# The Impacts of Racial Discrimination and Disrespectful Maternity Care on Severe Maternal Morbidity Among Black Birthing People in The United States

> **NIH NIH F31** · EMORY UNIVERSITY · 2023 · $47,694

## Abstract

PROJECT SUMMARY
Background: Severe maternal morbidity (SMM) is a significant public health problem in the United States (U.S.).
Rates of SMM in the U.S. increased 200% from 1993 to 2014. Black birthing people endured 70% more risk of
SMM during the antepartum period, 40% more during the intrapartum period, and 18% more risk in the
postpartum period when compared to their White counterparts. In the U.S., minority patients report experiencing
higher rates of both chronic racial discrimination (day-to-day occurrences of interpersonal racial discrimination
occurring outside the medical setting) and acute racial discrimination in medical settings (discrimination
experienced inside the medical setting, perpetuated by nurses, midwives, and obstetricians) and disrespectful
care. Moreover, previous studies have primarily focused on discrimination perpetrated by physicians rather than
nurses and midwives, who typically interact more frequently with hospitalized patients. While research shows a
relationship between racial discrimination and adverse health outcomes, no studies have measured the
relationship between experiences of discrimination (acute and chronic) and disrespectful maternity care
perpetuated by all provider types and SMM outcomes.
Purpose: This study aims to conduct a case-control study with a nested qualitative study collecting quantitative
and qualitative data on 100 self-identified Black birthing people who gave birth in a U.S. hospital within six months
of enrollment.
Methods: The case-control design will compare 50 cases (birthing people who experienced an SMM outcome)
and 50 controls (birthing people who didn't experience SMM outcomes). Participants will complete five surveys,
including a demographic survey and scales assessing racial discrimination from providers while seeking
antepartum, intrapartum, and postpartum care, respectful maternity care from all providers, and racial
discrimination in their daily lives. The study is comprised of three parts: (1) measure the association between
experiencing an SMM outcome and experiences of discrimination and respectful care; (2) analyze survey data
and purposively recruit a sample for qualitative interviews; (3) conduct 15-20 interviews of birthing people
identified by low scores on the respect scale (indicating low respect) and high scores on the discrimination scale
(indicating a high level of discrimination).
Implications: This study, for the first time, will provide information on both acute and chronic interpersonal racial
discrimination and maternal disrespect in Black birthing people experiencing SMM outcomes, a population at
high risk for health inequities. Importantly, we will measure discrimination and disrespectful care received from
all provider types, including midwives and nurses, the latter of who has been omitted from previous health
inequities research. The findings of this study have the potential to impact practice in many ways, including the
revision of standardized care...

## Key facts

- **NIH application ID:** 10689069
- **Project number:** 5F31NR020575-02
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Roseline Jean Louis
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $47,694
- **Award type:** 5
- **Project period:** 2022-09-01 → 2025-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10689069

## Citation

> US National Institutes of Health, RePORTER application 10689069, The Impacts of Racial Discrimination and Disrespectful Maternity Care on Severe Maternal Morbidity Among Black Birthing People in The United States (5F31NR020575-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10689069. Licensed CC0.

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