Positive deviance to address health equity in quality and safety in obstetrics

Elizabeth A. Howell, Zainab N. Ahmed, Shoshanna Sofaer, Jennifer Zeitlin

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Racial/ethnic disparities persist in obstetrical outcomes. In this paper, we ask how research in obstetrical quality can go beyond a purely quantitative approach to tackle the challenge of health inequity in quality and safety. This overview debriefs the use of positive deviance and mixed methods in others areas of medicine, describes the shortcomings of quantitative methods in obstetrics and presents qualitative studies carried out in obstetrics as well as the insights provided by this method. The article concludes by proposing positive deviance as a mixed methods approach to generate new knowledge for addressing racial and ethnic disparities in maternal outcomes.

Original languageEnglish
Pages (from-to)560-571
Number of pages12
JournalClinical Obstetrics and Gynecology
Issue number3
StatePublished - 1 Sep 2019


  • disparities
  • equity
  • obstetrics
  • positive deviance
  • quality improvement
  • quality of care


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