Research Overview
Field: Public Health
Project Title: Case Studies of Continuity-of-Care Initiatives for Women Across the Reproductive Life Course
Name: Karen Yoda
Program: Laidlaw Scholars Leadership & Research Programme
Faculty Advisor/PI: Ishani Ganguli
Supervisor/Mentor: Margaret McConnell
Host Institution/Department: Harvard Medical School; Harvard T.H. Chan School of Public Health
Concentration/Major: Human Developmental and Regenerative Biology
College: Harvard College
House: Leverett House
Graduation Year: 2029
Maternal health outcomes in the United States remain poorer than those of other high-income countries despite advances in obstetric care. Increasingly, maternal health research has emphasized the importance of continuity of care across the reproductive life course, or the degree to which healthcare across multiple encounters is experienced as coherent, connected, and consistent with a patient’s medical needs and personal context. Continuity of care has been associated with improved maternal outcomes and patient experience, yet relatively few initiatives designed to strengthen continuity across the reproductive life course become routine practice. This study examines why promising continuity-of-care initiatives, including government policies, insurance programs, digital health technologies, and healthcare delivery models, struggle to move beyond the pilot stage into sustained implementation. Eight comparative case studies were selected across government, insurance, healthcare delivery, and technology sectors. Publicly available documents were analyzed using qualitative content analysis to identify recurring implementation barriers, supplemented by interviews with individuals involved in these initiatives. Findings suggested that implementation barriers often lie outside the implementing organization while cross-sector coordination emerged as a possible facilitator of implementation. In other words, continuity-of-care interventions are often initiated by organizations that do not control the conditions necessary for the intervention’s success. By comparing implementation efforts across multiple sectors, this study shifts attention from intervention design to the organizational and system-level conditions necessary for long-term integration into routine care. These findings may help inform policymakers, healthcare organizations, and other stakeholders seeking to strengthen continuity of care and integrate maternal health innovations into routine practice.