Background
Early initiation of prenatal care leads to better birth outcomes. In the City of Milwaukee in 2007, only 74% of African American women initiated prenatal care in the first trimester compared to 85% of White women1. While 86% of White women received adequate prenatal care, only 74% of African American women did[1]. The Institute of Medicine (IOM) released a report “Unequal treatment” that noted disparities in the quality of care received by African Americans, charging that covert and overt racism play a large role in these disparities[2].
"Racism don't come with the hospital and the baby and stuff, that's our time of love and joy, we just had our babies, you know. Racism comes out in our daily lives when we're trying to live our lives."
Purpose
To examine the presence and nature of racial discrimination in prenatal care.Methods
Using a community-based approach, researchers met with leaders at the YWCA of Greater Milwaukee to discuss the potential project. With their input, we designed a descriptive qualitative study using focus groups.
Population
Approximately 40 African American women with infants and who are consumers of YWCA services.
Timeline
October 2009 – October 2010
Current Status
So far, we have interviewed 8 African American women who:
- Were over the age of 18 with at least one child in the past year.
- All were single.
- 6 had an education of 12th Grade/GED or less; 2 had some college.
- 2 were employed; 6 were unemployed.
- 6 were earning under $10,000/year.
- 6 had early, adequate prenatal care; 1 had none.
- 7 had Medicaid as insurance; 1 had none.
- 7 visited the ER during their pregnancy; 3 of them visited 3 or more times; 2 visited 7 or more times.
Preliminary Findings
Although focus groups are ongoing, we have identified some very preliminary themes:
- Use of the Emergency Room (ER) during Pregnancy
Many women reported using the ER for care because they felt they were seen quickly, and that they received better care. Reasons for going to the ER included, headaches, sharp pain behind the eyes, swelling in hands and feet, or no fetal movement.
“Uh uh, I ain’t going to no doctor’s office, I’m going down here [to the ER], they’re going to TELL me what’s wrong.”
“Sometimes you need the ER. Look how many people don’t get the right care.”
“Sometimes the doctor’s office don’t tell you nothing, you need x-rays and tests. That’s why I go to the ER, I KNOW when something’s wrong with me.”
“They got everything right there like the x-ray room…”
“Draw my blood, cuz they not doing it at the doctor’s office. You know I’m gonna say it like it this, you go to the doctor’s office. If you put something to the back of my chest, make me cough, go up and down, look in my eyes, you don’t know if I got nothing. Then you send me over there across to the lab and it takes 2 weeks and you might don’t even call me back. No, I want to go to the emergency room because I think something’s wrong with me.”- Concerns Regarding Perceptions of Poor Care
Although women did not directly label these experiences as due to racism, they remained concerned about the care they received:
“I had my daughter on the 26th. On the 24th I went to the hospital and the man kept telling me that, ‘oh you’re not in labor, you’re in false labor’ but he never checked to me to see if I was dilated or anything so when the nurse came in, she checked me, and he sent me back home. So then on the 25th I ended up going right back. I was dilated at 2 on the 24th, on the 25th I was 3. So when I went to the clinic, he was real rude, he was like, ‘I hope that this baby comes because I’m tired of this.’ When he came in he checked me and sent me across the street to the hospital to have the baby.” “They just feel you have to come here, where else are you going to go, so they just want you to deal with it.”“I think they look at you like you don’t matter. And because you’re around here, where else are you going to go.”“I went on October the 5th [to the ER]. I was bleeding and I was like, ‘I ain’t never bled with the other kids and I seen my mucous cord’ and they sent me back home. I went home and sit there and thought about it…because they were like, ‘ah there’s nothing wrong with you’; I was only dilated 1 centimeter and they was like, ‘ oh you’re not dilated enough, you got to come back.’ [The other hospital] told me they were glad I came back. A little later at the [other hospital] I was 1 ½ centimeters, but they said I was in labor because I was bleeding.” This woman’s baby was born at 2:00 AM on October 6th.
