Dissertation Title: DISRESPECT IN MATERNITY HEALTHCARE SETTINGS: LIFTING BLACK WOMEN’S VOICES TO IMPROVE MATERNAL HEALTH OUTCOMES

Dissertation Chair: Dr. Harry J. Heiman

Dissertation Abstract: 

Background: Black women in the United States experience disproportionately high rates of maternal morbidity and mortality compared to women of other racial and ethnic groups. 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 severe maternal complications/morbidity or a maternal near miss. A complex interplay of factors such as preexisting chronic conditions, social determinants of health, medical racism and bias contribute to poor outcomes, and is often exacerbated by disrespectful practices in maternity care settings. While there is extensive quantitative research highlighting Black maternal health inequities, there are limited qualitative studies that highlight the birthing experiences of Black women, specifically providing a critical context through their voices and perspectives. Understanding these experiences is crucial for addressing healthcare disparities and improving maternal health outcomes.

Purpose of Research: The purpose of this study was to operationalize disrespect and expand our understanding of the birthing experiences of Black women who experienced a MNM, exploring their perceptions of disrespectful patient-provider encounters and the specific challenges they faced in receiving respectful care.

Methods: A qualitative secondary 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. The secondary analysis employed a practical thematic analysis, utilizing a Black Feminist framework, to systematically review and interpret interview transcriptions and video recordings to identify themes to center Black women’s birthing experiences with disrespect in maternity healthcare settings.

Findings & Results: The thematic analysis revealed several key themes and subthemes: women feeling unseen when they are not cared for as a unique individual, when their privacy is not valued, when they are shown a lack of compassion, and when their care is based on the insurance they have; feeling unheard when they experience poor outcomes due to not being listened to, and when they (or a loved one) try to advocate for their care; and not feeling communicated with when not given the opportunity to engage with their provider to make decisions, when there is a lack of transparency in information shared, and when there is a lack of education provided. The interplay of biased and discriminatory care often resulted from provider’s preconceived ideas of Black women and deeply ingrained stereotypes, which women noted on many instances, had an impact on all aspects of their birthing and delivery experiences with perceived disrespectful encounters with providers.

Discussion & Recommendations: The narratives highlight various dimensions of disrespect encountered by Black women and underscores the need for systemic reforms to address and prevent disrespectful maternity healthcare practices. The findings indicate that negative experiences contribute to delays in care, diagnosis, and treatment leading to poorer outcomes. Efforts to transform maternity care systems 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.