community? (Trauma-informed approach, starting with gratitude)
- How might the approach empower participants during study/ after study? (Resilience)
- How will the study approach center the perspectives of marginalized groups? (Centering the Marginalized)
- How will our research seek not only to understand but to eliminate inequities? (Critical Race Theory)
- How can we report back to the community both during and after our study? (Transparency/Accountability)
Research Advisory Council
Lessons learned from trauma informed research
- Co-create norms, rules for safety with collaborators
- Agree about titles, roles, scopes of work and compensation - put this in writing before starting the project
- Prior to starting, make sure everyone, especially community collaborators okay financial reimbursement amount and process before asking them to do any work.
- Create structured self-reflection on biases for research team
- Maximize everyone’s time, reducing burden on community collaborators (e.g. Can this meeting be a phone call? Or an email?)
Resources and citations to grow your anti racist praxis
"Dismantling Racism and Inequity in Health Care: The Critical Interplay Between Equity, Quality, and Safety," NEJM Catalyst Innovations in Care Delivery
Karthik Sivashanker describes how his organization has woven equity and anti-racism efforts into their already well-established quality and safety procedures. Access at NEJM Catalyst
"A paradigm shift to address racial inequities in perinatal healthcare," American Journal of Obstetrics and Gynecology
Ebony Carter, Sara Mazzoni and the EleVATE Women Collaborative share a case study on how group prenatal care may be one viable vehicle to improve Black prenatal care. PubMed
"Antiracist Praxis in Public Health: A Call for Ethical Reflections," Hastings Center Report
Faith Fletcher, Wendy Jiang, and Alicia Best provide commentary on the ways in which antiracist praxis (which emphasizes empowerment of traditionally marginalized populations) offers strategies to explicitly address power imbalance, stigmatization, and other consequences of structural racism in public health research. Pubmed
"Applying a critical race lens to relationship-centered care in pregnancy and childbirth: An antidote to structural racism," Birth Issues in Perinatal Care
Rachel R Hardeman, J'Mag Karbeah, and Katy B Kozhimannil describe how the two concepts of relationship-centered care and critical race theory have the potential to powerfully reduce racism's impact on childbirth outcomes for Black birthing individuals, infants, and families. PubMed
"Critical Issues in Antiracist Research Methods," Counterpoints
Anti-racism studies have blossomed over the years with schol- arship and political work reinforcing each other to cement anti-racist change, but how do we understand anti-racist research? How is anti-racist research methodology different from other methods of research investigation? What are the principles of anti-racism research? Access via JSTOR
Stanford Medicine — Office of Community Engagement
This office develops innovative models of engagement, nurturing community partnerships, and designing and implementing rigorous projects that promote health equity for diverse populations. Learn more