Black women in the US experience more pregnancy complications. Here's why that needs to change

The United States is amid a maternal health crisis, with Black women being more likely to die and more likely to experience adverse events during pregnancy than women of other races. Recent research shows that Black women are 2.6 times more likely to die from pregnancy than White women and their healthcare experiences are largely marred by obstetric racism, a form of racism that is specific to obstetric care.

As a result of the ongoing crisis and the increasing attention surrounding it, many Black women consider pregnancy with a heightened awareness of the unique dangers it might present to them and their infants. A doctoral dissertation from Purdue University recently explored how communication shapes Black women’s perceptions of and responses to the risks of pregnancy. In this study, 28 self-identified Black women were interviewed about their attitudes towards pregnancy and the influence of pregnancy-related communication with members of their social networks and healthcare providers.

Several Black women in the study were profoundly apprehensive about pregnancy. Gendered racism shaped their perceptions of pregnancy risk through prevailing narratives and statistics related to the Black maternal health crisis, the narratives of Black women in their lives and experienced or anticipated bias.

This apprehension informed their decision-making around pregnancy, including the setting in which they preferred to give birth, their provider demographic preferences and the way they participated in clinical encounters with healthcare providers. Another important finding of this study was that Black women’s apprehension about pregnancy is influenced by communication with healthcare providers, who can either amplify or attenuate perceptions of pregnancy risk. Closely examining the concerns Black women feel about pregnancy is important, because it has broader implications for behaviour and bears relevance to historical and contemporary forms of racism.

The long history of obstetric racism and the violation of Black women’s bodies contributes to their mistrust of the healthcare system. Black women consider not only their own experiences, but the experiences of other Black women in their lives and Black women in the public eye, such as Serena Williams (who publicly shared her own experience of mistreatment during pregnancy).

These realities are considered within the context of the historical brutalization of Black women’s bodies at the hands of healthcare providers. The current fear Black women are experiencing is thus inextricably linked to a broader, more overarching mistrust that marginalized communities have of the healthcare system. As the COVID-19 pandemic demonstrated, healthcare systems and the stakeholders within them need to demonstrate trustworthiness to advance equitable health outcomes. It’s, therefore, important to understand the fear and apprehension that characterizes how many Black women approach the healthcare system, particularly within the context of pregnancy, to take the steps necessary to redress the factors that lead to mistrust.

Mental health is an important component of overall wellbeing during pregnancy. Black women with fear and mistrust towards the healthcare system, bear the additional burden of self-advocacy and extensive personal research, driven by a natural desire to protect themselves and their babies. This additional work is unjust, adding to the physical and emotional burden of pregnancy. And, it is potentially detrimental to women’s mental and/or physical health during pregnancy. One participant indicated that her response to pregnancy included fear of losing her life. This anecdote, combined with other women’s narratives, reveals the stress that the current crisis is adding to women’s pregnancy experiences. Research demonstrates that stress can be harmful to pregnant women and may lead to complications during pregnancy.

Black women are forced to make critical decisions in the interest of themselves and their babies, because safety doesn’t feel to them like the default. This appeared to be an effective means of self-protection for Black women with high levels of health literacy, as well as Black women who were able to reach out to members of their social network who were health professionals for informal advice. However, for marginalized Black women with low levels of health literacy, these decisions appeared to be inadvertently unhelpful.

Although many participants in this dissertation study made well-researched, evidence-driven decisions to protect themselves and their babies, a few with lower levels of health literacy reported that they withheld information from their healthcare providers or chose not to follow providers’ guidance. These decisions, and their potential ramifications, underscore the fact that the healthcare system needs to work to foster safety for all women, taking proactive steps to redress the historical and ongoing wrongs that have eroded trust. Healthcare providers in particular play a critical role, as this study found that when they communicate clearly, foster agency in patients through empowering communication and are empathetic, they can attenuate Black women’s perceptions of pregnancy risk.

Likewise, policymakers can ameliorate Black women's concerns about pregnancy by facilitating access to resources that enhance their wellbeing during pregnancy. Community leaders interviewed as part of an environmental scan for this study highlighted Medicaid reimbursement and quality of service, broader insurance policies and reimbursement and transportation policies as relevant to current maternal health outcomes.

Studying Black women’s perceptions and experiences of pregnancy risk reveals both individual and systemic dimensions of the ongoing crisis, contributing to the evidence for the need for multilevel interventions to improve Black maternal health outcomes. Furthermore, listening closely to Black women's concerns also demonstrates the roles that healthcare providers and policymakers can play in reducing the dangers of pregnancy for Black women and attenuating their perceptions of risk.