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Abstract
Objective
The clinical application of race-adjusted algorithms may perpetuate health inequities. We assessed the impact of the vaginal birth after cesarean (VBAC) calculator, which was revised in 2021 to address concerns about equity. The original algorithm factored race and ethnicity and gave lower VBAC probabilities to Black and Hispanic patients.

Methods
From 2019 to 2020, we conducted a multi-site, ethnographic study consisting of interviews and audio recordings of 14 prenatal visits. We used grounded theory to describe the social processes of racialization.
Findings.
Across 4 sites, 12 obstetricians, 5 midwives, and 31 pregnant/postpartum patients participated. Seventy-four percent (N = 23) of the pregnant/postpartum individuals identified as racially minoritized, and the remaining 24% (N = 8) identified as White. We identified four processes that facilitated the "automation" of racism: adhering to strict cutoffs; the routine adoption of calculators; obfuscating the calculator; and the reflexive categorization of race and ethnicity. When clinicians adhered to strict cutoffs, they steered low-scoring Black and Hispanic patients toward repeat cesareans. If clinicians obfuscated the calculator, Black and Hispanic patients had to work to decode the role of race and ethnicity in their probabilities in order to pursue a VBAC. By reflexively categorizing race and ethnicity, the use of the calculator forced patients to choose a singular identity, even if it obscured the truth about their multi-faceted race or ethnicity.

Conclusion
The VBAC calculator's inclusion of race and ethnicity helped to automate racism by coding race into institutional practices and care interactions. This resulted in some clinicians discouraging or prohibiting Black and Hispanic patients from attempting a VBAC.

Significance
To date, no empiric study has examined whether the VBAC calculator produced inequities in access to VBAC services and reproduced racism in care. The VBAC calculator resulted in fewer VBAC attempts among racially minoritized patients, denying them the opportunity to undergo labor and a vaginal birthing experience.

International audience ; Background This research prioritization aimed to identify major research gaps in maternal, newborn, child and adolescent health (MNCAH) to help mitigate the direct and indirect effects of the COVID-19 pandemic. Methods We adapted the Child Health and Nutrition Research Initiative methodology. We defined scope, domains, themes and scoring criteria. We approached diverse global experts via email to submit their research ideas in MNCAH and MNCAH-related cross-cutting/ health systems area. We curated the research ideas as research questions (RQs) and sent them to the consenting experts for scoring via the online link. For each RQ, the research priority score (RPS) was calculated as an average of individual criterion scores and ranked based on RPS in each area. Results We identified top-ranked 10 RQs in each maternal, newborn, and child and adolescent health and 5 in the cross-cutting/health systems area. In maternal health, indirect effects on care, measures to improve care, health risks and outcomes, and preventing and managing SARS-CoV-2 infection/COVID-19 disease were priority RQs. In newborn health, clinical characterization and managing SARS-CoV-2 infection/COVID-19 disease, mode of transmission and interventions to prevent transmission were the focus. For child and adolescent health, top-ranked RQs were indirect effects on care, clinical status and outcomes, interventions to protect against SARS-CoV-2 infection/COVID-19 disease, and educational institute-related RQs. The cross-cutting RQs were the effects of the pandemic on availability, access, care-seeking and utilization of MNCAH services and potential solutions. Conclusions We call on partners, including governments, non-governmental organizations, research institutes, and donors, to address this urgent research agenda.

