Manifestations of Anti-Black Racism and Worry About Pregnancy and Birthing While Black: A Cross-sectional Secondary Analysis of Giving Voice to Mothers

Introduction: Pregnancy and childbirth traditionally bring worry or a sense of anxiety and distress, particularly among Black women that face historical and contemporary anti-Black racism. We employed two frameworks to assess manifestations of anti-Black racism, structural racism and obstetric racism, as predictors of worry about pregnancy and birth within the Black reproducing community. Methods: In a secondary cross-sectional analysis, we analyzed data from Black women in the Giving Voice to Mothers study who completed all relevant items (n = 260). We conducted descriptive analyses and logistic regression models to explore how worry about pregnancy and birth for the Black reproducing community varies with experiences of obstetric racism and different manifestations of structural racism. Results: Approximately 71% of the sample worried about pregnancy and birth for themselves and their community. Black women who experienced obstetric racism were statistically significantly more likely to be worried about pregnancy and birth experiences compared to Black women who did not. Furthermore, when structural racism was manifested and measured as hidden resources, among Black women reporting fewer pregnancy and birthing care options for women of color, those who experienced obstetric racism during care were 15.6 times more likely to worry about pregnancy and birthing experiences than those who did not (OR 15.667; 95% CI 1.348–182.058). Conclusion: The findings demonstrate the complexity of racialized harm enacted against Black women during the perinatal period and underscore the ways in which obstetric racism and contexts of structural racism powerfully shape the meaning and subsequent emotional impact of pregnancy and birthing while Black.