“You learn to go last.”: A qualitative study of perceptions of racism during prenatal care in a sample of low income African-American women in Milwaukee

Background. African American infants die at a rate nearly three times higher than White infants in Milwaukee and are at a much greater risk of adverse birth outcomes. Access to early, continuous, and quality prenatal care can significantly improve birth outcomes and reduce disparities. Although self-reported experiences of racism have been associated with adverse birth outcomes, there has been limited research on the impact of racism on women's prenatal care experiences.

Objective: To examine the presence and nature of experiences of racial discrimination during prenatal care from the perspectives of African American women in a low income Milwaukee neighborhood.

Methods: We conducted six focus groups with twenty-nine women and two individual structured interviews. We analyzed transcripts to identify important emergent themes.

Results: While a few women described perceiving mistreatment as clearly based on race, many more expressed being treated differently based on type of insurance or income level. They described being treated differently by health care providers and staff. They perceived a lower quality of care at clinics that accepted public insurance (versus private insurance), many perceived that only African American women were on public insurance. Many women also described lifetime experiences of racial discrimination and how it affected their lives.

Conclusion: Our findings suggest a need for increasing provider awareness of the patient's perception of discrimination in health care settings, how these perceptions influence patient-provider relationships, communication, and use of prenatal care services, especially among low-income African-American women.