Sage Journals: Discover world-class research

Abstract

Background: The Midwestern United States is a region with both positive overall maternal health outcomes and extreme racial inequities. There is growing attention to the role of structural racism in creating these disparities, yet limited research on how Black women define and experience structural racism in the Midwest.

Purpose: This qualitative study aims to understand how Black women in the Midwest experience structural racism, primarily related to their health care and neighborhood experiences.

Methods: We interviewed 20 Black women in the Midwest from August 2020 to August 2021. Participants were identified via network sampling. Interviewees responded to open-ended questions about defining structural racism, personal experiences with structural racism, and recommendations for addressing these issues. We analyzed interview transcripts using grounded theory, noted patterns, and analyzed memos for the main domains of structural racism.

Results: All individuals lived in urban areas and had at least some college education. Structural racism domains included the carceral system, education inequities and housing. Within the carceral system, racism occurred within interactions with police, judges, prosecutors, and the school-to-prison pipeline. Housing issues included affordability, safety, residential segregation, food deserts, and environmental hazards. Health care sub-domains included microaggressions, paternalism, and racial stereotypes. Participant recommendations to address the harms of racism included recruiting, retaining, and better-paying Black providers; reviewing, addressing, and eliminating racist practices; and centering Black women in care.

Implications: Policymakers and health care systems should consider the participant above recommendations to address the harms of racism. Further research should seek to understand if these or additional domains are identified for individuals in other geographic areas.

Introduction

Structural racism, encompassing the macro-level systems, social forces, institutions, ideologies, and processes that perpetuate inequities among racial groups,¹ has pervasive implications for reproductive health.² Named a fundamental cause of persistent racial disparities in maternal health,^3–5 structural racism underpins policies and practices that disadvantage Black women in the United States and contributes to disproportionately high rates of maternal mortality, preterm birth, and inadequate access to reproductive health care.^6–9 For example, Black women are 2.6 times as likely to die during childbirth compared to white women.¹⁰ Earlier work found that Black women who experienced interpersonal racism were more likely to have a preterm birth and increased stress levels during pregnancy,^11,12 whereas more recent literature has evaluated the impact of structural racism on preterm birth, infant mortality, small-for-gestational-age, and low birth weight.^13,14 While there has been increasing research in this area, the impact of structural racism on maternal health outcomes requires substantial additional research attention, especially for Black women in the Midwest.

While many Midwestern cities frequently appear on “best places to live” lists, the region may be considered among the worst places to live for Black people in part due to a complex history of racial inequities that continue to shape contemporary health outcomes. A recent study by Siegal et al.¹⁵ revealed striking geographic differences in the magnitude of structural racism, with some of the highest values observed in the Midwest; furthermore, these higher levels of structural racism were significantly associated with greater racial disparities in mortality for nearly all health outcomes studied (including firearm homicide, hypertension, stroke, obesity, asthma, HIV, and infant mortality). Kandasamy et al.¹⁶ found that the Midwest was the United States region with the highest infant mortality rate at 13.7 per 1000. The Midwest has the greatest gap in Black and white maternal mortality rates in the United States.¹⁷ the highest Maternal Vulnerability Index (MVI) gap for Black birthing people (46 of 100) compared to the Midwest average for all birthing people (37 out of 100); the MVI is an index scoring system measured across categories such as physical environment, socioeconomic determinants, mental health and substance abuse, and physical health,¹⁷ which offers insight into how Black individuals are more likely than white individuals to live in areas that are unfavorable to positive maternal health. Historical practices such as redlining, segregation, and discriminatory labor policies have contributed to racial disparities in housing, education, employment, and health care access,¹⁸ and while these issues are not unique to the Midwest, their ongoing impact may be particularly pronounced in the region. For instance, Minnesota’s homeownership gap between white households and households of color (after adjusting for socioeconomic and demographic factors) is among the largest in the nation, a disparity rooted in 20th-century racial covenants and redlining practices.¹⁹ The Midwest also remains one of the most segregated regions in the United States, with half of the top 10 most segregated cities located in the region (including Milwaukee, Chicago, Detroit, Cleveland, and St. Louis) based on the 2020 Census.^20,21 Additionally, the militarization of police departments in the Midwest has continued to disproportionately impact Black communities and contributes to elevated rates of incarceration and mortality,²² with one of the most high-profile cases being the 2020 murder of George Floyd in Minneapolis.