"They just feel you have to come here, where else are you going to go, so they just want you to deal with it."
"I think they look at you like you don't matter. And because you're around here, where else are you going to go."
- Experiences of Racist Behavior
One woman did describe a situation in which she felt the doctor was blatantly racist. When she was 4 months pregnant, she went to the ER for a bad headache.
“The doctor kept me waiting in the room for like an hour. When the doctor walked past I asked, ‘how long is you going to be’ and he said there was a lady that just came in that had a stroke. Okay, but there’s more than one doctor up in here though. And he said, ‘Well excuse me Miss Want-To-Be Black Pregnant Lady,’ so I snapped on him and I walked out.”
- Generational Differences in Perceptions of Racism
Many women also talked about how their perceptions and their mothers’ perceptions of racism differed. Many described their mothers as saying they weren’t racist, but that they behaved in way that was racist.
- Long waits for prenatal care
Many women complained about long waits for prenatal care, sometimes even spending all day at the clinic before they were seen by a doctor.
“I used to make sure I was off that day or leave early for that day or I would have been late for work.”
“They [administrative support staff] will get up when they’re ready to call your name. And then I have to call up the office to let them know I’m here, I’m just waiting for them to put me up in a room.”- Examples of a good prenatal care visit
Many of the women reported satisfaction with their prenatal care experiences,
“I always got what I needed. They were always caring and supportive. My doctor always called me, so I stuck with them.”
"They always made sure they answered all of my questions.”
“They know exactly who I am when I walk through the door.”
- Expectations of Racism
One woman, who sought care outside of downtown Milwaukee to get better care, also expected to encounter racist behavior,
“I’m just grateful that they’re not looking at me funny cuz you know there aren’t that many black people coming out there or whatever but I don’t get treated differently either.”
Another woman reported not sleeping in the hospital out of fear for her safety,
“Hospitals scare me. So I don’t sleep, I just sit up and watch everything they do. Cuz there might be somebody that don’t like you and they just come in there and do something to you while you ain’t paying attention.”
- Responses to poor care
Some women reported switching providers or clinics because of long waits or poor care.
"If I feel you are racist, I move around.”
Other women reported just tolerating poor care because of the convenience of a local clinic.
“I just deal with it there [because] I know the doctors there longer.”
“I was hoping the baby would come so I wouldn’t have to see him no more.”
“Some people have a snotty attitude but I try to overlook it, I don’t pay attention. If you don’t have nothing to do with me, I don’t pay attention. I don’t have too many problems, at least I try not to.”
Sources of Funding and Resources
Children’s Community Health Plan
Center for Urban Population Health
YWCA of Greater Milwaukee
Project Partners
University of Wisconsin-Milwaukee and the Center for Urban Population Health
Amy Harley, PhD, Faculty Principal Investigator
Mary Mazul, CNM, Student Principal Investigator
Trina Salm Ward, MSW, Student Co Principal Investigator
Farrin Bridgewater, BA, Student Intern
University of Wisconsin School of Medicine and Public Health
Samantha J. Perry, MPH, CHES, Wisconsin Population Health Fellow
YWCA of Greater Milwaukee
Allison Scheff, Job Developer
Martha Barry, PhD, Racial Justice Director
Lisa Boyd-Gonzalez, Chief Operating Officer
For more information, contact:
Trina Salm Ward
(414) 219-4084
References
[1]Wisconsin Department of Health Services, DPH, BHIP. Wisconsin Interactive Statistics on Health (WISH) data query system. Retrieved from http://dhs.wisconsin.gov/wish/, Infant Mortality Module.
[2]Smedley, B. D., Stith, A. Y. (2002). Unequal treatment: confronting racial and ethnic disparities in health care. Nalson, A.R. (Eds.) Institute of Medicine of the National Academies. Retrieved from http://www.nap.edu/openbook.php?isbn=030908265X
