"Ain't I A Woman?" Black Middle Class Women Discuss Race and Gender Preference in Healthcare
Background: Evidence of racial disparities in health care is remarkably consistent across a range of illnesses and health care services (IOM, 2002). Bias (mostly unconscious), stereotyping, and discrimination are among likely explanations for health care disparities (IOM, 2002). Health outcome and treatment differences persist after controlling for socioeconomic status (van Ryn & Burke, 2000) and although African Americans represent a sizable percentage of the middle class most disparities research does not address class heterogeneity. Furthermore, there is a significant body of literature that posits patient-provider race concordance may mitigate racial disparities in healthcare (LaVeist and Neru-Jeter, 2002, IOM, 2002). This study explores race and gender preference for black middle class women and draws on intersectional theories of race, class and gender to understand the preferences of an understudied group.
Study Design: The study uses in-depth interviews, focus groups and vignettes to explore the experiences of black middle-class women in health care settings.
Population Studied: Thirty African American women between 38 and 67 in a large urban area. The women are defined as middle-class based on either education, income, profession, or home ownership.
Results: Only one respondent, whose great-grandfather died as a result of the Tuskegee Experiment, expressed an explicit preference for a black provider. However, the majority of respondents (14 of 19 interview respondents) expressed a strong preference for a female OB/GYN (of any race) while 9 preferred a female primary care provider (of any race). Although the women did not express an explicit race preference they had a strong affinity for black female providers, indicating that 1) the intersection of race and gender is important for minority women; and 2) although women discussed a special connection with black female providers in some instances, this did not constitute an explicit race preference. Importantly, respondents complicated the idea of provider-level race preference by noting that other site-level factors like wait time, interaction with allied health/support staff, and the site’s racial composition affected their racial preferences.
Conclusions: Although increasing racial diversity among the healthcare workforce is generally positive, the black middle-class women in this study suggest that alone will not ameliorate racial disparities in healthcare. The complexities of the healthcare encounter, including time pressure, clinical uncertainty and the patient’s desire for expertise regardless of race or gender, all impinge on respondents’ race preferences. Moreover, understanding the dual identities of minority women, i.e., black and female, highlight the importance of both race and gender preference for black women. Lastly, women noted that site-level factors may be conflated with the race of provider. That is, having a black provider does not necessarily lead to better care or protect women from discrimination or bias. As such, they do not necessarily prefer a black provider or rely solely on black providers to mitigate institutional-level bias.