Abstract for: Drivers of perinatal care inequities among pregnant people in South Dakota: patient, provider, and health system interactions

Improving perinatal health care (PHC) access and quality is a critical strategy to address maternal morbidity. Communities at higher maternal morbidity risk report lower PHC utilization and poorer quality of received PHC. Systems research on PHC predominantly focuses on structural and logistical barriers to PHC access and care provision. Clarifying the mechanisms that shape perceptions of PHC quality may help inform strategies to improve equitable PHC utilization. Transcripts from 14 interviews and four group sessions from an ongoing community-based system dynamics project in South Dakota were analyzed by two research staff through an iterative, multi-stage coding process using inductive memoing and thematic analysis. Coded excerpts were analyzed using deductive causal polarity and temporality alongside inductive identification of impacts on PHC utilization and perceived quality. Variables and relationships were used to identify feedback loops to inform CLD development. This study contextualizes relationships among factors and feedback loops influencing PHC utilization among unique South Dakota communities that experience higher maternal morbidity risk and inequitable access to quality PHC. The resulting CLD focuses on perceived PHC quality and interactions across patients and their social networks, healthcare providers, and institutional and societal contexts, explicitly representing how feedback processes unfold over time and contribute to persistent inequities in utilization and engagement.