Age-Based Reproductive Healthcare Stereotype Threat (HCST) as a Stressor Affecting Prenatal Mental Health in Pregnant Women of Advanced Maternal Age: Measurement, Process, Outcomes, and Interactions with Ethnicity/Race, SES, and Other Social Identities

Abstract

Purpose of Review Reproductive health, and pregnancy more specifically, is the first critical link between generations. Beginning with this first critical link, pregnancy acts as a domino, affecting the expression of genes and determining the lifespan mental and physical health and reproductive potential of offspring and, likely, of subsequent generations. Given the powerful intergenerational domino that is pregnancy, the development of innovative models to enhance reproductive health and outcomes is an invaluable public health investment. Recent Findings While U.S. pregnancy and birth outcomes have improved dramatically since the 1960s— including substantial progress within the past 15 years, largely catalyzed by the Healthy People initiative—group-based disparities remain. What’s more, social change and medical advancements have led to an evolving window of female reproductive age. Despite becoming more common, being an older expectant mother remains a stigmatized social identity. The concept of healthcare stereotype threat (HCST) is introduced in relation to reproductive health. Stereotype threat is a situational predicament in which an individual who possesses a stigmatized social identity fears confirming negative group-based stereotypes. HCST is a healthcare-specific form of stereotype threat, arising out of stereotypes that are salient in healthcare settings. It is hypothesized that the experience of age-based reproductive HCST is an overlooked stressor affecting prenatal mental and physical health among women of advanced maternal age. Summary The hypothesized process of age-based reproductive HCST is described; outcomes and consequences are discussed; interactions with ethnicity/race, SES, and other aspects of social identity are considered; and strategies for prevention and intervention are explored, including active and passive shifts in three areas: (1) internally, in both providers and patients; (2) in the external environment, or the physical healthcare setting itself; and (3) within interpersonal interactions that occur within healthcare settings, particularly between physicians and patients. Implications for gynecological, infertility, and obstetric care and improving the reproductive outcomes of older women are discussed.

Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age

“…11 Women generally go beyond the medical and social models of care to include feelings of experienced risk and resilience factors (e.g., prior use of ART). 8,11 Providers express a more objective and science-based perception because they focus on the biomedical risk and physiological outcomes. Midwives adopt a more holistic attitude that encompasses the psychological and social wellbeing of the patient.…”

“…, prior use of ART). 8 , 11 Providers express a more objective and science-based perception because they focus on the biomedical risk and physiological outcomes. Midwives adopt a more holistic attitude that encompasses the psychological and social wellbeing of the patient.…”

“…Despite having become more common, older expectant mothers remain a stigmatized social identity, 8 with some still referring to the outdated term “geriatric pregnancy.” Although the impact of AMA and delayed childbearing on maternal and perinatal outcomes has been studied extensively, no universal consensus on its definition exists. This terminology currently refers to the later years of a woman's reproductive life span and generally applies to women age ≥35 years.…”

A Pregnancy Decision-Making Model: Psychological, Relational, and Cultural Factors Affecting Unintended Pregnancy

“…One of our primary reasons for crafting the PDMM, in addition to the hopes of spurring new research on the psychology of pregnancy decision-making in cultural context, was that the PDMM might be used to improve social services available to people facing unintended pregnancy. Because of the vitriolic public conversations surrounding reproductive issues, pregnant people often fear judgment from healthcare providers regarding their pregnancy options (Abdou, 2017). In order to combat their own assumptions, healthcare providers in fields such as medicine, nursing, psychology, social work, and counseling can use the PDMM to improve their awareness of the decisional complexities that clients might face when experiencing an unintended pregnancy.…”

“…Young people (especially those from low-income areas) who become pregnant may fear becoming “another statistic” if they become teenage parents (Greene, 2006). Older adults may be concerned about fulfilling stereotypes about advanced maternal age; in fact, the only published paper connecting stereotype threat to pregnancy decisions covers stereotype threat in the context of advanced maternal age (Abdou, 2017). In the United States, bias related to who accesses abortion may also enact stereotype threat for pregnant people who are Black/African American, young, unpartnered, uneducated, and/or living in poverty.…”