Community Recommendations for Hospital-Based Maternity Care: Insights from Black and Pacific Islander Mothers in San Francisco

Introduction: Hospitals in the United States are increasingly working to advance maternal health (MH) equity. To succeed, these efforts must be community-driven, centering voices of those with experience of health inequities, suboptimal care, and the impacts of structural racism. However, robust hospital engagement with such guidance remains rare. We documented community-driven strategies for advancing MH equity. Methods: Using a community-based participatory research approach, we conducted longitudinal in-person strategy sessions with individuals from communities disproportionately burdened by MH inequities: Black and/or Pacific Islander individuals who had recently delivered or considered delivering in San Francisco hospitals. Two 2.5-h discussion-intensive meetings focused on generating and refining recommendations for improving hospital maternity care. Participants then selected their top 15 recommendations. Experienced community-based team members led recruitment and facilitated sessions. We independently reviewed data for accuracy and conducted thematic analysis to categorize recommendations into domains. Results: Participants developed and refined 48 unique recommendations to improve hospital maternity care for their communities, categorized into seven domains. Top-rated recommendations included: Respecting patient preferences/requests. Trainings to educate and un-bias clinicians. Engaging patients and clinical teams with the “Black Birthing Bill of Rights.” Racially-, culturally-, and/or community-concordant programs and care teams. Hospital-based community task forces. Collecting patient feedback at discharge using tablets with clinician photos. Discussion: The recommendations affirm guidance from other realms of reproductive care and reveal new strategies for hospitals to better serve affected communities. Health Equity Implications: Community-generated recommendations offer actionable and responsive ways for hospitals to improve maternal health care. These strategies are likely transferable across diverse hospital settings.