Perceptions of Pregnancy Risk and Self-Protective Health Decision Making Among Black Women: "We Can Protect Ourselves...

Racism across the life course has led to disproportionately high rates of maternal morbidity and mortality among Black women in the United States. Yet, few studies examine Black women's subjective interpretations of pregnancy-related risk, particularly within the context of their health care experiences. This qualitative study, informed by Social Amplification of Risk Framework and Black Feminist Theory, explores how Black women perceive pregnancy-related risk, how these perceptions influence health behaviors, and how gendered racism within health care settings constrains their agency.

Semistructured interviews were conducted with 28 self-identified Black women who were currently pregnant, recently pregnant, or planning to become pregnant. Transcripts were analyzed using reflexive thematic analysis to examine healthcare interactions and experiences within health care systems and their impacts on risk perceptions and decision making.

Participants expressed concerns related to the impact of pregnancy on the health and well-being of self and fetus and a perception of health care as generally safe yet potentially harmful. Participants enacted agency to mitigate these risks by maintaining a healthy lifestyle, seeking information, engaging in self-advocacy, and making intentional decisions about their care provider and birth plan. However, participants reported that health care providers constrained enactment of their agency through disempowering responses to Black women's participation in their health care.

Findings underscore the need to rebuild the trustworthiness of health care systems and highlight the ways in which clinicians may foster Black women's agency to facilitate shared decision making and improve quality of care.