Toward Reproductive Justice: A Community-Informed Mixed-Methods Model for Social Work and Maternal Health Research

Background

Black women in the U.S. face maternal mortality rates two to three times higher than white women, a disparity brought into focus by Serena Williams’ widely publicized childbirth complications (Walker & Boling, 2023). This study examines how Black women in Louisiana assess pregnancy risk and make perinatal care decisions, guided by one overarching research question: How does perceived risk of pregnancy complication shape perinatal care decisions—including pregnancy planning and provider choice?

Methods

This exploratory sequential (QUAL→QUAN) mixed-methods study was guided by Reproductive Justice and Health Belief Model frameworks. The qualitative phase began with an autoethnography of the researcher’s pregnancy (January–November 2022), which included prenatal and postpartum medical records (n = 14), day of delivery (n = 1), audio journals/notes (n = 11), photos (n = 75), tweets (n = 12), and one formal self-interview. An expert panel (n = 4)—including a hospital and insurance executive, nurse practitioner/doula, and women’s policy director—refined the interview guide used in semi-structured interviews with 13 U.S.-born Black women in Louisiana (urban n = 8; rural n = 5), recruited through referral sampling. Transcripts were analyzed in MAXQDA using critical narrative analysis (autoethnography) and thematic analysis (interviews). The expert panel also helped interpret findings and identify variables for a follow-up cross-sectional survey. Interview participants contributed to cognitive testing of the survey instrument. The final survey (n = 186), distributed through convenience sampling, measured perceived pregnancy risk, perceived respect, and provider choice. Variables drawn from qualitative themes were tested using hierarchical logistic regression to predict whether individuals selected providers based on race, culture, or gender. Integration occurred throughout the design, measurement, and interpretation phases.

Results

In the qualitative phase, one key theme—“You Cannot Ignore It Once You’re Aware”—described how participants selected providers based on race, culture, or gender and often citing Serena Williams’ 2018 childbirth experience as reinforcing their sense of risk. Quantitative results supported qualitative findings. Respondents with higher perceived pregnancy risk were as much as 66% more likely to select a provider based on race, culture, or gender (Model 2 OR = 1.66, p < .05). The timing of pregnancy also mattered: individuals who were pregnant in years after Serena Williams’ high profile story were more than twice as likely (141% to 148% more likely) to select a provider based on race, culture, or gender (Model 4 OR = 2.41, p < .01; Model 5 OR = 2.48, p < .05).

Conclusion and Implications

This study suggests that heightened public awareness—such as the 2018 case of Serena Williams—is linked to Black women assess risk and make decisions about their perinatal care. The integration of findings across methods offers both depth and broader transference. Notably, the inclusion of a cross-sector expert panel may bridge the fragmented systems that often fail to communicate—linking healthcare and insurance administration, direct care providers, and government policy. This mixed-methods design reflects more than the parallel use of qualitative and quantitative tools, but integration that contextualize findings to advance equity-driven social work research.