Perinatal healthcare inequities: A qualitative causal network analysis.

Introduction: Persistent healthcare inequities exist within the Military Health System (MHS). The objective of this study was to use qualitative interviews to assess the intersection of operational and cultural experiences of military service with the lived experience of individuals on their use and experience of perinatal health care. Methods: This is an IRB-approved qualitative study of the perinatal experience of servicemembers and TRICARE beneficiaries. A total of 36 semi-structured interviews were conducted with individuals who delivered an infant within the last 5 years. Causation coding and deductive methods were used to generate a variable list of antecedent variables, mediating variables, and outcomes. Themes were organized into causal chains based on participant stories. A causal network was developed using cross-case mapping to generate a thematic narrative from a systematic comparison of within-case causal networks. Results: A complex detailed causal network was developed, depicting structural and social factors affecting birth experiences. Such causal relationships impact individual experiences to varying degrees. Antecedent variables included experiences of dismissal, lack of support, concerns about the pregnancy, knowledge of poor outcomes, family experiences, and systemic issues. Mediating variables included delays in care, lack of command support, fragmented care, microaggressions, and fear of medications and interventions. Outcomes included mistrust of the medical system, fear and anxiety, early cessation of human milk feeding, and decreased military retention. Conclusion: Comprehensive and logical pathways illustrate challenges faced by birthing individuals in the MHS. Results suggest that outcomes including mistrust, fear, anxiety, and early cessation of human milk feeding may be mediated by participant healthcare experiences and concerns.