"This year is not about carrying the heaviest burden"- a qualitative study on Black women's postpartum experiences

There is a growing literature that seeks to understand Black women/birthing people's postpartum experiences, particularly in the context of structural, political and historical exclusion of Black people in the United States. The overarching goals of this manuscript were to explore Black women's postpartum experiences, how racism impacts the postpartum year, and for those insights to reimagine a model of postpartum care that enables Black birthing people to achieve that vision of wellness. We conducted four focus groups with 23 self-identified Black women in the Washington DC metropolitan area who had given birth in the prior two years. Participants attributed the intense overwhelm that characterizes the postpartum period to the historical legacy of slavery, the Jim Crow era, and the enduring "strong Black woman" racial trope. Most participants reported receiving only one postpartum care visit amidst unmet care needs. Structural barriers like transportation, minimal paid leave, and crowded and racially segregated healthcare systems contributed to feelings that postpartum care and wellness were inaccessible. Racist encounters with healthcare providers and fears of family policing sometimes led to care avoidance as a means of mitigating harm while simultaneously motivating attempts to seek racially and culturally concordant care. Participants also shared the ways in which they resisted racism while also rejoicing in mothering and child (ren). Our findings demonstrate an urgent need to reimagine postpartum care to address the enduring impact of the historical context, the manifestations of racism, and the structural ways that postpartum is neglected, while also promoting wellness and joy.