As previously detailed in conceptual models, multiple dimensions of racism historically and contemporaneously interact and reinforce each other to impact racial health inequities.^6,23,24 Ford and Airhihenbuwa detail a framework called Public Health Critical Race Praxis (PHCRP) with four focuses: (1) current patterns of racialization, (2) the production of knowledge, (3) conceptualization and measurement, and (4) action.²⁵ Focus one includes highlighting race as a social construction and characterizing racism during the study period.²⁵ Focus two explains how research is inherently subjective, and the structure and conventions of academia reinforce existing race hierarchies.²⁵ Focus three centers on defining and measuring race, racism, and related constructs.²⁵ Focus four is centered on the translation of research to action, including challenging injustices, telling the stories of the marginalized, and improving our vocabulary to understand racial injustice and power dynamics.²⁵ In this paper, we apply PHCRP and build on existing conceptual models^6,23,24 by sharing the knowledge of Black women in the Midwest, centered on their definitions of and experiences with racism. By centering their voices, we aim to provide a more nuanced understanding of the specific barriers and challenges faced in this region, as well as to inform policies and practices that promote equity in reproductive health care.

We acknowledge there is a need to further define, recognize, and understand how structural racism contributes to health disparities,^2,24,26 particularly related to reproductive health. Specifically, there remains a paucity of research that centers the lived experiences of Black women in the Midwest. This study seeks to address these gaps by exploring the perspectives of Black women in the Midwest on how structural racism impacts their reproductive health.

Methods

Research team

The study team included Black, Latinx, and Native American women, including the study principal investigator (A.K.C., PhD) and faculty mentors (B.D.C.B., PhD, MPA; R.H., PhD, MPH). The study team has trained in qualitative research methods (A.K.C., R.H., B.D.C.B., M.L., MD). The lead author conducted the interviews (A.K.C.). Interviews were analyzed by two researchers (A.K.C., M.L.).

Study design

In this descriptive qualitative study, we conducted semi-structured interviews with 20 Black women. We utilized an existing interview guide by Chambers et al.,²⁴ which focused on the conceptualization of structural racism experienced by Black women in California, particularly as it impacts their maternal and infant health outcomes (Appendix 1). This interview guide was based on prior research informed by the emancipatory paradigm, which suggests that power structures systematically oppress groups including Black women leading to Black health disparities.²⁷ The interview questions focused on understanding the interviewees’ experience with structural racism. We were also interested in other dimensions of identities that may impact their experience with structural racism and health. We also asked interviewees what ideas they may have to address structural racism in their communities. This study was conducted from July 2020 to July 2021.

Sampling method

This study included 20 individuals who identify as Black women over 18. No individuals dropped out of the study. The lead author (A.K.C.) recruited individuals via flyers and network sampling, where she asked eligible individuals in her community network if they would like to participate voluntarily and to share the study information with their networks. Study fliers were also emailed and posted in Facebook groups. The voluntary nature of the study was emphasized. Written consent forms were obtained from all study participants at least 2 days prior to the interview to allow time for review of the consent forms. The study was approved by the Institutional Review Board of the University of Minnesota.

Data collection

The lead author (A.K.C.) conducted participant interviews that were audio-recorded and transcribed. One interview was conducted per participant. Each interview was 30 min and conducted over Zoom with video (n = 18) or phone (n = 2). Data saturation were achieved when new insights no longer emerged from the data.

