I Wouldn't Let it Get to Me: Pregnant Black Women's Experiences of Discrimination

The Influence of Racism in Healthcare: COVID-19 Vaccine Hesitancy Among Black Mothers in Chicago

Black mothers and children experience significant health disparities in the USA. These health disparities have been attributed, in part, to experiencing racism in healthcare. This study aimed to explore how experiences of healthcare discrimination and mistreatment experienced by Black mothers may influence COVID-19 vaccine beliefs and decision-making for themselves and their families. From April 2021 to November 2021, we conducted 50 semi-structured interviews among Chicago residents. Ten participants self-identified as female and with reported children; these data were extracted from the larger sample for data analysis. Interview content included perceptions and experiences with the COVID-19 vaccine and experiences with healthcare discrimination, mistreatment, and medical mistrust. Interview transcripts were transcribed verbatim and coded using the MAXQDA 2022 qualitative software. Themes were identified using a team-based thematic analysis to understand how experiences of racism in healthcare may influence COVID-19 vaccine decision-making. Four themes were generated from the data: (1) experiences of healthcare discrimination and mistreatment, (2) distrust and fears of experimentation, (3) the influence of discrimination and distrust on COVID-19 vaccine decision-making, and (4) overcoming vaccine hesitancy. The results of this study highlight the current literature; Black mothers experience racism and discrimination in healthcare when seeking care for themselves and their children. It is evident in their stories that medical racism and historical medical abuse influence vaccine decision-making. Therefore, healthcare and public health initiatives should be intentional in addressing past and present racism in healthcare to improve vaccine distrust.

Intersecting Expectations when Expecting: Pregnancy-Related Weight Stigma in Women of Colour

Weight stigma is a social justice issue that can lead to weight-based discrimination and mistreatment. In pregnancy, emerging evidence has highlighted that weight stigma predominantly affects individuals who have larger bodies and is associated with postpartum depression and avoidance of healthcare. Racial and ethnic background will influence perceptions of, and responses to, weight stigma and therefore it is necessary to ensure diverse voices are represented in our understanding of weight stigma. Semi-structured interviews were conducted with ten women who were within one year postpartum; nine identified as Black or African American and one as Hawaiian. Thematic analysis led to identification of three themes: (1) sources of weight stigma and their response to it, (2) support systems to overcome weight stigma, and (3) intersectional experiences. Women reported that sources of weight stigma included unsolicited comments made about their weight often coming from strangers or healthcare professionals that resulted in emotional distress. Support systems identified were family members and partners who encouraged them to not focus on negative remarks made about weight. Intersectional accounts included comparing their bodies to White women, suggesting that they may carry their weight differently. Women shared that, although they felt immense pressure to lose weight quickly postpartum, motherhood and childcare was their utmost priority. These findings inform further prospective examination of the implications of weight stigma in pregnancy among diverse populations, as well as inform inclusive public health strategies to mitigate weight stigma.

A Mixed Methods Approach to Understand Mother-Father Relationship and Perceived Stress Among Black Pregnant Women

BACKGROUND

Black women in the United States report moderate to high levels of perceived stress during pregnancy. Though lower levels of involvement and support from father of the baby (FOB) and higher levels of conflict have been associated with higher levels of maternal perceived stress, it is not clear how Black pregnant women experience the mother-father relationship and its influence on perceived stress.

PURPOSE

To examine and describe the mother-father relationship and its role in experiences of perceived stress from the perspective of Black pregnant women.

METHODS

Using a convergent, mixed methods approach with ideal-type analysis, we conducted a secondary analysis of data among 60 Black pregnant women enrolled in the Biosocial Impact on Black Births study. Women completed online self-report questionnaires and participated in a semi-structured interview by telephone.

RESULTS

Participants who reported more conflict with FOB also reported higher levels of perceived stress (ρ(47) = .431, P= .002). Themes (importance, communication, support, conflict, satisfaction, and stress) emerged from the data. Five distinct mother-father relationship typologies were identified following an ideal-type analysis of the combined dataset: Cared For; Managing Expectations; Just Friends, For the Kids; It's Complicated; and Can't be Bothered.

CONCLUSIONS

These findings are an innovative exemplar of ideal-type analysis and provide a deeper understanding of the nuance and dynamics within the mother-father relationship and how it influences perceived stress among Black pregnant women.

IMPLICATIONS

Clinicians must recognize the significance of the mother-father relationship and, when appropriate, encourage paternal involvement or intervene if there is conflict during pregnancy.

Intersectionality in nursing research: A scoping review

Background

An intersectional approach to health research provides an analytical foundation to explain the multidimensionality of health status, resource accessibility, privilege, oppression, and current and historical context. The use of intersectionality in health research has known limitations. Its use in health-related fields too often focuses on outcomes, such as health disparities, rather than processes, such as power structures and social determinants.

Objective

This scoping review serves to examine how intersectionality has been implemented by nurses in the peer-reviewed literature. We offer insight into how it may be incorporated to inform future nursing research and healthcare provision.

Design & Methods

Systematic searches of PubMed (n = 257), SCOPUS (n = 807), EMBASE (n = 396), CINAHL (n = 224), and Health Source: Nursing and Academics (n = 491), published since the seminal publication on intersectionality (1989 - 2023), identified 131 research articles that met inclusion and exclusion criteria. Data extraction and synthesis were used to describe the breadth and depth of the literature specific to the application of intersectionality in nursing research.

Results

The included studies used intersectionality to examine the intersections of numerous identities, such as race, gender, and immigration status. However, most studies were descriptive/observational in nature, underreported their methods, and conducted deficit-based research instead of strength-based inquiries. Of note, the vast majority of included articles were published within the last five years.

