UAMS group to study ways to improve the health of Marshallese mothers

Researchers at the University of Arkansas for Medical Sciences aim to evaluate whether group antenatal care and increased bilingual care will improve maternal health outcomes for Marshallese women.

A UAMS team in Northwest Arkansas will study the potential of such programs to meet the needs of the local Marshallese community.

Marshallese women in the United States see nearly double the infant mortality rate of non-Hispanic whites, according to UAMS researcher Britni Ayers.

Preliminary research by Ayers found that 15 percent of Marshallese women in Arkansas received no antenatal care, compared to 1.6 percent of all women in the United States. Additionally, half of Marshallese women do not attend the recommended number of prenatal visits.

The research also showed that 19% of Marshallese babies were born preterm, compared to 9.6% nationwide, and 15% were born with a low birth weight, compared to 8.3% nationwide.

About 12,000 Marshallese live in Springdale, the largest concentration of Marshallese in the United States, according to the Marshallese Educational Initiative. About 300 Marshallese babies are born in the region each year, Ayers said.

Language barriers, cultural differences and lack of insurance are the main obstacles Marshallese women face when receiving medical care, according to representatives of the nonprofit Arkansas Coalition of Marshallese.

Some Marshallese women may find it difficult to understand what the doctor is telling them because they don’t speak the same language, said Michelle Pedro, a policy advocate and communications specialist for the organization. Residents may also not find resources in their own language when visiting a medical facility in the area.

“If you’re from the Marshall Islands, where your native language is understood almost nowhere else, it can be life or death,” Pedro said.

Marshallese translators can be hard to find, and many Marshallese women may be anxious about receiving prenatal care due to financial issues or a lack of confidence, according to Stephanie Takamaru, project manager for the nonprofit. Women often don’t attend prenatal appointments for these reasons or because of misconceptions they have due to being unfamiliar with the Western medical system, she said.

Marshallese residents are generally community-minded and women often bring a friend on a date with them, Pedro said.

Research has confirmed that fear of the medical system is common among pregnant Marshallese women, according to Ayers, an assistant professor at the UAMS Office of Community Health & Research in Springdale.

“It’s ubiquitous. Marshallese women expressed fear of the antenatal care process in all of our focus group interviews,” she said.

Marshallese women often avoid prenatal care to avoid debt, according to Takamaru.

Both Pedro and Ayers said women often find it difficult to apply for insurance because they don’t know how or don’t have access to an internet application.

Research involving 67 Marshallese women in Northwest Arkansas found that most women also needed to enroll in WIC and SNAP benefits, but only about 13%-16% had. About 84% did not have adequate nutrition to meet basic needs and none of the women reported owning a home; all reported renting or sharing a home, according to the study.

Group care and bilingual care are important parts of research planned at UAMS.

The group prenatal care program is called CenteringPregnancy, and the model has found success in other parts of the country, though it hasn’t been used with Marshallese women, Ayers said.

The UAMS team plans to recruit 40 Marshallese women to participate in 90-minute small group sessions.

In a series of 10 sessions, a bilingual Marshallese Registered Nurse and other prenatal health professionals will deliver brief individual exams and lead pregnancy-related discussions. A bilingual Marshallese Care Navigator will also help each participant sign up for social support services.

Marshallese health navigators will help transport women to appointments and enroll in health insurance, as well as WIC and SNAP benefits as needed, according to Ayers.

The funding for the research comes from a two-year, $420,750 National Institute of Nursing Research grant to the National Institutes of Health.

The UAMS team is starting the process of recruiting women for the program with plans to launch it within a month or two.

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