ReDesigning Partner Compensation in Perinatal Community-Based Participatory Research

Abstract

Perinatal community-based participatory research (CBPR) is an effective approach to elevate and address the high rates of adverse outcomes and inequities during the perinatal period. It relies on authentic partnerships between academic researchers and community-based organizations and community advisory board members, many of whom are women. Challenges to compensation of community partners exist within perinatal CBPR related to bureaucratic restrictions, unique factors for women, and a lack of support and transparency. A redesign of compensation practices for community partners is imperative to ensure they are fair, adequate, equitable, flexible, sustainable, and informed. Perinatal health researchers must collaborate with their institutions’ financial offices to develop creative solutions that convey respect, value the needs and expertise of the community partners, and promote transparency.

Introduction

Respectful and authentic community-based participatory research (CBPR) involves facilitating equitable partnerships between community partners and academic researchers across all phases of the research process. ¹ CBPR is grounded in a research justice framework ² and well-suited to elevate and address the high rates of adverse outcomes and inequities during the perinatal period. Leading reproductive health organizations and policy experts, like the Black Mamas Matter Alliance ³ and National Birth Equity Collaborative, ⁴ have called for perinatal CBPR to advance perinatal health equity, emphasizing its role in improving research quality, and prioritizing outcomes that matter to patients and their communities. Perinatal health equity is defined as assuring optimal health for pregnant, birthing, and postpartum individuals by valuing all populations equally, recognizing and rectifying historical injustices, and providing quality perinatal care and resources according to need.^5,6 Perinatal health researchers have used CBPR to better understand best practices for designing interventions that address the United States perinatal health crisis, especially among Black pregnant women.^7,8

Unique to CBPR is its engagement with community-based organizations (CBOs) and community advisory board (CAB) members. CBOs are defined by the Patient-centered Outcomes Research Institute as any nonfederal, nonacademic, nonresearch organization that provides services, support, resources, or advocacy to members of a defined community. ⁹ CABs include members of the community of interest and provide infrastructure for them to voice priorities or concerns regarding the research process from inception of the research question to dissemination. CBOs and CABs serve as essential sources of leadership as co-investigators and co-owners of the CBPR process, which is a shift from traditional research processes that view communities as participants or advisors. ¹⁰

An important and often overlooked component of CBPR is the establishment of equitable compensation of CBOs and CABs for their expertise, time, and partnership. Novac-Pavlic et al. (2023) describe four compensation principles essential to respectful and authentic CBPR: (1) offer fair and equitable payment, (2) be flexible, (3) support informed choices, and (4) differentiate compensation (monetary and nonmonetary) from reimbursement. ¹¹ In perinatal CBPR, CBO leaders and CAB members are predominantly women, including pregnant individuals and parents. Fair, adequate, equitable, flexible, sustainable, and informed compensation of women and women-led CBOs is an investment in that person and organization. Economic support of women is important because, with financial stability and resources, women are twice as likely as men to reinvest their earnings in their families and communities, which can expedite community development. ¹²

This perspective article describes current challenges in perinatal CBPR compensation for CBOs and CAB members and proposes solutions for providing fair, adequate, equitable, flexible, sustainable, and informed compensation that are consistent with Novac-Pavlic et al.’s compensation principles. ¹¹ We call on perinatal health researchers to collaborate with their institutions’ financial offices to implement equitable solutions for community partner compensation. While these challenges and solutions are broadly applicable to CBPR, we will focus on those unique to perinatal research that engage women or women-led CBOs.

Compensation Challenges in CBPR

Despite the call and value in expanding perinatal CBPR, there are bureaucratic challenges, inadequate infrastructure, and scarce guidance from academic institutions, which limit the ability of perinatal health researchers to pay CBOs and CAB members in ways that honor their contributions and respect their needs. Consequently, compensation decisions among universities and researchers are often subjective and based on prior experiences of what is considered “fair.” ¹³ Such decisions, resulting in uninformed, unfair, inflexible, and inaccessible payment processes, can deleteriously hinder the research process and lead to distrust from CBOs and CAB members toward researchers. ¹³

Compensation challenges with CBOs

Challenges to compensation for CBOs often begin early in the research process (Table 1). As grant proposals are being written, academic partners continue to draw their usual salary, while CBOs and CAB members are typically uncompensated for consulting, planning, or writing contributions. This creates an inequitable burden on community partners. For instance, in preparing grant budgets, academic institutions routinely include standard indirect rates for government funding (historically 30–70% of direct costs), while indirect budgeted amounts for CBOs (e.g., computers, phones, internet, workspace, printing, office supplies, or salary support for ancillary staff like accountants), are typically excluded. When grants are awarded to academic institutions, university financial processes for setting up subawards, contracts, and vendor payment systems to CBOs are often time- and staff-intensive and can result in delayed payment. This typically requires CBO partners to front operational costs for months while navigating complex onboarding requirements, diverting limited staff away from community programming, and perhaps delaying project activities until payments are released.

