Breaking Barriers: Resilience and Coping Strategies of Black Mothers in Maternal Care in South Carolina

Background and Purpose: The United States (US) has the highest maternal mortality rate among developed nations, with stark racial disparities. Black women experience two to three times higher risks of pregnancy-related complications and mortality compared to white women. In South Carolina (SC), Black women are twice as likely as white women to experience maternal mortality due to structural inequities in healthcare access and quality. While existing research highlights these disparities, there is limited exploration of Black mothers’ resilience and coping mechanisms in navigating these challenges. This qualitative study addresses this gap by examining how Black mothers in SC exercise agency and adaptability in response to systemic barriers in maternal healthcare.

Methods: With support from the SPARC Graduate Research Grant from the Office of the Vice President for Research at the University of South Carolina and Social Work Grand Challenges Doctoral Award, this study involved semi-structured interviews with 20 Black mothers who had given birth in 2018 or later across SC. Patients received a $25 incentive for completing the interview. The study utilized critical race theory, Black feminist thought, and resilience theory as theoretical frameworks, examining the ways Black mothers navigate obstacles in maternal healthcare. Braun and Clarke’s thematic analysis was conducted to identify key coping strategies and sources of resilience using MAXQDA software. This analysis followed a six-step process:familiarizing with the data, generating initial codes, generating initial themes, reviewing themes, defining and naming themes, and writing up the report.

Results: Six themes emerged from the study’s thematic analysis:

1. Resilience through Advocacy and Agency:Black mothers employ self-advocacy strategies to challenge discriminatory healthcare practices and demand equitable treatment.
2. Empowerment through Knowledge and Education:Accessing and sharing healthcare information enables Black mothers to make informed decisions and navigate complex maternal care systems.
3. Social Support as a Coping Mechanism:Family, community networks, and doulas serve as crucial sources of emotional and informational support.
4. Navigating and Coping with Structural Racism:Participants described experiences of implicit bias and systemic barriers, as well as the strategies they use to mitigate these challenges.
5. Seeking Alternative and Holistic Care Approaches:Many Black mothers prioritize culturally affirming, patient-centered care, including midwifery and alternative birthing practices.
6. Resilience in Emotional and Mental Health:Strategies such as faith, mindfulness, and therapy help Black mothers cope with stress and trauma related to maternal healthcare inequities.

Conclusions and Implications: Findings highlight the resilience of Black mothers in navigating systemic barriers within maternal healthcare. Despite challenges rooted in structural racism, participants employed advocacy, knowledge-sharing, and community support to secure quality care. Positive provider relationships and culturally affirming care were critical in mitigating these challenges. This study underscores the need for systemic reforms, including expanding access to culturally competent care, integrating mental health support, and implementing anti-racism training for healthcare providers. Social workers, policymakers, and healthcare professionals must collaborate to dismantle these disparities and advance equitable maternal health outcomes for Black mothers in South Carolina and beyond.