International audience ; Background This research prioritization aimed to identify major research gaps in maternal, newborn, child and adolescent health (MNCAH) to help mitigate the direct and indirect effects of the COVID-19 pandemic. Methods We adapted the Child Health and Nutrition Research Initiative methodology. We defined scope, domains, themes and scoring criteria. We approached diverse global experts via email to submit their research ideas in MNCAH and MNCAH-related cross-cutting/ health systems area. We curated the research ideas as research questions (RQs) and sent them to the consenting experts for scoring via the online link. For each RQ, the research priority score (RPS) was calculated as an average of individual criterion scores and ranked based on RPS in each area. Results We identified top-ranked 10 RQs in each maternal, newborn, and child and adolescent health and 5 in the cross-cutting/health systems area. In maternal health, indirect effects on care, measures to improve care, health risks and outcomes, and preventing and managing SARS-CoV-2 infection/COVID-19 disease were priority RQs. In newborn health, clinical characterization and managing SARS-CoV-2 infection/COVID-19 disease, mode of transmission and interventions to prevent transmission were the focus. For child and adolescent health, top-ranked RQs were indirect effects on care, clinical status and outcomes, interventions to protect against SARS-CoV-2 infection/COVID-19 disease, and educational institute-related RQs. The cross-cutting RQs were the effects of the pandemic on availability, access, care-seeking and utilization of MNCAH services and potential solutions. Conclusions We call on partners, including governments, non-governmental organizations, research institutes, and donors, to address this urgent research agenda.

International audience ; Background This research prioritization aimed to identify major research gaps in maternal, newborn, child and adolescent health (MNCAH) to help mitigate the direct and indirect effects of the COVID-19 pandemic. Methods We adapted the Child Health and Nutrition Research Initiative methodology. We defined scope, domains, themes and scoring criteria. We approached diverse global experts via email to submit their research ideas in MNCAH and MNCAH-related cross-cutting/ health systems area. We curated the research ideas as research questions (RQs) and sent them to the consenting experts for scoring via the online link. For each RQ, the research priority score (RPS) was calculated as an average of individual criterion scores and ranked based on RPS in each area. Results We identified top-ranked 10 RQs in each maternal, newborn, and child and adolescent health and 5 in the cross-cutting/health systems area. In maternal health, indirect effects on care, measures to improve care, health risks and outcomes, and preventing and managing SARS-CoV-2 infection/COVID-19 disease were priority RQs. In newborn health, clinical characterization and managing SARS-CoV-2 infection/COVID-19 disease, mode of transmission and interventions to prevent transmission were the focus. For child and adolescent health, top-ranked RQs were indirect effects on care, clinical status and outcomes, interventions to protect against SARS-CoV-2 infection/COVID-19 disease, and educational institute-related RQs. The cross-cutting RQs were the effects of the pandemic on availability, access, care-seeking and utilization of MNCAH services and potential solutions. Conclusions We call on partners, including governments, non-governmental organizations, research institutes, and donors, to address this urgent research agenda.

International audience ; Background This research prioritization aimed to identify major research gaps in maternal, newborn, child and adolescent health (MNCAH) to help mitigate the direct and indirect effects of the COVID-19 pandemic. Methods We adapted the Child Health and Nutrition Research Initiative methodology. We defined scope, domains, themes and scoring criteria. We approached diverse global experts via email to submit their research ideas in MNCAH and MNCAH-related cross-cutting/ health systems area. We curated the research ideas as research questions (RQs) and sent them to the consenting experts for scoring via the online link. For each RQ, the research priority score (RPS) was calculated as an average of individual criterion scores and ranked based on RPS in each area. Results We identified top-ranked 10 RQs in each maternal, newborn, and child and adolescent health and 5 in the cross-cutting/health systems area. In maternal health, indirect effects on care, measures to improve care, health risks and outcomes, and preventing and managing SARS-CoV-2 infection/COVID-19 disease were priority RQs. In newborn health, clinical characterization and managing SARS-CoV-2 infection/COVID-19 disease, mode of transmission and interventions to prevent transmission were the focus. For child and adolescent health, top-ranked RQs were indirect effects on care, clinical status and outcomes, interventions to protect against SARS-CoV-2 infection/COVID-19 disease, and educational institute-related RQs. The cross-cutting RQs were the effects of the pandemic on availability, access, care-seeking and utilization of MNCAH services and potential solutions. Conclusions We call on partners, including governments, non-governmental organizations, research institutes, and donors, to address this urgent research agenda.