Table 1.

Challenges and Solutions for Compensation and Reimbursement of CBOs Engaged in Perinatal CBPR

	Challenges	Solutions
Compensation Type	Administrative burden from financial engagement with academic partner	Offer alternatives to having money transferred to the CBO, i.e., academic partner pays associated research costs (most appropriate for small grants without salaries)
		Work with academic financial staff and provide CBO support for administrative tasks (e.g., drafting forms/invoices/scopes of work, navigating online systems)
	Accounting costs of managing grant budget	Include salary for CBO accountant in budget
		Include indirect costs for CBO in budget
	Limited benefits from partnership opportunities with academic institutions and their resources	Create opportunities for in-kind education and training offerings for CBO staff and clients (e.g., staff training)
		Provide in-kind support for oral history projects
		Offer in-kind assistance with CBO grant writing unrelated to the CBPR grant
		Provide co-authorship and co-presentation opportunities and cover travel-related expenses and conference registration fees
Reimbursement	No reimbursement for indirect costs	Have CBO charge indirect rate
		Include CBO operating costs in grant budgets
Support and Transparency	Lack of awareness of hidden costs of partnerships	Co-develop budgets transparently
		Outline different payment options with an explanation of burden, requirements, and timelines of each to allow for informed decisions

CBO, community-based organization; CBPR, community-based participatory research.

Compensation challenges with CAB members

Challenges with compensation to CAB members are multifold (Table 2). First, before funding is secured, CAB members may be asked to invest significant time away from their caregiving or work responsibilities to provide expertise, despite the reality that grants may not be awarded and individuals cannot be retroactively paid. These current funding structures place disproportionate burdens and risk on CAB members during the pre-award phase. Second, CAB member payments can be challenging (Table 2). When grants are administered by academic institutions, the academic financial processes often create unnecessary compensation burdens, like difficulty among CAB members accessing and navigating payment systems, delayed payment processing times, and less desirable forms of payment. While cash payments may be preferred, authorization of cash distribution is uncommon among academic institutions. Use of gift cards is common, but also problematic, as it makes assumptions on how the CAB member wants to spend the money. ¹⁵ Reloadable debit cards and peer-to-peer payment services such as PayPal, Venmo, and Zelle may be plausible alternatives, but are sometimes not allowed by academic institutions and often involve a service fee. They also require the recipient to have a bank account, debit or credit card, digital access, and a moderate level of digital literacy. While some academic institutions have a mechanism for payments by check or debit card, bank accounts are usually needed to cash a check, and a social security number may be required for issuing payments via debit card. In the United States, gendered financial disparities exist, as men are more likely than women to have a bank account. ¹² Furthermore, receipt of compensation as income may preclude eligibility for some social service programs. CAB member compensation as a vendor/supplier consultant payment also requires a 1099-NEC tax filing above a certain threshold. For tax year 2026, the threshold increased from $600 to $2000. ¹⁴

Table 2.

Challenges and Solutions for Compensation and Reimbursement of CAB Members in Perinatal CBPR

