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Birth Equity

The Problem

Significant racial disparities in health outcomes exist for pregnant and postpartum patients in Nebraska and across the U.S. Nationwide, maternal mortality rates have been climbing rapidly over the last 5 years, with Non- Hispanic Black mothers experiencing an excessively high burden of mortality. Nebraska is no exception to these alarming rates and inequities in the burden of excess deaths. More than 80% of pregnancy-related deaths are preventable. Furthermore, about 30% of Black, Hispanic, and multiracial women report being mistreated while receiving maternity care. A patient-centered approach can improve obstetric care for Women of Color.  

Birth Equity (BE) Initiative Aim

By December 2025, more than 75% of NE birthing hospitals will be participating in the Birth Equity Initiative and more than 75% of participating hospitals will have all key strategies in place to address maternal disparities and promote birth equity between October 2023 and December 2025. 

Developed with Intentionality

NPQIC began conceptualizing the Birth Equity Initiative in 2021. Community partners, clinical leaders, and patient voices have provided crucial input for key strategies and resource development. In Phase 1, the initiative will be implemented in the birthing facilities in Douglas and Lancaster Counties, which serve the largest proportion of Nebraska’s birthing people who identify as Black or people of color. NPQIC will then utilize early feedback to make any necessary updates and disseminate the initiative statewide in Phase 2. 

We'd like to specifically recognize I Be Black Girl, the Nebraska Black Doula Collective, and A Mother's Love for working with us to develop this initiative with patient-first, culturally appropriate considerations. Additionally, we thank the community of Black doulas who have shared their lived experiences and wisdom with us

Birth Equity Resources

National Guidance

ACOG Committee Opinion 729: Importance of Social Determinants of Health and Cultural Awareness in the Delivery of Reproductive Health Care (January, 2018)

ACOG Committee Opinion 825: Caring for Patients Who Have Experienced Trauma (April, 2021)

ACOG Commitment to Changing the Culture of Medicine and Eliminating Racial Disparities in Women's Health Outcomes

Joint Statement Obstetrics and Gynecology: Collective Action Addressing Racism (August, 2020)

Centers for American Progress: Eliminating Racial Disparities in Maternal and Infant Mortality A Comprehensive Policy Blueprint (May, 2019)

ACOG Committee 736: Optimizing Postpartum Care (May, 2018) 

CDC Vital Signs: Many Women Report Mistreatment During Pregnancy and Delivery (September, 2023)


Patient Education Maternal Urgent Warning Signs

AWHONN “Save Your Life”

CDC “Hear Her” Campaign

AIM “Urgent Maternal Warning Signs” 

Pre-Eclampsia Foundation

Postpartum Care

MMHLA: The Fourth Trimester Fact Sheet

Respectful and Equitable Care Resources

Diversity Science: Dignity in Pregnancy & Childbirth: Preventing Racial Bias in Perinatal Care (Free)

Office of Minority Health (US DHHS): Culturally and Linguistically Appropriate Services (CLAS) in Maternal Health Care (Free)

March of Dimes: Awareness to Action: Dismantling Bias in Maternal and Infant Healthcare

AWHONN: Respectful Maternity Care Implementation Toolkit (RMC-IT)

ACOG: Respectful Care e-Modules  (Free)

Improving Patient-Reported Race and Ethnicity Data Collection

American Hospital Association:

HPOE: Reducing Health Care Disparities: Collection and Use of Race, Ethnicity and Language Data

NPQIC Process Flow and Sample Language for Collecting Data on Patient Race & Ethnicity (Adapted from ILPQC)

Review of Hospital Maternal Health Data by Race, Ethnicity, and Medicaid Status

AHA: Framework for Stratifying Race, Ethnicity, and Language Data

MassDPH: Racial Equity Data Road Map


Engaging Patients and Community in QI

CDC: Personal Stories of Pregnancy-Related Complications

AHRQ: Guide to Patient and Family Engagement in Hospital Quality and Safety

AHA: A Playbook for Fostering Hospital-Community Partnerships to Build a Culture of Health

Momma's Voices