Strategies for risk communication during prenatal care among recently pregnant Black women

Many health care institutions and professional organizations are prioritizing addressing structural racism as a strategy for reducing maternal health disparities. Improving patient-provider risk communication has been identified as a promising avenue for advancing health equity prenatal care quality; however, input from those most impacted by racism are lacking. This study explores Black women's experiences with, and preferences for, risk communication during prenatal care offers strategies for effectively discussing socioecological drivers of health and risk with Black women.

Data for this qualitative study were derived from a national, cross-sectional mixed-methods study. Seventeen Black women who were recently pregnant participated in semi-structured interviews about how their prenatal providers approached discussions about race, racism, and pregnancy-related risks and ways that clinicians can improve these communication practices. Thematic analysis was applied to interview data to identify themes.

Four themes developed in analysis. 'Frame in Racism' and 'Acknowledge the System' encapsulates preferences for open communication about racism's impacts on pregnancy health. The themes 'Travel Together' and 'Individuality Matters' refer to individualized collaborative clinical strategies.

Participants voiced preferences for communication including discussion about structural and social determinants of health, including racism. Interviewees desired increased specificity about risks for pregnancy-related conditions, including thoughtfully tailored treatment plans that recognize Black women's collective history without diminishing the importance of individual lived experiences and preferences.

Prenatal providers can incorporate the identified communication strategies into clinical practice to support an inclusive, patient-centered environment. However, our findings show that simply pointing out racism's existence is insufficient. By fostering open dialogue about specific actions pregnant women and their prenatal providers can take together to help mitigate the individual- and structural-level risks faced by Black women during pregnancy and birth, providers can signal meaningful partnership with Black women who are pregnant.