Maternal and Child Health Journal

, Volume 17, Issue 10, pp 1753–1759 | Cite as

“You Learn to Go Last”: Perceptions of Prenatal Care Experiences among African-American Women with Limited Incomes

  • Trina C. Salm Ward
  • Mary Mazul
  • Emmanuel M. Ngui
  • Farrin D. Bridgewater
  • Amy E. Harley
Article

Abstract

African American infants die at higher rates and are at greater risk of adverse birth outcomes than White infants in Milwaukee. Though self-reported experiences of racism have been linked to adverse health outcomes, limited research exists on the impact of racism on women’s prenatal care experiences. The purpose of this study was to examine the experiences of racial discrimination during prenatal care from the perspectives of African American women in a low income Milwaukee neighborhood. Transcripts from six focus groups with twenty-nine women and two individual interviews were analyzed to identify important emergent themes. Validity was maintained using an audit trail, peer debriefing, and two individual member validation sessions. Participants identified three areas of perceived discrimination based on: (1) insurance or income status, (2) race, and (3) lifetime experiences of racial discrimination. Women described being treated differently by support staff and providers based on type of insurance (public versus private), including perceiving a lower quality of care at clinics that accepted public insurance. While some described personally-mediated racism, the majority of women described experiences that fit within a definition of institutionalized racism—in which the system was designed in a way that worked against their attempts to get quality prenatal care. Women also described lifetime experiences of racial discrimination. Our findings suggest that African American women with limited incomes perceive many provider practices and personal interactions during prenatal care as discriminatory. Future studies could explore the relationship between perceptions of discrimination and utilization of prenatal care.

Keywords

Racial discrimination Prenatal care Racial disparities Racism 

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Trina C. Salm Ward
    • 1
    • 2
    • 3
  • Mary Mazul
    • 2
    • 4
  • Emmanuel M. Ngui
    • 2
    • 3
  • Farrin D. Bridgewater
    • 3
    • 5
  • Amy E. Harley
    • 2
    • 3
  1. 1.College of Health SciencesUniversity of Wisconsin-MilwaukeeMilwaukeeUSA
  2. 2.Zilber School of Public HealthUniversity of Wisconsin-MilwaukeeMilwaukeeUSA
  3. 3.Center for Urban Population HealthMilwaukeeUSA
  4. 4.Wheaton-Franciscan - St. Joseph Women’s Outpatient CenterMilwaukeeUSA
  5. 5.School of EducationUniversity of Wisconsin-MilwaukeeMilwaukeeUSA

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