An Intersectional Examination of How Class, Marital Status, and Age Shape Discrimination Among Black Women Who Are...

Intersectionality posits that multiple social categories (eg, race, gender, class) interact to create systems in which people experience discrimination differently. Among Black women, limited work has explored intersections beyond race, pregnancy status, and gender. This study compares experiences of racism and discrimination by multidimensional social category, inclusive of socioeconomic status (SES), marital status, and age, among Black women who are postpartum.

We analyzed cross-sectional survey data from 197 self-identified Black women aged 18 years or older with a live birth at a university hospital system from 2019 to 2021. Surveys included information on demographics, the Perceived Racism Scale, and the Perceived Discrimination Scale. Demographics included SES (low: education less than a bachelor's degree or <$20,000 annual income), marital status, and age (young: <26 years). Latent class analysis identified 3 groups: no additional marginalized social categories, 2 additional marginalized social categories (low SES and unmarried), and 3 additional marginalized social categories (low SES, unmarried, and young)-hereafter, groups 1, 2, and 3. Kruskal-Wallis tests determined group differences in median scores on the racism and discrimination scales, and modified Poisson regression estimated prevalence ratios (PRs) and 95% CI for scoring in the top quartile of each scale.

Among Black women who were postpartum (3-32 months), the median perceived racism score was 101 (IQR, 71-138; possible range, 0-430) and did not differ by group (P = .40). The median perceived discrimination score was 29 (IQR, 22-35; possible range. 9-47) and differed by group (P = .02). Compared with group 1, group 2 was 2.5 times as likely to report top-quartile discrimination (PR, 2.5; 95% CI, 1.3-4.7), indicating heightened discrimination among Black women who were postpartum, low SES, and unmarried.

In this sample of Black women who were postpartum, additional marginalized social categories, such as being lower SES and a single mother, heightened experiences of discrimination. Findings support the need for perinatal health care providers and researchers to consider an intersectional lens.