Clinicians' Perspectives on Racism and Black Women's Maternal Health

Abstract

Objective: The objective of this study was to explore clinician perceptions of how racism affects Black women's pregnancy experiences, perinatal care, and birth outcomes. Materials and Methods: We conducted 25 semi-structured interviews with perinatal care clinicians practicing in the San Francisco Bay Area (January to March 2019) who serve racially diverse women. Participants were primarily recruited through “Dear Perinatal Care Provider” email correspondences sent through department listservs. Culturally concordant, qualitatively trained research assistants conducted all interviews in person. The interviews ranged from 30 to 60 minutes and were audio-recorded and professionally transcribed verbatim. We used the constant comparative method consistent with grounded theory to analyze data. Results: Most participants were obstetrician/gynecologists ( n = 11, 44%) or certified nurse midwives ( n = 8, 32%), had worked in their current role for 1 to 5 years ( n = 10, 40%), and identified as white ( n = 16, 64%). Three themes emerged from the interviews: provision of inequitable care ( e.g. , I had a woman who had a massive complication during her labor course and felt like she wasn't being treated seriously ); surveillance of Black women and families ( e.g. , A urine tox screen on the Black baby even though it was not indicated, and they didn't do it on the white baby when, in fact, it was indicated ); and structural care issues ( e.g. , the history of medical racial experimentation ). Conclusion: Clinicians' views about how racism is currently operating and negatively impacting Black women's care experiences, health outcomes, and well-being in medical institutions will be used to develop a racial equity training for perinatal care clinicians in collaboration with Black women and clinicians.

Overlap between birth trauma and mistreatment: a qualitative analysis exploring American clinician perspectives on patient birth experiences

“…Emerging information about patient mistreatment is not unique to maternity care, and exploration continues into potential contributing factors, including clinician burnout, compassion fatigue, and scarcity of resources or time [ 49 – 51 ]. Mistreatment in maternity care settings, however, has its own complex origins, and it must be explored within the larger context of gender discrimination, intersectionality [ 52 – 54 ], violence against women, structural violence [ 52 , 54 ], and the racist and exploitative history of obstetric care [ 37 , 55 , 56 ].…”

Antibias Efforts in United States Maternity Care: A Scoping Review of the Publicly Funded Health Equity Intervention Pipeline

“…For example, an NIH-funded project proposed a standardized labor induction protocol as a way to "inhibit" the influence of perinatal provider bias in labor management (Hamm K23HD102523). These interventions reflect growing support for systemic change 4,18,21,39 and provide crucial tools to complement provider bias-reduction efforts. Similarly, high-quality measures of patients' maternity care experiencesparticularly those co-developed by Black women and birthing people and other communities inequitably burdened by racist care 35,42,43 -will be critical to understanding where interventions are needed, whether they are effective, and for whom.…”

“…2 The need for antibias/antiracism training has been endorsed not only by BIPOC community members but also by perinatal care providers who have witnessed racist stereotypes and discrimination leading to the mistreatment of Black patients. 10,18,19 Antibias training for health care providersoften targeting "implicit" or subconscious biases-is now mandated in some states (eg, California), 20 and recommended by the federal government, 21 professional societies, 22 and birth equity leaders. 23 Regulators and hospital leaders need an evidence base to select and implement effective antibias training.…”

Effect of the COVID-19 Pandemic on Maternal Health in the United States

“…Maternal mortality data highlight disparities in health outcomes based on maternal race and ethnicity. Although race is the variable collected in the vital statistics reports, patients, maternity caregivers, and public health experts generally agree that systemic and long-standing societal and health care racism rather than race is the reason for these differences ( Chambers et al, 2021 ; Chambers et al, 2022 ; U.S. GAO, 2022 ). The maternal death rate for non-Hispanic Black women was 44.0 per 100,000 live births in 2019, then increased to 55.3 in 2020, and 68.9 in 2021 ( U.S. GAO, 2022 ).…”