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Accelerating birth equity using collaborative systems mapping
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DOI：10.1186/s12961-025-01373-1.png)
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Recognizing the complexity of cross-sector collaboration, holistic and innovative approaches are required to achieve birth equity. This project applied systems thinking and the Remove, Repair, Remediate, Restructure, and Provide (R4P) framework to understand and address systemic barriers to birth equity. This paper describes the systems thinking activities used to identify system actors and critical actions they can take to advance birth equity. We applied systems thinking tools through the R4P lens in a series of collaborative and iterative activities. We conducted an environmental scan and synthesis of reports with recommendations to improve birth equity. In addition, we engaged a diverse group of birth equity actors, including those from federal agencies, state and local health departments, community-based organizations, funders, academic institutions, health systems and national nonprofits, through systems mapping workshops to co-create a series of birth equity tools. Our collaborative efforts produced an innovative Birth Equity Ecosystem Map, Birth Equity Iceberg, and interactive Birth Equity Action Map. The Birth Equity Ecosystem Map is a comprehensive synthesis of recommendations defining an equitable ecosystem, while the Birth Equity Iceberg summarizes insights on systemic barriers to achieving birth equity most critical to address in the next 5 years. The Birth Equity Action Map is an interactive and strategic tool, synthesized from diverse system actors’ experiences and perspectives, that describes needed actions and responsible actors for each systemic barrier identified. We probed for and organized actions by the five dimensions of the R4P framework to encourage comprehensive action to achieve equity. The Birth Equity Action Map and connected resources developed through this project help actors identify actions they can work on to overcome identified systemic barriers to birth equity in their community and key partners for each. The tools we developed demonstrate how systems thinking and R4P can offer a more holistic and effective approach to tackling issues of birth equity and lead to more actionable insights, thereby contributing significantly to the public health goal of achieving equity. These tools can be used by birth equity advocates to assess and leverage their strengths, resources and unique context to identify priorities and collectively advance birth equity.
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