Study reveals discrimination in pregnancy care

It’s no secret that stress can lead to physical conditions ranging from elevated blood pressure to gastrointestinal problems.

But what about the stress associated with racism and discrimination during pregnancy?

Shaniece Criss, associate professor of health sciences at Furman University, has been studying racism’s impact on pregnancy and birth outcomes with colleagues from the University of Maryland, Brown University and the Universities of California Berkeley, San Francisco and Los Angeles.

They not only concluded that it can lead to a higher rate of premature birth and low birthweight, but that there are variations in the experiences of women of different races.

“This study really looks at racism as a social determinant of health – both interpersonal racism between people and systemic racism,” Criss said. “The stress the mother has from experiences of discrimination and racism impacts the birth outcome.”

Chronic stress can cause wear and tear on the body that can result in the flooding of adrenalin and cortisol, leading to increased heart rate, breathing and blood pressure in the mother, she said. Meanwhile, preterm birth and low birthweight can lead to lifelong health issues for the child, and impacts the parents as well in terms of medical bills, time and worry.

The researchers conducted 11 focus groups consisting of 52 women who identified as Black, Latina, Middle Eastern, and Asian American and Pacific Islanders, or AAPI, Criss said.

While other studies have also documented the effects of interpersonal discrimination on preterm birth and birth weight, she said, this study revealed nuances in the experiences the women had with the health care system while pregnant and giving birth.

“We wanted to go further and have focus groups across the United States with diverse women and it showed that people’s experiences are different,” she said. “We were able to get more nuanced evidence for each group about their specific experience.”

For example, the South Asian Indian group said they were often misidentified as Middle Eastern, Criss said. And there were differences between the Asian groups as well, she said. For instance, it was harder for new immigrants to identify their experiences as racist, she said.

“(They) did talk about things in medical services,” she said, “but didn’t name it as racism.”

The researchers said many of the women described “unequal power dynamics in the patient-provider relationship and the feeling that their voice had limited influence, particularly in responding to discrimination.”

One black woman, for instance, related how her doctor asked what she was going to name her baby and when she replied, “David,” the doctor said, “Oh good, a nice normal name,” Criss said.

The study also found that:

* Black and Latina women said they’d experienced chronic racism-related stress.

* Black women said that prior bad experiences with providers influenced their health care decisions.

* Latinas felt vulnerable because of language barriers or immigration status.

* And Vietnamese women were concerned about the impact of racism on the mothers’ mental health and their children.

“The U.S. Census may lump people together,” Criss said, “but the experiences are really different.”

Published in the Journal of Racial and Ethnic Health Disparities, the study could help inform the development of tailored interventions for different racial groups so patients get equal treatment in health care, Criss said.

“Pregnancy is a critical time for the mother and baby and we can make sure they have better experiences,” she said. “That could improve the health of a lot of people.”