Racial microaggressions in prenatal care settings and perceived quality of prenatal care among Black/African American women

Abstract

In the United States, Black/African American (AA) women face significant health disparities, including higher rates of Adverse Pregnancy Outcomes (APOs). This is despite increased utilization of prenatal care (PNC) over time, which is a critical intervention for identifying and managing pregnancy-related complications. While most research has focused on PNC entry, less attention has been given to the quality of PNC received. This study investigates the association between perceived racial microaggressions during PNC and perceived quality of PNC among AA women. We obtained data for a sample of 445 AA women from the ongoing Life Course Influences on Fetal Environments-2 Birth Cohort (LIFE-2) Study in Metropolitan Detroit, Michigan. We assessed perceived quality of PNC (QPNC) using the 28-item Quality of Prenatal Care Questionnaire; perceived racial microaggressions while seeking/receiving PNC were measured using the 17-item Daily Life Experiences (DLE)– PNC scale. We used linear regression with robust standard errors to estimate the association between continuous DLE-PNC and QPNC scores. The mean QPNC score was 117.9 (SD = 20.3). One in five women (20%) reported experiencing racial microaggressions during PNC. In the unadjusted model, each one-unit increase in DLE-PNC score was associated with a 0.21-point decrease in QPNC score (β = −0.21; 95% CI: −0.37 to − 0.04). This association remained after adjusting for sociodemographic characteristics (β = −0.20; 95% CI: −0.37 to − 0.03) and additionally for healthcare access and utilization (β = −0.19; 95% CI: −0.36 to − 0.02). Addressing racial microaggressions in PNC is essential to advancing the quality and equity of care experienced by AA women. Future research should move beyond measures of PNC initiation to incorporate women’s experiences of care quality throughout pregnancy.