Improving prenatal outcomes for American Indian women through group prenatal care

Abstract

American Indian (AI) women face significant maternal health disparities, characterized by higher rates of adverse pregnancy outcomes, limited healthcare access, and complex systemic barriers. Traditional individual prenatal care models have demonstrated persistent limitations in addressing these multifaceted challenges, highlighting the need for culturally responsive interventions that acknowledge historical trauma and Indigenous healing practices. This quality improvement project examines the implementation of culturally adapted group prenatal care (GPC) as an innovative intervention to address these disparities. Using a multi-theoretical framework that integrates the Social Ecological Model with Indigenous Cultural Responsiveness Theory, the study reimagines prenatal care as a holistic, community-centered process. The project employs the AGREE II instrument to develop a comprehensive cultural adaptation toolkit for the Centering Pregnancy GPC model, creating a flexible framework customizable across diverse Tribal communities. Implementation at a Northern Plains Reservation Tribal Health Center utilizes a mixed-methods, community-based participatory design. The intervention brings together 8?12 women with similar due dates for 90- to 120-minute sessions that combine clinical care with facilitated group discussions and cultural practices. The project's anticipated outcomes span both short-term (6?12 months) and medium-term (1?3 years) timeframes. Initial projections suggest significant improvements in clinical metrics, including increased early prenatal care engagement, reduced preterm birth rates, and enhanced maternal health literacy. Psychosocial outcomes indicate strengthened social support networks, improved mental health resilience, and enhanced cultural connectivity. The AGREE II-guided toolkit development demonstrates promising potential for systematic cultural adaptation across diverse Tribal settings. This comprehensive assessment of culturally adapted GPC offers an innovative blueprint for addressing maternal health disparities in AI communities. By positioning healthcare delivery as a mechanism for both clinical care and cultural preservation, the project provides a transformative approach that honors Indigenous knowledge systems while meeting contemporary clinical standards. The resulting toolkit offers a replicable framework for culturally responsive maternal healthcare that extends beyond traditional medical interventions to support broader community healing and empowerment.