	Challenges	Potential solutions
Compensation Type	Payment types do not meet CAB members’ needs and values	Co-develop the payment type with CAB members so that they are able to define what is valued. Include five different compensation payment options (check, gift card, reloadable debit card, peer-to-peer payment option, and Cash app) and a non-monetary option with an explanation of burden, requirements, and timelines of each to allow individuals to make an informed choice. Ask CAB members if the compensation type feels fair.
	Payment methods require reporting of social security number
	Payment methods require bank account
	Federal requirements to report compensation as income may preclude eligibility for some social service programs and require tax filing above a certain threshold	In 2026, the threshold limit for 1099 tax filing of nonemployment compensation increased from $600 to $2000. 14 Consider alternatives to monetary compensation (see below and Box 1).
Childcare and Travel Reimbursement	Childcare needs and expenses related to meeting participation (in person or on a virtual platform, especially if early postpartum or lactating)	For in-person meetings, pre-identify private space for lactation and pumping. Provide reimbursement to offset costs of participation (e.g., increased compensation, schedule rides via ride share services). Offer option for virtual meetings. Create a culture that is accepting of infants, children, and teenagers being seen and heard.
	Transportation needs and expenses related to in-person meeting participation (especially among pregnant and postpartum individuals and parents)
Alternatives to Monetary Compensation	Compensation alone does not make CAB members feel valued	Offer meals and when possible, order from local female-owned vendors.
		Offer non-monetary compensation that has value to the individual (e.g., diapers and other baby supplies, laundry service).
		Provide co-authorship and co-presentation opportunities and cover travel-related expenses and conference registration fees.
Support and Transparency	Individuals agree to participate on CAB (or other activities) without knowing how they will be compensated	Describe compensation amounts and payment options (see Compensation Type above) when an individual is invited to participate on a CAB (or other activities).
	Difficulties accessing payment (e.g., unable to use an online gift card)	Offer 1:1 technical assistance to individuals who require assistance accessing their compensation.

CAB, community advisory board.

Box 1: Examples of Alternative Compensation in Perinatal CBPR

“Conducting brainstorming sessions with CAB members is a great way to come up with alternative compensations. On one occasion, members expressed a desire to record their oral histories. I was able to identify a grant that fit this project, and we received funding to make it happen. CAB members who participated now own their video recordings, professionally edited, giving them a meaningful product to share with family and friends.”

–R. Mirabal-Beltran, Principal Investigator of the Wash and Spin to Health Initiative

“When the CBO needed supplies to participate in a study about interactive video home visits (cameras, printers, iPads, etc), instead of transferring money from the university to the CBO (a long and burdensome process) for the CBO to buy the supplies, we had our university buy the supplies and the CBO kept them for future use.”

–K. Bower, Co-Investigator of the Early Home Visiting Study

“When we approached the CAB members for our R01 about partnering on a article, we accounted for and paid them by incorporating time into our existing meetings to conceptualize and write the article. We also used the opportunity to help build their skills related to publication and authorship. Each member now has their own ORCiD ID and they fully understand the publication process.”

–A. Dunn Amore, Co-Investigator of the Weight of it All (WOIA) Study

Compensation challenges unique to perinatal CBPR

For pregnant individuals and parents, these compensation challenges can be exacerbated by additional factors. In the United States, 4% of births are among adolescents ¹⁶ and 7% are among individuals without lawful immigration status. ¹⁷ Adolescents typically do not have a bank account, debit or credit card, and individuals without documentation may not have a social security number, limiting compensation options. Pregnant individuals and parents may have additional challenges in attending CAB meetings with respect to time, transportation, and childcare limitations. CAB members who are pregnant or new parents are especially vulnerable to unjust compensation practices, given their psychological, economic, and relational transitions and potential need for financial security. Collectively, these burdens disproportionately place strain on CBOs and CAB members and can negatively influence the researcher–partner relationship, thereby eroding trust and undermining equitable partnerships.

There are limited well-described guidelines for CBPR compensation decisions and concurrently, a lack of public and published transparency within the scientific community on whether compensation was given to study participants, standard payment amounts, types (e.g., reimbursements for out of pocket expenses, compensation for time and burden, or incentives), or rationales (e.g., local norms, study budget, burden of responsibility).^13,18,19 In a recent scoping review on ethical issues in studies that used photovoice, a CBPR method, compensation amount, and type were only mentioned in 6 of the 25 studies. ²⁰ In a separate scoping review examining engagement of people with lived experiences in CABs, compensation was discussed in 30 of the 53 studies, and a lack of adequate compensation was noted as a challenge to study participant recruitment. ²¹ No studies were found that provided evidence-based guidelines for CBPR compensation in perinatal health research or that associated ethical compensation practices with health outcomes.