Data analysis

We analyzed interview transcripts using grounded theory,²⁸ which emphasizes an inductive approach to qualitative analysis. Two coders (A.K.C., M.L.) independently reviewed and analyzed all data to identify initial codes. The codebook was developed inductively based on existing methods where new data are continuously compared with previously collected data to create the codebook.²⁸ Line-by-line coding was used to identify initial codes. Analytic memos were used to explain how codes converged. Discrepancies in codes were discussed among researchers (A.K.C., M.L., R.H.), where a third reviewer (R.H.) resolved any differences. Researchers (A.K.C., M.L., R.H.) also discussed and identified how codes fit into larger domains and overarching theory. Consensus was reached without major changes required, where a high level of agreement and stability in the coding framework was achieved. This ensured that the results accurately reflected the data while maintaining consistency across coders. All participants were given the opportunity to provide feedback on the study findings.

Results

We interviewed 20 women aged 20–74, with a median age of 34. Nine women were under the age 30. All women lived in urban areas of the Midwest, and 75% lived in the Minneapolis-St. Paul regional area. Additional individuals were from Missouri and Illinois. All women had at least some college education. Demographic information is further detailed in Table 1.

Table 1.

Demographic Characteristics

Variable	Count (%)
Race
Black	20 (100%)
Ethnicity
African American	16 (80%)
African	3 (15%)
Latinx	2 (10%)
Country of origin
USA	17 (85%)
Foreign-Born	3 (15%)
Age (mean, SD)	38, 16
Number of births (mean, SD)	1.1, 1.4
Given birth	11 (55%)

SD, standard deviation.

Racism was overall conceptualized as a social construct that is generational, oppressive, and pervasive. For example, a participant explained, “there is no problem with being Black—it’s what is attached to Blackness that is a problem.” This quote demonstrates how the negative, socially constructed notions that are attached to Blackness is what creates problems, not the inherent nature of being Black. Another participant expands on the causes of racism in the United States: “If you were part of the group of people who were forcibly brought here as slaves to create the economy upon the stolen land of the Indigenous people—you’re already structurally a part of the society in a perverse way.” This quote highlights not only the history of racism in the United States but also how the current economy is built on the oppression of Black and Indigenous people. Finally, another participant notes how this trauma is ingrained in our bodies. “The trauma of institutional and structural racism is in our DNA.” This quote references the epigenetic and generational effects of racism.

Perspectives or feelings regarding structural racism included feelings of hopelessness, privilege, perseverance, and the need for advocacy. Some individuals described racism as unavoidable and described feelings of hopelessness. For example, “I have definitely felt like no one sees me, I am dismissed, and I will just have to live my life like this.” This quote shows how overwhelming it can feel to face racism as an individual. Still, others have described a hope for the future. “It’s not going to happen in my lifetime, but I’m contributing to it because I know that I’m in a better place than my parents and my grandparents…and I’m going to pass that on.” This quote describes strength, not giving up, and hope for improvement with each generation. Other participants described feeling privileged due to access to resources, such as education, socioeconomic status, or owning a car, which may affect some of the extent that they personally feel the effects of structural racism. Additional participants emphasized the importance of family and community support. For example, the Black community support following the murder of George Floyd, and family support helping children with racism in education.

Systemic racism domains included the carceral system, education inequities, food deserts, redlining, and health care. Representative quotes are shown in Table 2.

Table 2.

