"We Are Not Treated Softly": Black Women's Perceived Pregnancy Risk and Experiences with Social Workers

Background and Purpose
Black women in the U.S. experience maternal mortality and morbidity at rates two to three times higher than white women (Hoyert, 2022), often navigating healthcare systems marked by racialized disrespect and dismissal (Davis, 2020). Although social work is rooted in justice-oriented care and widely present in health and hospital systems, it remains underutilized—and at times, perceived as complicit—in the reproductive harm experienced by Black birthing people (Roberts, 1997). This qualitative study examines the reproductive risk perceptions of Black women in Louisiana and their experiences with social workers during pregnancy, labor, and postpartum care. Grounded in the Health Belief Model and reproductive justice, the study asks: (1) How do Black women describe risk of adverse pregnancy outcomes? (2) How do they describe their experience with social workers in these contexts?

Methods
This study employed a qualitative design guided by Black Feminist Thought (Collins, 2000) and reproductive justice frameworks (Ross, 2017). Using purposive and snowball sampling, semi-structured interviews were conducted with 13 U.S.-born Black women residing in Louisiana who had experienced pregnancy within the past 10 years (2014-2024). Participants included both urban (n = 8) and rural (n = 5) residents with between 1 and 5 pregnancies. Interviews lasted between 50 and 90 minutes and were conducted in person (n =11) or online (n=2) based on participant preference. Transcripts were analyzed using reflexive thematic analysis (Braun & Clarke, 2021). Rigor was enhanced through iterative coding, reflexive memoing, and member checking with participants and an expert panel of Black maternal health professionals.

Results
Two primary themes emerged. First, “You Cannot Ignore It Once You’re Aware” captured participants’ proactive engagement in racial reconnaissance to prepare for harm. Women described selecting providers based on race or gender, declining recommended interventions, or emotionally bracing for anticipated disrespect—often informed by lived experience, historical knowledge, and community narratives. Second, “We Are Not Treated Softly” illuminated how participants experienced discrimination, non-consensual drug testing, and surveillance during pregnancy, labor/delivery, or post-partum. Social workers, when present, were recalled almost exclusively in punitive roles—evaluating mental health fitness, drug testing, or initiating child welfare investigations.

Conclusions and Implications
This study highlights how Black women navigate perceived risk by making strategic decisions to protect themselves during pregnancy and childbirth. Participants rarely identified social workers as sources of advocacy, trust, or culturally affirming support. These findings reveal a gap between the profession’s stated commitment to justice and its role in perinatal care. Rather than reinforcing punitive risk narratives, social work must take the lead in creating supportive, rights-based environments. Aligning with reproductive justice requires not only improving social work education, practice, and policy, but also building trust and clearly communicating the supportive functions social workers can provide in maternal health settings.