Date of Conferral

8-11-2026

Date of Award

August 2026

Degree

Doctor of Public Health (DrPH)

School

Health Sciences

Advisor

Marshae McNeal

Abstract

Secondary postpartum hemorrhage (SPPH) is a significant contributor to maternal morbidity in the United States and occurs after hospital discharge during the postpartum period. Persistent disparities in terms of maternal outcomes suggest access to prenatal care alone may not adequately address clinical and social factors associated with SPPH. Guided by the Social Ecological Model, which recognizes that health outcomes are influenced by a collective approach to examining health. The purpose of this study was to examine associations between SPPH, prenatal care access, and social determinants of health from 2019 to 2022 while controlling for maternal age, race, and delivery type. A quantitative, cross-sectional analysis was conducted using Pregnancy Risk Assessment Monitoring System data (N = 16,541). Chi-square analyses and multivariable logistic regression models were used to assess associations between SPPH and selected predictors. Prenatal care access was not a statistically significant predictor of SPPH according to the adjusted model (p = 0.234). However, maternal age (p < 0.001; OR = 1.014), maternal abuse (p < 0.001; OR = 1.214), and income (p = 0.008; OR = 1.031) were significantly associated with increased odds of SPPH, while vaginal delivery was associated with decreased odds (p < 0.001; OR = 0.517). These findings suggest SPPH is influenced by multilevel determinants supporting use of the SEM. Based on these findings, interventions and policies were created to support psychosocial screening, postpartum care coordination, expanded postpartum coverage, and community-based support systems. This study highlights the importance of multilevel approaches to improving maternal health outcomes and reducing preventable postpartum complications.

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