Structural Domains

Domain	Sub-domain	Example
Law Enforcement	Police	“I ended up having to place a complaint with the Minnesota Human Rights Commission against the police department…so basically just because he is white and they identify with him, they treat the legal and criminal actions as acceptable when they are not-they have dual standards.”
	Judges/prosecutors	“And it’s systemic because the policeman racially profiles and the prosecutor continue with that, and the judge makes it even worse.”
Redlining	Housing/residential segregation	“I think Minneapolis is a structural example of housing inequity based on racism, I think the effects of that are still seen today.”
	Environmental hazards	“A lot of predominately Black neighborhoods are very close to sewage sites, large dumping areas, some type of a chemical plant.”
	Public transportation	“Public transportation is less accessible to communities of color.”
Education	Blocking access	“When I wanted to take honors or AP classes, she (the guidance counselor) would try to get in my way like maybe you shouldn’t take this honors class or AP class, you should take this lower-level class it would be better for you. I had to fight a lot. Sometimes I would have to go to another guidance counselor.”
	Funding	“My hometown… is one of the poorest cities, but it has the largest revenue. But the revenue that is brought in is not shared in aspects in daily life-so our education system is horrifically in shambles-legislatures are not investing.”
	Racially oriented bullying	“I definitely got teased at school based on my hair, my name. It was very racially oriented bullying. I’ve been called the n-word.”
Health care	Hyper-sexualization of Black women	“A young woman of color is more likely to be asked about their sexual practices at a young age, and even if they say no, they are asked multiple times.”
	Higher pain tolerance	“When I was working in the hospital, we had a patient that has been with the same OBGYN for such a long time and he had this belief that Black people had a higher pain tolerance, so some medications he prescribed her had a lot of adverse reactions but wouldn’t change them because he said the side effects will not last long.”
	Microaggressions	“I will say hello in the medical field. And I will wear all my Black things like my braids and bright colors, and I am getting all these what are you doing here type looks. And when I say hi, they will look down or go past me.”
	Be our own doctors first	“We have to know about our own health and be our own doctors first…(My mom) told me the medicines she was on and I was like you should not be taking this medicine. So she called the doctor, asking to go off the drug. He said oh you can’t. She said oh can you talk to me. Then I read him the mechanism and everything for the drugs, and he prescribed a different type of medicine for my mom.”
	Paternalism	“I used to work at a teen sexual health care clinic, pushing long-acting contraceptives from a paternalistic view, thinking it will best protect against pregnancy because we saw a young population, and these are long-acting. But 1. not necessarily what everyone wants 2. A little paternalistic 3. Reminiscent of other forms of long-acting contraceptives forced on Black women.”
	Mistrust and safety	“I think a lot of people don’t have trust, especially Black women, in their providers because of the history of medicine…I don’t know how you can even feel safe in a system with that knowledge.”
	Knowing of someone who died in childbirth	“One of the judges, her daughter died because of neglect. She was bleeding. The husband was asking them to check.”
	White doctors not listening	“We are so used to, as Black women, being dismissed… No one is going to listen; we are just going to die quietly.”
	Scared to have children	“Do I want to bring a life into this world that could possibly be seen as a risk, a threat, to be murdered before they turn 15.” “Constantly being in fear of losing that child.”
	Lack of reproductive health care options	“I think that they are bigger on birth control for Black women than they are for family planning... I think there is more emphasis on stopping the creation of Black children than planning for them in advance.”

Within law enforcement, structural racism was most commonly noted within policing, judges and prosecutors, and the school-to-prison pipeline. Regarding policing, in reference to the murder of George Floyd, one participant described:

“Just looking at the 24-hour news outlet and seeing how the police officer had his knee on his neck it is so symbolic of the oppression the African American community has been under for over 400 years. And again his situation and other’s situations, although it is putting the spotlight on the criminal justice system it is very reflective across all sectors in society because it raises the conversation of white supremacy and its victims.”

This participant noted that the murder of George Floyd (by a Minneapolis police officer in May of 2020) is a reflection of white supremacy throughout not only the criminal justice system but also throughout society. Another participant noted how racism exists at multiple levels in the criminal justice system. “I also see a lot with traffic tickets. I strongly believe there is racial profiling. It’s systemic because the police racially profiles and the prosecutor continues with that and the judge makes it even worse.” This quote illustrates the additive effect of racism at different levels within the justice system.

