Narrative Nation

Racial disparities in maternal care are among the most glaring and persistent among all health disparities.

In New York City, Black women are up to eight times more likely to die from pregnancy-related causes than white women. Black women are also more likely than white women to report that their concerns and preferences regarding birth were disregarded. Although substantial investments and multiple interventions have been made by professional associations, hospitals, and community-based organizations in New York State, racial disparities in maternal outcomes have not improved. New and unconventional approaches that meaningfully engage women of color are needed. Narrative Nation created the Irth platform (as in “Birth,” but without the “B” for bias), a consumer-facing review and rating app for women of color to share how their birthing experiences were responsive to their individual preferences, needs, and values. In 2021, NYHealth awarded Narrative Nation a grant to pilot Irth at a large New York City hospital.

Under this grant, Narrative Nation will test Irth at One Brooklyn Health System, which serves a racially diverse patient population and accounts for one of the highest number of births among New York City hospitals. It will gather patient reviews via the Irth app from women of color who have had a recent birthing experience at One Brooklyn Health System. Reviews will be collected online and in person through inpatient recruitment, community events, and a network of local midwives and doulas, who will help women download and use the app. One Brooklyn Health System’s community-based partners that serve Black and Latina communities will also help recruit patients to participate. One Brooklyn Health System will use the data collected from Irth reviews, in conjunction with its traditional patient experience surveys, to make quality improvements such as adjusting pain management protocols, increasing access to lactation consultants, and designing patient-centered treatment plans. A workgroup with representation from maternity services, nursing, prenatal, patient safety, and patient experience will prioritize actionable strategies and set strategic targets for reducing harmful practices and improving patient experience. The project will track how many women download the tool, how many submit data, and whether the data can be used to inform quality improvement for maternity care. The pilot phase will help determine the feasibility of implementing Irth in other hospital settings, and findings will be shared with City and statewide networks, including New York City Baby Cafés, New York City Department of Health and Mental Hygiene, New York State Department of Health, National Council of Negro Women, and leading New York City-based doula networks.