Experiences of Obstetric Racism and Adverse Health Outcomes in Black Mother-Infant Dyads in the United States: The Mediating Role of Maternal Mental Health Ayomide Popoola
W
hen examining structural barriers within existing communities in any context, it is essential to understand previous relationships the community has had with that system. In these modern times, “racism in the United States is pervasive and is a major contributor to sexual and reproductive health disparities [amongst] African American women” (Prather et al., 2018, p. 250). Decades of literature have shown the detriment of such health disparities in the Black community, specifically when examining Black mother and infant dyad outcomes. Black mothers in the United States are at a higher risk than any other racial group when experiencing pre-, during, and post-pregnancy complications (Dominguez et al., 2008). However, a significant knowledge gap within the medical and psychological community remains regarding how far these effects go when looking at mother and infant mental health outcomes. The vast majority of medical literature around the Black pregnancy experience focuses primarily on mother and infant mortality rates. Very little literature explores how these experiences may contribute to adverse mental health outcomes between Black motherinfant dyads and the mechanisms that potentially cause these heritable responses to racism. Obstetric Racism and Black Maternal Health A growing field of literature highlights experiences of pregnant Black women, illustrating that pregnant Black women often encounter racial discrimination while receiving obstetric care (Noursi et al., 2020). This form of discrimination is called obstetric racism, defined by Davis (2018) as the intersection of obstetric violence and medical racism. Obstetric racism is institutional violence perpetrated against women of colour during pregnancy, childbirth, and postpartum periods (Davis, 2018). General theories of modern medicine established on the exploitation of reproductive Black women and African Americans, which have historically contributed to Black women’s experiences and the generational trauma they are often still exposed to in these medical systems they must navigate (Campbell, 2021). Modern examples of obstetric racism include the enigmatic rates of C-sections Black women
experience. Approximately 36.8% of cesarian operations occurred in Black women compared to women of other races combined at 32.7% (Huesch & Doctor, 2015). It has been argued that the higher rates of c-sections are directly related to the strikingly higher infant and mother mortality in Black women (Campbell, 2021). In addition, Black women report receiving an inferior quality of obstetric care compared to their white counterparts regardless of socioeconomic status and other external factors. For example, Black women have reported an inability to communicate their needs during pregnancy due to differences in interactions between Black patients and healthcare providers and their institutions (Campbell, 2021). These experiences of obstetric racism are attributed to the many implicit and explicit biases health care providers and systems promote through the overmedicalization of Black bodies. Biases surround minority experiences and are seen exceedingly in Black women seeking healthcare services, with 30% of Black women in the United States reporting incidents with some form of racial trauma while giving birth in hospitals (Saluja & Bryant, 2021). Furthermore, black women are four to eight times more likely to die during childbirth than white women (Allan, 2020). Beliefs instilled in the minds of many medical practitioners are heavily biologically based and historically include things like thicker skin and less sensitive nerve endings (Saluja & Bryant, 2021). These beliefs have been proven dangerous as they cause health care providers to rate the presence of pain in Black individuals substantially lower, leading to improper care, especially in high-intensity environments such as labour and delivery settings (Saluja & Bryant, 2021). Obstetric racism and other types of medical racism are significantly positively correlated to higher levels of psychological distress amongst Black reproducing women (Prather et al., 2018). Mental Health Disparities in Black Women Along the axis of said disparities in Black women, the burden of mental illness plays a significant role in individual experiences and outcomes; in individual experiences and outcomes; however, it is