Housing-related concerns that participants noted include residential segregation, environmental hazards, and intergenerational wealth. In regard to residential segregation, several individuals reported recent discrimination during the housing loan process. One participant shared that despite having a strong credit score, a decade of continuous employment, and savings, they were denied a housing loan. Her experience highlights how housing discrimination still occurs in present society. Another participant explained the lack of access to healthy foods. “If I didn’t have a vehicle there is no place to go get something healthy.” Similarly, other participants noted that there are more fast food, liquor, and convenience stores than grocery stores in many areas, especially predominantly Black neighborhoods. Furthermore, another participant emphasized the proximity of predominantly Black communities to environmental hazards: “A lot of predominantly Black neighborhoods are very close to sewage sites, large dumping areas, some type of a chemical plant.” This participant further notes that future physicians at their medical school come from predominantly white, wealthier suburbs (rather than predominantly Black neighborhoods). These points highlight both the impact of environmental hazards in a community and also an example of the links between residential segregation, opportunity, and intergenerational wealth.

Education-related concerns that participants noted include a lack of investment in the education system (especially in communities of color), racially oriented bullying, and blocking access to educational opportunities. A participant shared their experience with not being allowed to access advanced coursework in High School. “When I wanted to take honors or AP classes, she (the guidance counselor) would try to get in my way like maybe you shouldn’t take this honors class or AP class, you should take this lower level class it would be better for you. I had to fight a lot. Sometimes I would have to go to another guidance counselor.” Her experience showcases bias in guidance within education. Another woman explained an experience with racism in graduate school. “I let the professor know ahead of time I was going on an educational trip, he said okay, when I got back he said I can take my exam at some time this week. I got an email saying it’s not fair to other students, I don’t feel comfortable grading your assignment, and I question your work ethic. That put me on academic probation. And I was doing so well, all A’s at that point…The last student that went up against a professor was kicked out of school. That kind of killed my mojo, I didn’t really care to strive in that kind of environment anymore.” This quote highlights the bias and retaliation that Black women have faced in higher education, and the impact it can have on students.

Several sub-domains occurred within health care, particularly as participants were explicitly asked about their experiences with structural racism within the health care system. These included microaggressions, paternalism, racial stereotypes, distrust, fear, and safety concerns.

Several women mentioned fear around childbirth due to the history of racism in medicine, their own previous experiences, or hearing about the experiences of other Black women. Regarding the history of how health professionals treated Black individuals, a participant explained that “I think a lot of people don’t have trust, especially Black women, in their providers because of the history of medicine… I don’t know how you can even feel safe in a system with that knowledge.” The legacy of medical racism continues to the present day. Another woman shared a contemporary example: “One of the judges, her daughter died (during childbirth) because of neglect. She was bleeding. The husband was asking them to check.” This participant noted that this is just one example where even Black women with more privileged social and economic positions can die during childbirth. This fear can be carried into interactions with the health care system.

Furthermore, several women in this sample are health professionals or health professionals in training. They were able to provide additional insight into the practice of medicine, particularly surrounding physician attitudes. One participant who was also a nurse explained encountering an obstetrician and gynecologist (OBGYN) who believed Black individuals had a higher pain tolerance than their counterparts: “When I was working in the hospital, we had a patient that has been with the same OBGYN for such a long time and he had this belief that Black people had a higher pain tolerance, so some medications he prescribed her had a lot of adverse reactions, but wouldn’t change them because he said the side effects will not last long.” Individuals who work in health care can provide a unique perspective in that they may hear providers’ thoughts that may not be shared with patients-highlighting areas of bias and concern within the medical field. Still, health provider perspectives are felt by patients. One participants explains, “I think a lot of providers don’t see us as humans.” Another participants adds, “we are so used to, as Black women, being dismissed…no one is going to listen, we are just going to die quietly.” These quotes describe the disregard for Black life.

