Safe to Deliver: Black Women's Perceptions of Social Safety in Perinatal Care Settings

U.S. Black women face disproportionately higher rates of maternal morbidity and mortality, largely driven by structural racism. The Social Safety Theory suggests that social threat contributes to adverse health outcomes. While existing research primarily examines bias and discrimination, studies on social safety remain scarce. This qualitative study explored Black women's perceptions of social safety in perinatal healthcare.

Participants (N = 25) were U.S. residents aged 18 or older who self-identified as Black or African American, had internet access, and had given birth after 2018. Participants were recruited primarily through paid Facebook advertisements. Zoom interviews, conducted from March to April 2024, followed a semi-structured guide informed by the Socioecological Model. Interview transcripts were analyzed using Braun and Clarke's method for thematic analysis, with consensus coding to ensure credibility.

Social safety was shaped by eight overlapping themes: advocacy, autonomy and decision-making, communication with healthcare personnel, discrimination and bias, preparedness, representation, trust in healthcare personnel, and support systems. Participants described how intersecting identities such as age, body size, chronic conditions, insurance type, and marital status compounded racialized inequities in care. When social safety was fostered, women reported feeling respected, supported, and empowered; when absent, experiences of dismissal and discrimination eroded trust and heightened vulnerability.

Findings highlight the need for greater attention to factors that shape social safety for Black women in perinatal healthcare. Future research should prioritize the development of a tailored instrument to assess social safety in perinatal care.