Perceptions of blame among black women during prenatal care: A mixed methods study

Abstract

Objective

There is evidence that prenatal health care providers may disproportionately attribute adverse pregnancy and birth outcomes to individual-level factors during clinical encounters with Black women, as opposed to citing the complex mechanisms by which racism shapes maternal health inequities in the US. This focus perpetuates the false narrative that Black women are responsible for their exposure to risks, potentially resulting in feelings of blame. The purpose of this mixed methods study was to explore experiences of blame-related communication during Black women’s prenatal care encounters.

Methods

Data for this study come from a cross-sectional, mixed methods study of Black women’s prenatal care experiences, including communication about pregnancy risks and blame. Blame was measured with survey and interview questions which assessed responses to communication about blame, exposure to risks, and pregnancy complications. Thematic analysis was used to analyze interview data (N = 17) that also explored strategies for alleviating feelings of blame. Mixed methods analysis compared congruency in blame experiences across survey and interview data.

Results

Nine (53 %) participants described experiencing blame during prenatal care. Four themes developed that identified experiences of blame and responses to blame-alleviation through communication practices. Mixed methods results describe differences across qualitative and quantitative approaches and how provider-perpetrated and self-blame give rise to internalized blame for adverse pregnancy conditions.

Conclusions

Participants perceived blame when provider communication focused on individual-level factors and excluded discussion about the role of structural and interpersonal racism in shaping pregnancy health. High levels of survey and interview blame data incongruency suggest that quantitative blame measures inadequately capture experiences of blame during prenatal care.

Practice Implications

Two communication practices that may reduce blame during prenatal care are proposed: direct communication about the relationship between racism and health, and telling patients, “it’s not your fault,” when unexpected complications arise.