Participant suggestions to address racism in health care

Participants were also asked what they think should be done to address structural racism particularly as it relates to Black health outcomes. Figure 1 outlines ideas from Black women to address the harms of racism, which were identified on both the individual and system levels. A participant explained the importance of working against systems. “People need to realize that structural racism and white privilege is a thing, and the next step is to actively work against the systems that have given you privilege” and “the point of antiracism is to give up power.” These quotes show the importance of white people being willing to give things up in an antiracism framework. Another participant explained the importance of having Black individuals in leadership positions with decision-making power: “If we could be where the decisions are being made and our voices count and they matter.” Another solution is to increase the number of Black medical providers. A participant detailed how difficult it has been to find a Black clinician and why that is important to her: “I cannot find an African American doctor to save my life–I thought I came across one, but then she retired. I really feel like that is such a hindrance in the health care profession. I feel like as an African American woman, I’m coming into the industry, not just with a physical ailment but as someone who is coming through with trauma- living with traumatic events every day and having traumatic events coming every time. I feel like I come to a medical setting and I don’t get that kind of empathy or that understanding. It affects the health outcomes and problems I come to the visit with.” This quote highlights the shortage of Black medical professionals and the importance of Black providers for health care experiences and outcomes. Intersectionality is also an important consideration. As “all oppressive identities are related…especially to Black people.” This quote emphasizes the importance of thinking of intersectionality when we are trying to address the racism that Black individuals face.

FIG. 1.

Recommendations developed by and for Black women and their communities in the Midwest.

Discussion

This study summarizes how 20 Black women in the Midwest experience structural racism, primarily related to their reproductive health care and neighborhood experiences, and outlines their recommendations to address the impacts of racism in their lives. We identified domains of structural racism in law enforcement, health care, housing, and education. Participant recommendations to begin to address racism in health care included recruiting, retaining, and better-paying Black providers, reviewing, addressing, and eliminating racist practices, and centering Black women in care.

The findings of this study are consistent with the literature and add additional considerations, especially around the experience of Black women in higher education and clinical care. Chambers et al.²⁴ conducted focus groups with 32 Black women in California. They identified nine structural racism domains: negative societal views, housing, medical care, hidden resources, law enforcement, employment, community infrastructure, policing Black families, and education. We identified similar domains in this study. Participants in our study also noted discrimination in higher education. Not only did participants experience additional barriers to getting into and completing higher levels of education, but individuals in this study also noted the racism exhibited by other health professionals.

This study also follows quantitative work, which found an association between the Multidimensional Measure of Structural Racism (MMSR) and infant birth outcomes among Black and white people in Minnesota.²⁶ Respondents in our study also identified all components of the MMSR as important components of structural racism. The MMSR includes the following components: residential segregation, education, employment, income, homeownership, and criminal justice inequity.²⁶ In addition, participants in our study identified racism in health care, public transportation, and community resources. Furthermore, researchers found a significant association between high police contact neighborhoods and preterm birth among Minneapolis residents.²⁹ Interviewees in our study noted stress with increased police contact incidents as well as worry about the future interactions of their children and police, especially for young Black boys.

This study has several limitations. The use of network sampling led to a focused group of individuals. For example, the average individual interviewed has more years of education compared with the general population as everyone in this group had at least some college education. This study provides us insight into patterns in how Black women in the Midwest with higher education experience racism in their neighborhoods, schools, and health care. Further research should explore the effects and dynamics of compounded discrimination in this population. Compounded discrimination may include race, socioeconomic status, pregnancy status, and gender.³⁰ A larger sample size, potentially including more individuals who experience various forms of compounding discrimination, may allow for a greater understanding of these experiences.

Health equity implications

Participants in this study identified several clinical and policy implications related to health equity. Notably, this sample includes only college-educated, urban women in the Midwest, and thus these recommendations pertain to this population.

The Midwest context—characterized by significant racial segregation, stark disparities in maternal health outcomes, and a history of structural racism—provides critical background for these findings and their implications.

Policy recommendations include funding Black women-owned birth practices and insurance reimbursement for health professionals across various traditions. Systems-level solutions include transparent reporting avenues, reviewing and eliminating racist policies and practices, and implementing policies to recruit, retain, and better pay providers of color. Clinical implications include truly listening to and centering Black women as the experts and decision-makers in their care. Clinicians should also be aware of fear and safety concerns people Black individuals in this study identified especially around birth, pre- and post-natal care. Policymakers, clinicians, and health care administrators should seriously consider these interventions identified directly by participants.

