Author ORCID Identifier

https://orcid.org/0009-0005-5589-5715

Date of Award

8-7-2024

Degree Type

Dissertation

Degree Name

Doctor of Public Health (DrPH)

Department

Public Health

First Advisor

Harry J. Heiman, MD

Second Advisor

Kimberley E. Freire, PhD

Third Advisor

Natalie D. Hernandez, Ph.D

Abstract

Background: Black women in the United States experience disproportionately high rates of both maternal mortality and morbidity, compared to women of other racial and ethnic groups, and experience profound inequities regardless of health or social status. Black women are nearly three times more likely to die from a pregnancy-related cause than White women and have a two to three-fold increased risk of experiencing maternal complications/severe maternal morbidity (SMM) or/maternal near miss (MNM). A complex interplay of factors such as preexisting chronic conditions, social determinants of health, racism, bias, and disrespectful care contribute to poor outcomes. Research suggests that disrespectful care during childbirth contributes to severe maternal complications/SMM and MNM.

Purpose of Research: The purpose of this study was to expand our understanding of the birthing experiences of Black women that resulted in a MNM, specifically in relation to understanding their perspectives around experiencing disrespect in maternity healthcare settings.

Methods: A qualitative secondary data analysis was performed using data from Morehouse School of Medicine’s national cross-sectional qualitative survey that sought to capture the birthing experiences of women who experienced maternal complications and/or MNM. A practical thematic analysis, utilizing Black Feminist framework, guided the analysis of interview transcriptions and video recordings to identify themes to center Black women’s birthing experiences with disrespectful patient-provider encounters.

Findings & Results: A total of 43 women from across the U.S. that identified as Black or African American and reported experiencing a maternal near miss, were selected for analysis. At the time of their interviews, women were between 25-44 years of age. Most reported an annual household income of $50,000 or above and had completed college or a graduate/professional degree. The analysis provided an in-depth understanding of Black women’s experiences and revealed critical themes and subthemes, including women feeling unseen when encountering racial bias and discrimination, experiencing a lack of compassion and privacy, insurance discrimination, feeling unheard due to an inability to self advocate, and suffering from poor outcomes due to not being listened to, and lack of communication and shared decision-making, leaving Black women feeling disempowered to make choices about their care due to a lack of transparency and clear information.

Discussion & Recommendations: The narratives highlight various dimensions of disrespect encountered by Black women and underscore the systemic nature of the issues within maternity care settings and the impact of provider bias and discrimination on patient outcomes. The findings indicate that negative experiences contribute to delays in care, diagnosis, and treatment leading to poorer outcomes. Efforts to transform maternity care systems to provide equitable and respectful care require targeted interventions, policies, and systemic changes in healthcare practice, expanding and diversifying the maternity healthcare workforce by improving training, certification, and reimbursement for clinical and non-clinical providers such as midwives and doulas, and utilizing a trauma-informed care approach with Black women.

DOI

https://doi.org/10.57709/37395554

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