Investigating structural maternal health inequities among Black reproductive aged women in Georgia; a mixed methods and multi-level approach

Project Summary/Abstract
Racial injustice and oppression are prevalent and devastating causes of health disparities. Black women are 2-
3 times more likely than White women to experience severe maternal morbidity (SMM) and to die from
pregnancy-related causes. The maternal health crisis is particularly profound in Georgia, where Black women
account for 35% of all births and the pregnancy-related mortality ratio is 1.5 times higher than national
estimates. Research that examines disparities in maternal health often focus on individual-level behaviors
when the root of the issues are better conceptualized as being within structures and systems that perpetuate
injustice intergenerationally and over the life course. This study will address three major gaps in the literature
to date. First, traditional measures of structural racial discrimination (SRD) often fail to capture the full range of
historical oppression, and research is needed to explore an array of measures to better understand and
address the contemporary effects of historically unjust practices, policies, and structures. Second, it is unclear
what multi-level strategies could mitigate the impact of SRD on SMM and promote resilience for Black women.
Third, with research seeking to address multi-level inequities, it is important to integrate qualitative methods
that center the experiences of Black women within SRD in order to approach solutions. The objective of this
proposal is to ascertain new information from diverse perspectives using a robust mixed-methods
approach to understand how SRD affects Black maternal health outcomes at the population, health
system, and individual level. At the population level, we will conduct a secondary data analysis to estimate
county-level associations between measures of SRD and Black-White SMM disparities (Aim 1). Recognizing
that provider practices are influenced by individual biases and institutional structures, we will use a causal
attribution framework to characterize physician perceptions regarding the underlying causes of Black-White
maternal health disparities and the racial climate of the organizations in which they practice. (Aim 2). Lastly, we
will assess Black women’s lived experiences of obstetric and institutional racism and how these experiences
influence access to care and health status before, during, and after pregnancy, using a framework of radical
healing for communities of color to identify risk and resilience coping processes. (Aim 3). This multi-level and
mixed-methods study will allow us to contextualize Black maternal outcomes and capture structural
intersectionality constructs that have yet to be studied. Our findings will provide critical insight on potentially
modifiable factors for addressing the current maternal health crisis in a southern state where the legacy of
slavery and oppression lingers.

Grant Number: 7R01HD109005-04
NIH Institute/Center: NIH
Principal Investigator: Sheree Boulet