Footnotes

Authors’ Contributions

A.K.C.: Conceptualization, data curation, formal analysis, funding acquisition, methodology, and writing—original draft. M.L.: Methodology, formal analysis, validation, and writing—original draft. B.D.C.B.: Conceptualization, methodology, and writing—review and editing. R.H.: Conceptualization, methodology, investigation, funding acquisition, and writing—review and editing.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This work was supported by NIH Grant T32HD095134.

Supplementary Material

Appendix

Cite this article as: Kristensen Cabrera A, Lucas M, Chambers Butcher BD, Hardeman R (2025) Perspectives from Black women in the Midwest about structural racism and reproductive health, Health Equity 9:1, 702–710, DOI: 10.1177/24731242251400599.

Abbreviations Used

Cite this article as: Kristensen Cabrera A, Lucas M, Chambers Butcher BD, Hardeman R (2025) Perspectives from Black women in the Midwest about structural racism and reproductive health, Health Equity 9:1, 702–710, DOI: 10.1177/24731242251400599.

References

1. Gee

, Ford

. Structural racism and health inequities. Du Bois Rev 2011;8(1):115–132; doi: 10.1017/S1742058X11000130

Bailey

, Krieger

, Agénor

Structural racism and health inequities in the USA: Evidence and interventions. Lancet 2017;389(10077):1453–1463; doi: 10.1016/S0140-6736(17)30569-X

3. Hardeman

, Medina

, Kozhimannil

. Structural racism and supporting black lives—The role of health professionals. N Engl J Med 2016;375(22):2113–2115; doi: 10.1056/NEJMp1609535

4. Phelan

, Link

. Is racism a fundamental cause of inequalities in health? Annu Rev Sociol 2015;41(1):311–330; doi: 10.1146/annurev-soc-073014-112305

Wallace

, Mendola

, Liu

Joint effects of structural racism and income inequality on small-for-gestational-age birth. Am J Public Health 2015;105(8):1681–1688; doi: 10.2105/AJPH.2015.302613

6. Howell

, Zeitlin

. Improving hospital quality to reduce disparities in severe maternal morbidity and mortality. Semin Perinatol 2017;41(5):266–272; doi: 10.1053/j.semperi.2017.04.002

MacDorman

, Thoma

, Declcerq

Racial and ethnic disparities in maternal mortality in the United States using enhanced vital records, 2016–2017. Am J Public Health 2021;111(9):1673–1681 .

8. Beroukhim

, Mahabamunuge

, Pal

. Racial disparities in access to reproductive health and fertility care in the United States. Curr Opin Obstet Gynecol 2022;34(3):138–146 .

9. Purisch

, Gyamfi-Bannerman

. Epidemiology of preterm birth. Semin Perinatol 2017;41(7):387–391 .

10.

10. CDC. Working Together to Reduce Black Maternal Mortality. 2024. Available from: https://www.cdc.gov/womens-health/features/maternal-mortality.html#:∼:text=Racial%20Disparities%20Exist,structural%20racism%2C%20and%20implicit%20bias

11.

Rosenberg

, Palmer

, Wise

Perceptions of racial discrimination and the risk of preterm birth. Epidemiology 2002;13(6):646–652; doi: 10.1097/00001648-200211000-00008

12.

Dole

, Savitz

, Hertz-Picciotto

Maternal stress and preterm birth. Am J Epidemiol 2003;157(1):14–24; doi: 10.1093/aje/kwf176

13.

Chambers

, Erausquin

, Tanner

Testing the association between traditional and novel indicators of county-level structural racism and birth outcomes among black and white women. J Racial Ethn Health Disparities 2018;5(5):966–977; doi: 10.1007/s40615-017-0444-z

14.

14. Chantarat

, Van Riper

, Hardeman

. Multidimensional structural racism predicts birth outcomes for Black and White Minnesotans. Health Serv Res 2022;57(3):448–457; doi: 10.1111/1475-6773.13976

15.

15. Siegel

, Wiklund

. The relationship between state-level structural racism and disparities between the non-hispanic black and non-hispanic white populations in multiple health outcomes. J Natl Med Assoc 2023;115(2):207–222 .

