Work As a Social Determinant of Health: Centering the Perspectives of Black Women during Pregnancy and Postpartum

Background and Purpose:

Black women experience the highest infant and maternal mortality rates in the United States (U.S.). Limited research has focused on adverse birth and maternal health outcomes among college-educated Black women, although research has indicated these outcomes persist among this population. Previous research has shown that work policy such as paid leave is associated with racial disparities in breastfeeding duration, impacting infant health. However, there is a dearth of research examining the perspectives of college-educated Black women on work during pregnancy or postpartum. This study explored college-educated Black women’s experiences during pregnancy and postpartum to better understand work-related social determinants of health. Participants also offer recommendations for work policy changes to improve maternal and infant health.

Methods:

Seventeen in-depth semi-structured interviews were completed with college-educated Black women from eight states in the U.S. Participants were asked several questions about workplace experiences during pregnancy and postpartum. For example, “How would you describe your experience at work during your most recent pregnancy?”, “How would you describe the support you received when you returned to work?” and “ What support did you need to transition back to work after your most recent pregnancy?”. Interviews were transcribed and analyzed for themes.

Results:

Black women described (1) lack of paid leave as a burden to family finances which influenced returning to work, (2) expressed that being the family breadwinner influenced decisions about work during pregnancy and postpartum, and (3) work factors influenced the initiation and duration of breastfeeding. Participants’ work policy recommendations were (1) paid leave and extended time off postpartum up to six months, (2) access to designated lactation space with supplies, (3) flexible work schedules and transitions back to work (e.g., telework, staggered return to work), (4) better leave preparation and return to work supports (e.g., work coach or postpartum navigator) and (5) access to local or onsite childcare to improve return to work during the postpartum period.

Conclusion:

Findings provide insight into workplace factors influencing pregnancy and postpartum recovery from the perspectives of Black women. In addition, participants provided workplace policy and intervention recommendations to support maternal and infant health. Moreover, the intersection of race and gender oppression in U.S. society influences the work experiences of Black women. Therefore, workplace policy action centering Black women’s experiences should address pay equity, paid parental leave during pregnancy and postpartum, access to workplace breastfeeding supports, flexible work schedules, and childcare needs. In addition, future social work research should focus on work as a social determinant of health to address racial disparities in health.