Healthcare Experiences As Predictors for Preterm Birth

Background: African American mothers experience disproportionately higher rates of preterm births in the United States. Prior research has identified disparities in maternal health outcomes for African American women, with attention to discrimination and experiences during reproductive healthcare. However, there is limited empirical evidence on how self-reported negative healthcare experiences, such as feeling unheard, lack of privacy, or discrimination due to weight or LGBTQ+ identity, predict preterm birth. While previous research has highlighted the importance of the provider-patient dyad on healthcare outcomes, further exploration is needed to understand the relationship between provider-patient interactions and maternal healthcare outcomes for African American women.

This study examines whether negative healthcare experiences predict adverse preterm birth for Appalachian women who identify as African American or Black.

Methods: Utilizing a binomial logistic regression model, a secondary data analysis was conducted to examine the association between preterm birth and reported negative healthcare experiences. The sample size was 5,121, of which 78.3% identified as non-Black and 21.7% identified as Black. Independent variables included six domains: overall bad healthcare experience, bad relational experience, bad experience due to privacy, bad experience due to access, bad experience due to LGBTQ+ identity, and bad identity due to weight. An interaction term was used to assess the moderating effect of African American racial identity on negative healthcare experiences and preterm birth. Covariates included age and number of pregnancies.

96.6% of the participants denied bad experiences related to LGBTQ+ identity; however, about 35.1% of participants reported a bad relational experience, and 8.7% reported feeling unwelcomed due to their LGBTQ+ identity.

Findings: Data analysis indicates that negative healthcare experiences increase the odds of preterm births among African American women. Participants who reported bad experiences may be more likely to experience preterm births, suggesting that interpersonal interactions within the healthcare system, particularly those rooted in structural inequalities or bias, may contribute to increased risk for preterm delivery.

Conclusion and implications: Findings highlight the importance of examining how healthcare experiences shape health outcomes for African American women, who continue to be disproportionately impacted by adverse reproductive health outcomes. Furthermore, these findings support the need for structurally competent care that prioritizes respectful and equitable healthcare experiences to advance health equity for African American women.