Examining Black Birthing People's Experiences with Racism, Discrimination, and Contextualized Stress and Their Perspectives on Racial Concordance with Prenatal Providers.

Abstract

Introduction: We examine Black birthing people's experiences with racism, discrimination, and contextualized stress and whether those experiences are associated with preference for racially concordant prenatal care providers.

Methods: This cross-sectional study is the quantitative component of a larger, mixed-methods study. Data were from initial (August-October 2021) and follow-up (December 2022-January 2023) surveys among self-identified Black and/or African American birthing people who delivered a baby at a university system between 2019 and 2021 and were at least 18 years old. Respondents were 3-32 months postdelivery at the initial survey, which collected data on demographics and the Perceived Racism (ranges 0-430), Perceived Discrimination (ranges 0-36), and Jackson, Hogue, Phillips Contextualized Stress Measure (ranges 0-355) scales. The follow-up survey assessed views on racial and gender concordance and continuity with prenatal providers. Pearson correlation coefficients assessed relationships between scale scores and agreement that racial concordance is important and preferable. Poisson regression assessed whether a top quartile score on scales was related to importance of and preference for racial concordance with providers.

Results: Participants (n = 200) scored medians of 99.5 on the racism scale, 33 on the discrimination scale, and 177 on the contextualized stress scale. Of follow-up survey participants (n = 69), 78.3% agreed they would choose a racially concordant prenatal provider if possible (n = 54) and 42.0% agreed that racial concordance with their provider was important (n = 29). Scoring higher on discrimination and contextualized stress scales was positively correlated with agreeing that racial concordance was important. Regression analyses showed no significant associations between scale scores and agreeing that racial concordance with one's prenatal provider is important or preferable.

Conclusion: Black birthing people experience high levels of racism, discrimination, and contextualized stress. The overwhelming majority would choose racial concordance with their prenatal provider if possible.