Conclusions

Future researchers using intersectionality as a framework can improve their approach by reporting clear definitions and operationalization of intersectionality. Observational science dominated the included studies; future research should focus on intervention development and evaluation using an intersectional lens. Lastly, caution should be placed on research that focuses solely on deficits among marginalized communities, which places scientists at risk of perpetuating stereotypes or enhancing already-existing stigmas.

A critical examination of epistemological congruence between intersectionality and feminist poststructuralism: Toward an integrated framework for health research

The theoretical perspectives of intersectionality and poststructuralism have contributed meaningfully to advancing issues of social injustice within the realm of women's health research. However, the question of whether the two approaches are epistemologically commensurate has been at the heart of a polarized debate within third- and fourth-wave feminist literature in recent years. In this paper, we draw on the extant literature to explore existing dilemmas within this debate and critically reflect on points of epistemological tension and congruence between the two perspectives. It will be demonstrated that intersectionality and poststructuralism, especially feminist poststructuralism, represent concordant theoretical perspectives and a synthesized theoretical framework for application in qualitative research into women's health will be proposed. We argue that an intersectional feminist poststructuralist framework contributes to a deepened analysis of women's disparate healthcare experiences, and the social mechanisms, power relations, and discourses that mediate these experiences, while offering avenues for advocacy and political praxis on a multitude of levels.

Experiences of racial Trauma among perinatal women of color in seeking healthcare services

OBJECTIVE

To describe the experiences of perinatal Black, Indigenous, and other People of Color (BIPOC) women in healthcare interactions.

METHODS

We conducted eight virtual focus groups with perinatal BIPOC women across the USA from November 2021 to March 2022. A semi-structured interview protocol was used, and focus groups were audio recorded and transcribed verbatim. Our team used reflexive thematic analysis to analyze the qualitative data and describe our findings.

RESULTS

Three latent themes emerged related to racial trauma in healthcare interactions: (1) observations and experiences of anti-Black bias, (2) experiences of dismissal of pain and withholding of care, particularly among Black and Latinx patients, and (3) common race-based traumatic experiences across all BIPOC women, including a consistent lack of bodily autonomy and deferral to White people for decision-making. Recommendations from participants included more transparent communication and greater empathic care for all patients, with calls to specifically address anti-Black bias in healthcare treatment.

CONCLUSION

The study's findings suggest that perinatal healthcare needs to reduce mental stress and exposure to racial trauma for perinatal BIPOC women. This study offers a discussion of implications for future training for healthcare providers and implications for addressing systemic racial disparities in perinatal mental health.

Exploring the Application of Intersectionality as a Path toward Equity in Perinatal Health: A Scoping Review

OBJECTIVE

To conduct a scoping review to determine how past studies have applied the theory of intersectionality, a critical feminist research paradigm, to understand the physical health and mental health outcomes of perinatal people as a step toward addressing maternal health disparities and injustice. The study includes a review of existing research on maternal physical and mental health outcomes, presents the strengths and limitations of existing studies, and provides recommendations on best practices in applying intersectionality in research to address systemic issues and improve outcomes for the perinatal population.

METHODS

We conducted an extensive literature search across four search engines, yielding 28 publications using the intersectionality framework that focused on the outcomes of perinatal people, with a total sample of 9,856,042 participants. We examined how these studies applied intersectionality and evaluated them based on three areas: conceptualization, research method, and interpretation/findings.

RESULTS

Our findings indicate that maternal health researchers have provided good descriptions of the interaction of systemic inequalities and have used analysis that allows for the examination of interlocking and mutually reinforcing social positions or systems. We find that improvement is needed in the areas of conceptualization, reflexivity, and understanding of power structure. Recommendations are provided in the form of a checklist to guide future research toward an impactful approach to addressing perinatal health disparities.

RELEVANCE

Our scoping review has implications for improving applied health research to address perinatal health disparities, mortality, and morbidity. Recommendations are given along with references to other tools, and a guidance checklist is provided to support scholars in creating an impactful approach to applying intersectionality in the goal of addressing maternal health disparities.

Navigating Pregnancy and the Healthcare System during COVID-19: A Qualitative Study with Perinatal Women of Color

OBJECTIVE

To address health disparities in the perinatal period (i.e., during pregnancy and through one year after birth) by exploring the intersectional experiences of perinatal Black, Indigenous, and other People of Color (BIPOC) women during the COVID-19 pandemic. In this study, participants were asked if and how COVID-19 had impacted their experiences of receiving healthcare, whether they had faced any challenges during this time, how they had navigated these challenges, and what recommendations they had for improving perinatal healthcare.

METHODS

Between November 2021 and March 2022 our team conducted eight virtual focus groups comprising perinatal BIPOC women. A semi-structured interview protocol was used, and interviews were voice recorded and transcribed verbatim. The data were analyzed using reflexive thematic analysis.

RESULTS

Three major themes common in BIPOC perinatal healthcare experiences during COVID-19 were generated through engaging in reflexive thematic analysis: (1) an overwhelming lack of support from providers, (2) experiences of blame and shame, and (3) difficulties navigating institutional policies that were unclear or ever-changing during the COVID-19 pandemic. Recommendations from participants included greater empathic communication from providers in the face of uncertainty during COVID-19, greater access to information and guidance for caring for themselves and their babies, and an overall request for greater compassion while navigating an exciting and busy time.

RELEVANCE

These findings have implications for trauma-informed and inclusive perinatal care that can reduce the impacts of systemic inequalities for perinatal BIPOC women. This study offers a discussion of implications for future training for maternal health providers and implications for community-based programs.