ReDesigning Compensation in Perinatal CBPR

A multifold compensation redesign in perinatal CBPR in alignment with Novac-Pavlic et al.’s compensation principles ¹¹ is needed. First, early, clear, and transparent communication between the academic partner and CBO is essential during the grant proposal phase, including role and workload expectations and up-front reimbursement expenses. ²² Next, creative financial and administrative alternatives that support the CBO’s needs and values should be encouraged (Table 1). Codeveloping the grant budget is also essential and should include the CBO’s administrative support, accountant’s salary, and other operating and indirect costs. At any point in the research process, nonmonetary support can be offered by the academic partner to the CBO, including staff training, oral history project support, grant writing support (for other grants), co-authorship and co-presentation on scholarly work (including travel expenses), and networking opportunities. Researchers should also advocate to limit their institution’s bureaucratic burdens and provide financial staff and processes to support fiscal arrangements with the CBO.

To address compensation challenges in paying CAB members, being flexible and supporting informed decision-making in compensation is essential (Table 2). Researchers should urge their institution’s financial leaders to examine their internal systems and processes to minimize time and resource burdens, allow for transparency in payment tracking, and offer multiple payment options that are the least restrictive in use and meet the diverse needs of CAB members and their individual preferences. Academic partners should outline different payment options, with an explanation of the burden, requirements, and timeliness of each option to promote an informed choice. Options should include checks, gift cards, reloadable debit cards, and peer-to-peer payments. Another promising option is CashApp, a mobile payment platform that does not require the user to have a bank account and allows participants to use the funds however they choose. ¹⁵ To promote transparency, researchers should share current tax filing requirements and payment thresholds to CAB members for nonemployment compensation and report the CAB monetary and nonmonetary compensation in publications, similar to study participant compensation.

Specific to perinatal CBPR, pregnant individuals and parents who serve on CABs may have childcare, lactation, and transportation needs and expenses to attend meetings and events. Upfront provision of vouchers for childcare and transportation or an increase in total compensation to include these expenses is imperative to ensure equitable CAB participation. As a last alternative when advance arrangements are not feasible, reimbursement for childcare and transportation is acceptable, although not fair, as it requires the member to pay for these additional expenses up front. Inclusive environments that provide lactation spaces and are welcoming of infants, children, and teenagers (e.g., flexible meeting formats, child-friendly spaces, encouraging family presence and participation) are also important. Pregnant individuals and parents may also value nonmonetary compensation and support that reduces daily burdens and acknowledges caregiving responsibilities, especially when the challenge of monetary compensation is insurmountable. These include not only the provision of meals at in-person meetings, but also take-away boxes for leftovers to share with family members at home, material goods like infant supplies, transportation services, and invitations to participate in research or academic special events. Altogether, perinatal health researchers must intentionally create space for open, respectful dialogue with CAB members regarding valued monetary and nonmonetary compensation, as their preferences may vary. Some members may welcome compensation for their contributions while others may express discomfort with being paid. Navigating these perspectives requires thoughtful facilitation and the development of study infrastructures that honor individual preferences.

Conclusion

Acknowledgment, prioritization, and centering of community partners’ valuable contributions are imperative to perinatal CBPR and require careful attention to determine adequate, equitable, flexible, sustainable, and informed compensation. CBOs typically enter community-academic partnered research relationships trusting that the academic partner will be a good steward of their time, resources, and expertise. To build trust and foster strong, ongoing community partner relationships, perinatal health researchers must collaborate with their institutions’ financial offices to implement equitable practices for community partner compensation. While institutional barriers exist, creative solutions in compensation practices can be developed through advanced planning, shared decision-making, and intentional advocacy that convey respect, promote transparency, and minimize burdens to the CBOs and CAB members. Redesigned community partner compensation will be critical to build trusting relationships and expand funding of perinatal CBPR,^23,24 thereby advancing perinatal health equity and improving perinatal health outcomes.

Acknowledgement

The authors thank Christina Marea and Lauren Arrington for creating a space where we could redesign compensation for perinatal CBPR.

Authors’ Contributions

H.M.B.: Conceptualization, data curation, writing: original draft, writing—review and editing, and project administration. K.M.B.: Conceptualization, data curation, writing—original draft, and writing—review and editing. A.D.A.: Conceptualization, writing—original draft, and writing—review and editing. J.N.S.S.: Writing—review and editing. K.N.R.: Conceptualization, writing—original draft, and writing—review and editing. D.S.: Writing—review and editing. R.M.B.: Conceptualization, data curation, writing—original draft, writing—review and editing, supervision, and project administration.