Understanding the Impact of Systemic Racism on How Black Women Seek Prenatal and Postpartum Care: How Does This Effect Maternal Outcomes?
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Authors
Poole, Sheena
Issue Date
2026-03
Type
Dissertation
Language
en
Keywords
Postpartum , Black women , Maternal Health , Healthcare Innovation & Delivery
Alternative Title
Abstract
The purpose of this qualitative study was to explore how Black women experience perinatal and postpartum care within the context of systemic racism and how those experiences influence when and how they seek help. The problem addressed was the persistent and disproportionate burden of adverse maternal outcomes among Black women that cannot be explained by individual or purely medical factors. Guided by critical race theory, this study examined how structural racism and discriminatory care in health systems undermine safety, trust, and engagement for Black women. Thirteen Black women in Texas, pregnant or within 18 months postpartum, completed virtual semi‑structured interviews. Data were analyzed using six‑phase thematic analysis within a descriptive phenomenological approach. Transcripts were coded using NVivo and manual methods and organized into 12 themes across four questions on help‑seeking amid systemic racism, effects of prior maltreatment, timing and trajectories of discrimination, and preparation for childbirth and postpartum care. Participants reported recurrent dismissal of concerns, structural racism in care, and emotionally costly adaptive engagement. Prior maltreatment shifted decisions about disclosure, trust, and adherence, and discrimination over time, forming trajectories that shaped when participants sought care. Participants reported preparing proactively, advocating for themselves, and relying on partners and community, yet facing systemic and logistical barriers that limited these supports. Conclusions highlight that inequity arises not from rare events but from routine processes that determine how symptoms are heard, decisions made, and care accessed. Recommendations highlight validation‑forward communication; symptom‑driven escalation; respectful documentation; coordinated referrals; protected advocates; timely postpartum access; and equity‑focused metrics, including longitudinal and mixed methods designs, to test equity interventions.