Navigating Pregnancy and the Healthcare System during Covid-19: A Qualitative Study with Perinatal Women of Color

Background: The Coronavirus disease (COVID‐19) has magnified maternal health disparities to an unprecedented level, where pregnant people have difficulty accessing quality maternal care and support. Recent data show an alarming increase of 33% in maternal deaths during the COVID‐19 pandemic. While in the global context, where the average maternal mortality ratio has decreased in the past 25 years by 45%, maternal mortality in the U.S. has increased by 58%. In the U.S., systemic racism coupled with multiple forms of oppression put perinatal Black, Indigenous, and Other People of Color (BIPOC) women in a uniquely vulnerable position during the pandemic, especially when they have higher lifetime exposures to chronic stressors. To address health disparities in the perinatal period (i.e., during pregnancy and through one year after birth), this study explored the intersectional experiences of perinatal BIPOC women during the COVID‐19 pandemic to examine if and how COVID‐19 had impacted their experiences of receiving healthcare, whether they had faced any challenges during this time, how they had navigated these challenges, and what recommendations they had for improving perinatal healthcare.

Methods: Between November 2021 and March 2022, our team conducted eight virtual focus groups comprising 41 perinatal BIPOC women from across the U.S. This study used a purposeful sampling method to identify participants through Illinois All Our Kids Early Childhood Networks initiative (AOK Networks) and public health listservs across the U.S. Participants were between the ages of 19 and 45 years. 49% were self‐identified as Black (n=20), 24% identified as Latina (n=10), 20% identified as Asian/Asian Pacific Islander (n = 8), two identified as multiracial, and one participant identified as Indigenous. Geographically, most of the participants were living in the Midwest (n = 24; 58%) at the time of the study. A semi‐structured interview protocol was used. Interviews were voice recorded and transcribed verbatim. The data were analyzed using reflexive thematic analysis.

Results: Three major themes common in BIPOC perinatal healthcare experiences during COVID‐19 were generated through engaging in reflexive thematic analysis: (1) An overwhelming lack of support from providers, (2) Experiences of blame and shame, and (3) Difficulties navigating institutional policies that were unclear or ever‐changing during the COVID‐19 pandemic.

Conclusions and Implications: The profound impacts of structural barriers to obtaining full access to medical care and increased risk for mental health problems for BIPOC perinatal women were found. The impacts of COVID‐19 will be long‐lasting. Recommendations from participants included greater empathic communication from providers in the face of uncertainty during COVID‐19, greater access to information and guidance for caring for themselves and their babies, and an overall request for greater compassion while navigating during pregnancy. These findings have implications for trauma‐informed and inclusive perinatal care to reduce the impacts of systemic inequalities for perinatal BIPOC women. This study offers implications for future training for maternal health providers and implications for community‐based programs. Future studies can explore the role of support persons such as home visitors or doulas to assist in the perinatal period and reduce risks for perinatal mental health problems.