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


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.

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We gratefully acknowledge the following contributors to this project—the generous women who were willing to share their stories with us; Samantha J. Perry, MPH, CHES, who conducted many of the focus groups; the support and collaboration of the YWCA, including Martha Barry, PhD, Racial Justice Director, Allison Scheff, Job Developer, and Lisa Boyd, Chief Operating Officer; funding through the Children’s Community Health Plan to reimburse participants for their time; and resources from the Center for Urban Population Health and the YWCA. We also thank Mary K. Madsen, Department of Health Informatics and Administration, College of Health Sciences, University of Wisconsin-Milwaukee, for providing comments and feedback on this manuscript.

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Correspondence to Trina C. Salm Ward.

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Salm Ward, T.C., Mazul, M., Ngui, E.M. et al. “You Learn to Go Last”: Perceptions of Prenatal Care Experiences among African-American Women with Limited Incomes. Matern Child Health J 17, 1753–1759 (2013). https://doi.org/10.1007/s10995-012-1194-5

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  • Racial discrimination
  • Prenatal care
  • Racial disparities
  • Racism