Testimonies and Healing: Anti-oppressive Research with Black Women and the Implications for Compassionate Ethical Care

"Black Women Should Not Die Giving Life": The lived experiences of Black women diagnosed with severe maternal morbidity in the United States

OBJECTIVE

We sought to understand the lived experiences of Black women diagnosed with severe maternal morbidity (SMM) in communities with high maternal mortality to inform practices that reduce obstetric racism and improve patient outcomes.

METHODS

From August 2022 through December 2022, we conducted a phenomenological, qualitative study among Black women who experienced SMM. Participants were recruited via social media and met inclusion criteria if they self-identified as Black cisgender women, were 18-40 years old, had SMM diagnosed, and lived within zip codes in the United States that have the top-five highest maternal mortality rates. Family members participated on behalf of women who were deceased but otherwise met all other criteria. We conducted in-depth interviews (IDIs), and transcripts were analyzed using inductive and deductive methods to explore birth story experiences.

RESULTS

Overall, 12 participants completed IDIs; 10 were women who experienced SMM and 2 were mothers of women who died due to SMM. The mean age for women who experienced SMM was 31 years (range 26-36 years) at the time of the IDI or death. Most participants had graduate-level education, and the average annual household income was 123,750 USD. Women were especially interested in study participation because of their high-income status as they did not fit the stereotypical profile of Black women who experience racial discrimination. The average time since SMM diagnosis was 2 years. Participants highlighted concrete examples of communication failures, stereotyping by providers, differential treatment, and medical errors which patients experienced as manifestations of racism. Medical personnel dismissing and ignoring concerns during emergent situations, even when raised through strong self-advocacy, was a key factor in racism experienced during childbirth.

CONCLUSIONS

Future interventions to reduce racism and improve maternal health outcomes should center on the experiences of Black women and focus on improving patient-provider communication, as well as the quality and effectiveness of responses during emergent situations. Précis statement: This study underscores the need to center Black women's experiences, enhance patient-provider communication, and address emergent concerns to mitigate obstetric racism and enhance maternal health outcomes.

Renewed calls for abortion-related research in the post-Roe era

Nearly 50 years after Roe versus Wade, the United States Supreme Court's decision in Dobbs versus Jackson Women's Health Organization unraveled the constitutional right to abortion, allowing individual states to severely restrict or ban the procedure. In response, leading medical, public health, and community organizations have renewed calls for research to elucidate and address the burgeoning social and medical consequences of new abortion restrictions. Abortion research not only includes studies that establish the safety, quality, and efficacy of evidence-based abortion care protocols, but also encompasses studies on the availability of abortion care, the consequences of being denied an abortion, and the legal and social burdens surrounding abortion. The urgency of these calls for new evidence underscores the importance of ensuring that research in this area is conducted in an ethical and respectful manner, cognizant of the social, political, and structural conditions that shape reproductive health inequities and impact each stage of research-from protocol design to dissemination of findings. Research ethics relates to the moral principles undergirding the design and execution of research projects, and concerns itself with the technicalities of ethical questions related to the research process, such as informed consent, power relations, and confidentiality. Critical insights and reflections from reproductive justice, community engagement, and applied ethics frameworks have bolstered existing research ethics scholarship and discourse by underscoring the importance of meaningful engagement with community stakeholders-bringing attention to overlapping structures of oppression, including racism, sexism, and ways that these structures are perpetuated in the research process.

"A million other factors killing us": Black women's health and refusing necropolitics-as-usual during COVID-19

Ongoing social, economic, and political marginalization combined with racialized gender violence has sentenced Black women in the United States to disproportionate harm in the form of premature illness and death. Despite widespread recognition within the medical social sciences, public health, and social work of the health inequities that unevenly impact Black women, as a population, their suffering continues to be overlooked and marginalized in biomedical research, healthcare institutions, and health policy. This omission contributes to the naturalization and normalization of heightened morbidity and mortality of Black women. In this article, we draw from theory on necropolitics, misogynoir, and Black ecologies of care in analyzing findings from semi-structured interviews conducted between February and June 2021 with African American women (n = 16) who were experiencing a chronic health condition or caring for someone with a chronic health condition in Tucson, Arizona. Interviews explored women's healthcare-seeking behaviors, experiences with healthcare providers, and self-care and caregiving during the COVID-19 pandemic. Our findings suggest that necropolitical logics in the form of naturalization and normalization of Black women's suffering - and of the structures that render such suffering - permeated but did not entirely define women's experiences of the pandemic, including how they navigated biomedical spaces and negotiated interactions with healthcare providers, engaged in practices of care (including self-care), and perceived and made meaning of their own health statuses. We advance a Black ecologies of care framework: (1) to make visible and hold accountable necropolitical structures in tabulations of morbidity and mortality; and (2), despite the myriad harms represented in logics of necropolitics-as-usual, to foreground the life-affirming practices by women that persist nevertheless.