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Among women of low socioeconomic status, pregnancy rates are five times as high compared to women of high socioeconomic status, and almost 70 percent of pregnancies among African Americans are unintended, according a study in the journal Contraception.
"These disparities persist despite various clinical and public health interventions designed to address them," said Julie Chor, MD, MPH, assistant professor of obstetrics and gynecology at the University of Chicago Medicine.
Chor, an investigator with the UChicago Institute for Translational Medicine (ITM), started studying reproductive health disparities among poor and minority women as part of an award from the ITM that gives junior researchers salary support and protected time to explore the research of their choice.
Her project took her to John H. Stroger Jr. Hospital of Cook County to study the effectiveness of full-spectrum doulas, lay people who help women with a variety of reproductive issues ranging from childbirth and miscarriages to adoptions or abortions, in a high-volume, urban hospital that serves a large minority population of those in poverty. As the former Assistant Director of Family Planning at Stroger, Chor said that many women who seek services there have multiple unintended pregnancies.
In a setting that doesn't allow family or friends to be with women during abortion procedures, Chor found that women highly valued the presence and emotional support of trained doulas. The journal Contraception published her findings online in October, with the print edition currently in-press.
Her answer to the overarching disparities problem: an innovative health care model where full-spectrum doulas and other lay people offer basic health care information and emotional support to help women make informed decisions about their reproductive health.
For example, if a woman had a medical condition that makes pregnancy unsafe, a full-spectrum doula could help address those health issues before the woman becomes pregnant. Or if a woman did not want to become pregnant, a doula could help her identify a healthy contraceptive method.
More than 96 percent of women undergoing abortions who received support from a doula recommended doula services for routine care and were less likely to need additional clinical resources, according to a study Chor published in the American Journal of Obstetrics and Gynecology.
Now, thanks to a new NIH grant, Chor will expand her research to evaluate how lay health care workers could help improve reproductive health for women who do not routinely engage in preventive reproductive health care.
"Working with doulas has been immensely rewarding," Chor said. "I've gained a tremendous amount of perspective partnering with doulas."