Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Women

doi:10.1007/s40615-022-01475-4

. 2023 Dec;10(6):3007-3017.

doi: 10.1007/s40615-022-01475-4. Epub 2022 Nov 30.

Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Women

Thu T Nguyen¹, Shaniece Criss², Melanie Kim³, Monica M De La Cruz⁴, Nhung Thai⁵, Junaid S Merchant⁶, Yulin Hswen⁷, Amani M Allen^{8

9}, Gilbert C Gee¹⁰, Quynh C Nguyen⁶

Affiliations

¹ Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, 20742, USA. ttxn@umd.edu.
² Department of Health Sciences, Furman University, Greenville, SC, 29613, USA.
³ Department of Anthropology, Brown University, Providence, RI, 02912, USA.
⁴ School of Social Welfare, University of California, Berkeley, CA, 94720, USA.
⁵ Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, 94720, USA.
⁶ Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, 20742, USA.
⁷ Department of Epidemiology and Biostatistics, Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA.
⁸ Division of Epidemiology, University of California, Berkeley, CA, 94704, USA.
⁹ Division of Community Health Sciences, University of California, Berkeley, CA, 94704, USA.
¹⁰ Department of Community Health Sciences, University of California, Los Angeles, CA, 90095, USA.

PMID: 36449130
PMCID: PMC9713108
DOI: 10.1007/s40615-022-01475-4

Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Women

Thu T Nguyen et al. J Racial Ethn Health Disparities. 2023 Dec.

. 2023 Dec;10(6):3007-3017.

doi: 10.1007/s40615-022-01475-4. Epub 2022 Nov 30.

Authors

Thu T Nguyen¹, Shaniece Criss², Melanie Kim³, Monica M De La Cruz⁴, Nhung Thai⁵, Junaid S Merchant⁶, Yulin Hswen⁷, Amani M Allen^{8

9}, Gilbert C Gee¹⁰, Quynh C Nguyen⁶

Affiliations

¹ Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, 20742, USA. ttxn@umd.edu.
² Department of Health Sciences, Furman University, Greenville, SC, 29613, USA.
³ Department of Anthropology, Brown University, Providence, RI, 02912, USA.
⁴ School of Social Welfare, University of California, Berkeley, CA, 94720, USA.
⁵ Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, 94720, USA.
⁶ Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, 20742, USA.
⁷ Department of Epidemiology and Biostatistics, Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA.
⁸ Division of Epidemiology, University of California, Berkeley, CA, 94704, USA.
⁹ Division of Community Health Sciences, University of California, Berkeley, CA, 94704, USA.
¹⁰ Department of Community Health Sciences, University of California, Los Angeles, CA, 90095, USA.

PMID: 36449130
PMCID: PMC9713108
DOI: 10.1007/s40615-022-01475-4

Abstract

Background: Despite persistent racial disparities in maternal health in the USA, there is limited qualitative research on women's experiences of discrimination during pregnancy and childbirth that focuses on similarities and differences across multiple racial groups.

Methods: Eleven focus groups with Asian American and Pacific Islander (AAPI), Black, Latina, and Middle Eastern women (N = 52) in the USA were conducted to discuss the extent to which racism and discrimination impact pregnancy and birthing experiences.

Results: Participants across groups talked about the role of unequal power dynamics, discrimination, and vulnerability in patient-provider relationships. Black participants noted the influence of prior mistreatment by providers in their healthcare decisions. Latinas expressed fears of differential care because of immigration status. Middle Eastern women stated that the Muslim ban bolstered stereotypes. Vietnamese participants discussed how the effect of racism on mothers' mental health could impact their children, while Black and Latina participants expressed constant racism-related stress for themselves and their children. Participants recalled better treatment with White partners and suggested a gradient of treatment based on skin complexion. Participants across groups expressed the value of racial diversity in healthcare providers and pregnancy/birthing-related support but warned that racial concordance alone may not prevent racism and emphasized the need to go beyond "band-aid solutions."

