The Influence of Mistrust, Communication, and Advocacy on Black Women's Pregnancy-Related Healthcare Decisions

Despite advancements in medical care, continued health inequities and a history of medical malpractice have perpetuated medical mistrust among Black communities. This is of particular concern in obstetrics, wherein Black women experience major disparities in outcomes in comparison to their White counterparts. To explore the relationship between mistrust and obstetric care, we conducted semi-structured interviews about obstetric-related healthcare experiences of pregnant and postpartum women who identified as Black or African-American and were currently pregnant or recently postpartum. Of 14 potential participants who replied to outreach, eight completed an interview and were included in this study. Data were coded using a combined inductive-deductive method following the Donabedian Model and Institute of Medicine Framework for interpreting quality of care. Our findings revealed that many Black women may enter the obstetric setting with a mistrust of both their providers and the healthcare system. As a result, they may engage in proactive self-advocacy, such as hiring doulas, wearing attire featuring college logos during appointments to mitigate potential discrimination, and switching providers when they feel unheard. Additionally, insufficient patient-centered communication further exacerbated mistrust. Many participants indicated poor communication or education from providers and staff, with some still confused about their experiences months after birth. Several participants ultimately made healthcare decisions contrary to provider recommendations. We propose that future work examine the impact of interventions (e.g., better integration of doulas and third-party support into the healthcare team; training for providers on patient-centered communication) on medical mistrust among Black pregnant and postpartum women.