# Developing Autonomy-Centered models of 4th Trimester and Interconception care: Project 3

> **NIH NIH U54** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2024 · $865,338

## Abstract

ABSTRACT
The United States has among the worst maternal outcomes of developed countries, which are
disproportionately experienced by Black birthing people due to the intersections of racism, social determinants
of health, and inadequate health care delivery. Racial disparities in severe maternal morbidity (SMM) and
maternal mortality (MM) are particularly stark in Pittsburgh and surrounding Allegheny County, where Black
birthing people are more likely to die from pregnancy-related causes than in 97% of comparable cities. Notably,
80% of maternal deaths can be prevented, and 65% of maternal deaths occur in the postpartum period, which
underscores why postpartum clinical care is critical to reduce maternal mortality. Current models of postpartum
care are limited by: 1) gaps in health care delivery at the very timepoints at which people are vulnerable to
pregnancy-related death; 2) health care delivery frameworks that are not culturally sensitive and have not been
developed with community feedback; and/or 3) social determinants of health (e.g., low income), which our
formative work has found prevent some Black birthing people from attending postpartum clinic visits. If
thoughtfully delivered, postpartum care may identify physical signs and symptoms among birthing people that
signal impending pregnancy-related morbidity and mortality. In this project, we seek to develop a novel, equity-
centered model of postpartum care to reduce SMM and MM among Black birthing people in our region. We will
build upon an existing model of maternal health screening that is carried out at well-child visits, and integrate a
newer model of postpartum care, the “Fourth Trimester,” which includes early maternal physical examinations
and anthropometric screening at well-child visits. Using qualitative research methods, we will seek feedback
from people who receive care from the current postpartum care model, as well as feedback from clinicians and
staff to identify barriers and facilitators to postpartum care. Next, we will engage with partners from the
Community and Training Cores of the Equity in Birth Outcomes and Reproductive Health through Community
Engagement (EMBRACE) Center, to develop a community-informed model of postpartum care and to train
health care providers to provide equitable, anti-racist, and anti-oppressive clinical care. Finally, we will
implement the new model of postpartum care over a multi-year period in family planning clinics, to assess the
satisfaction of Black birthing people, and clinical and implementation outcomes. We will also pilot a novel cash
transfer intervention among a subset of these people, responding to prior research that suggests that financial
constraints not only contribute to acute stress in the postpartum period, but also undermine engagement with
postpartum healthcare. Our objective is for our new model of equity-centered postpartum care to be scalable to
other health settings, and for our development process to serve as a blu...

## Key facts

- **NIH application ID:** 10747795
- **Project number:** 1U54HD113030-01
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Stacy Bartlett
- **Activity code:** U54 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $865,338
- **Award type:** 1
- **Project period:** 2024-06-26 → 2030-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10747795

## Citation

> US National Institutes of Health, RePORTER application 10747795, Developing Autonomy-Centered models of 4th Trimester and Interconception care: Project 3 (1U54HD113030-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10747795. Licensed CC0.

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