16.

Kandasamy

, Hirai

, Kaufman

Regional variation in Black infant mortality: The contribution of contextual factors. PLoS One 2020;15(8):e0237314; doi: 10.1371/journal.pone.0237314

17.

Agarwal

, Berman

, Downey

Surgo Ventures - The U.S. Maternal Vulnerability Index (MVI). 2022. Available from: https://mvi.surgoventures.org/

18.

18. Rothstein

. The Color of Law: A Forgotten History of How Our Government Segregated America. New York: Liveright Publishing Corporation; 2017 .

19.

19. Horowitz

, Ky

, Starling

. et al. Systemic racism haunts homeownership rates in Minnesota. Federal Reserve Bank of Minneapolis. 2021. Available from: https://www.minneapolisfed.org/article/2021/systemic-racism-haunts-homeownership-rates-in-minnesota [Last accessed: January 5, 2025 ].

20.

20. Gordon

. Race in the Heartland: Equity, Opportunity, and Public Policy in the Midwest. Economic Policy Institute; 2019. Available from: https://www.epi.org/publication/race-in-the-heartland/ [Last accessed: January 5, 2025 ].

21.

21. Menendian

, Gambhir

, Hsu

. Roots of Structural Racism: The 2020 Census Update. Othering & Belonging Institute; 2021. Available from: https://belonging.berkeley.edu/roots-structural-racism-2020 [Last accessed: January 5, 2025 ].

22.

22. Police Brutality – The African American Midwest (AAMW). 2022. Available from: https://africanamericanmidwest.com/history-racism/police-brutality/ [Last accessed: January 5, 2025 ].

23.

Carmichael

, Abrams

, Ayadi

Ways forward in preventing severe maternal morbidity and maternal health inequities: Conceptual frameworks, definitions, and data, from a population health perspective. Womens Health Issues 2022;32(3):213–218; doi: 10.1016/j.whi.2021.11.006

24.

Chambers

, Arega

, Arabia

Black Women’s Perspectives on Structural Racism across the Reproductive Lifespan: A Conceptual Framework for Measurement Development. Matern Child Health J 2021;25(3):402–413; doi: 10.1007/s10995-020-03074-3

25.

25. Ford

, Airhihenbuwa

. The public health critical race methodology: Praxis for antiracism research. Soc Sci Med 2010;71(8):1390–1398; doi: 10.1016/j.socscimed.2010.07.030

26.

26. Chantarat

, Van Riper

, Hardeman

. The intricacy of structural racism measurement: A pilot development of a latent-class multidimensional measure. EClinicalMedicine 2021;40:101092; doi: 10.1016/j.eclinm.2021.101092

27.

27. Reason

, Bradbury

. Handbook of action research: Participative inquiry and practice. Sage; 2001 .

28.

28. Glaser

, Strauss

. The discovery of grounded theory. Strategies for Qualitative Research. Aldine: Chicago; 1967 .

29.

29. Hardeman

, Chantarat

, Karbeah

. Police exposure as a determinant of structural racism: An exploration of the association between preterm birth in neighborhoods with high police exposure. Health Serv Res 2020;55(S1):50; doi: 10.1111/1475-6773.13396

30.

Mehra

, Alspaugh

, Dunn

“‘Oh gosh, why go?’ cause they are going to look at me and not hire”: intersectional experiences of black women navigating employment during pregnancy and parenting. BMC Pregnancy Childbirth 2023;23(1):17; doi: 10.1186/s12884-022-05268-9

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB

Perspectives from Black Women in the Midwest about Structural Racism and Reproductive Health

Abstract

Introduction

Methods

Research team

Study design

Sampling method

Data collection

Data analysis

Results

Participant suggestions to address racism in health care

Discussion

Health equity implications

Footnotes

Authors’ Contributions

Author Disclosure Statement

Funding Information

Supplementary Material

Appendix

Abbreviations Used

References

Supplementary Material