Conclusion: Women's discussions of pregnancy and birthing revealed common and distinct experiences that varied by race, skin complexion, language, immigration status, and political context. These findings highlight the importance of qualitative research for informing maternal healthcare practices that reduce racial inequities.

Keywords: Birthing; Discrimination; Focus groups; Maternity care; Pregnancy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1**
Conceptual framework for reproductive health. Reprinted from Kramer et al. Changing the conversation: applying a health equity framework to maternal mortality reviews. Am J Obstet Gynecol. 2019;221:609.e1-609.e9. with permission from Elsevier

See this image and copyright information in PMC

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References

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1. Leonard SA, Main EK, Scott KA, Profit J, Carmichael SL. Racial and ethnic disparities in severe maternal morbidity prevalence and trends. Ann Epidemiol. 2019;33:30–36. doi: 10.1016/j.annepidem.2019.02.007. - DOI - PMC - PubMed
1. Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol. 2010;202:335–343. doi: 10.1016/j.ajog.2009.10.864. - DOI - PMC - PubMed
1. Powe NR, Cooper LA. Disparities in patient experiences, health care processes, and outcomes: the role of patient-provider racial, ethnic, and language concordance [Internet]. Commonw. Fund. 2004 [cited 2022 Sep 26]. Available from: https://www.commonwealthfund.org/publications/fund-reports/2004/jul/disp....
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[1] Artiga S, Pham O, Orgera K, Ranji U. Racial disparities in maternal and infant health: an overview - issue brief [Internet]. KFF. 2020. Available from: https://www.kff.org/report-section/racial-disparities-in-maternal-and-in.... Accessed 2 Nov 2022.

[2] Artiga S, Pham O, Orgera K, Ranji U. Racial disparities in maternal and infant health: an overview - issue brief [Internet]. KFF. 2020. Available from: https://www.kff.org/report-section/racial-disparities-in-maternal-and-in.... Accessed 2 Nov 2022.

[3] Leonard SA, Main EK, Scott KA, Profit J, Carmichael SL. Racial and ethnic disparities in severe maternal morbidity prevalence and trends. Ann Epidemiol. 2019;33:30–36. doi: 10.1016/j.annepidem.2019.02.007. - DOI - PMC - PubMed

[4] Leonard SA, Main EK, Scott KA, Profit J, Carmichael SL. Racial and ethnic disparities in severe maternal morbidity prevalence and trends. Ann Epidemiol. 2019;33:30–36. doi: 10.1016/j.annepidem.2019.02.007. - DOI - PMC - PubMed

[5] Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol. 2010;202:335–343. doi: 10.1016/j.ajog.2009.10.864. - DOI - PMC - PubMed

[6] Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol. 2010;202:335–343. doi: 10.1016/j.ajog.2009.10.864. - DOI - PMC - PubMed

[7] Powe NR, Cooper LA. Disparities in patient experiences, health care processes, and outcomes: the role of patient-provider racial, ethnic, and language concordance [Internet]. Commonw. Fund. 2004 [cited 2022 Sep 26]. Available from: https://www.commonwealthfund.org/publications/fund-reports/2004/jul/disp....

[8] Powe NR, Cooper LA. Disparities in patient experiences, health care processes, and outcomes: the role of patient-provider racial, ethnic, and language concordance [Internet]. Commonw. Fund. 2004 [cited 2022 Sep 26]. Available from: https://www.commonwealthfund.org/publications/fund-reports/2004/jul/disp....

[9] Meints SM, Cortes A, Morais CA, Edwards RR. Racial and ethnic differences in the experience and treatment of noncancer pain. Pain Manag Future Med. 2019;9:317–334. - PMC - PubMed

[10] Meints SM, Cortes A, Morais CA, Edwards RR. Racial and ethnic differences in the experience and treatment of noncancer pain. Pain Manag Future Med. 2019;9:317–334. - PMC - PubMed

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Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Women

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Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Women

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