Black Maternal Healthcare Experiences in South Carolina

Background/Purpose:

The United States (US) has the highest maternal mortality rate among developed nations, with significant racial disparities. Black women suffer disproportionately, facing two to three times higher risks of pregnancy-related complications and severe disability than white women. In South Carolina (SC), Black women and women of other races/ethnicities experienced 2.4 times higher mortality rates than white women. This study aimed to address a crucial gap in understanding the experiences of Black mothers in Southern US concerning the impact of structural racism on maternal health outcomes. Specifically, this qualitative study explored Black women’s perceptions of maternal health services and structural racism in SC.

Methods:

With support from a SPARC Graduate Research Grant from the Office of the Vice President for Research at the University of South Carolina, this study involved semi-structured interviews with 20 Black mothers who had given birth within the past five years across South Carolina. Patients received a $25 incentive for completing the interview. The study utilized Critical Race Theory and Black Feminist Thought as theoretical frameworks to analyze these experiences, focusing on how structural racism shapes Black women’s interactions with healthcare systems. Grounded theory analysis was performed using MAXQDA software. This analysis was an iterative process involving open, axial, and selective coding.

Results:

The three prominent themes emerged from the study’s grounded theory analysis:

1. Navigating Healthcare Access and Quality: This theme focuses on Black mothers’ efforts to navigate the healthcare system to secure quality care. It encompasses physical and informational access challenges, decisions about healthcare providers and birthing practices, and the importance of health education for empowerment.
2. Engaging in Interpersonal Dynamics and Support Systems: This theme captures the role of interpersonal relationships, emotional support, and community resources in shaping Black mothers’ healthcare experiences. It emphasizes the importance of supportive interactions with healthcare providers, the emotional journey of motherhood, and the value of community in providing a network of support.
3. Confronting Structural Racism and Systemic Barriers: This theme highlights how Black mothers perceive and confront structural racism and systemic barriers within the healthcare system. It includes experiences of bias and discrimination, the impact of systemic factors on healthcare access and quality, and the broader context of racial disparities in maternal healthcare.

Conclusions and Implications:

Findings suggest that systemic structures and interpersonal relationships within the healthcare system deeply influence Black mothers’ experiences. Despite varied educational and income levels, all participants faced challenges influenced by structural racism, including barriers to accessing high-quality care and discriminatory practices. Positive relationships with healthcare providers and robust support systems were crucial in navigating these challenges. This study underscores the need for systemic policy reforms, culturally competent care models, enhanced provider education on bias and racism, and the inclusion of community-based support to improve maternal health outcomes. Social workers, healthcare professionals, and community organizations can collaborate to dismantle these disparities, ensuring equitable maternal health outcomes for Black mothers in South Carolina and beyond.