Understanding Levels of Perceived Racism and Discrimination When Utilizing Perinatal Care

Social and structural determinants of health, grounded in historical racism and discrimination, significantly influence maternal health outcomes. Because of this, communities of color experience a higher burden of maternal health disparities. In the last several decades, there has been an increased awareness of the need to integrate critical race theory into public health research to address maternal health disparities in the context of perinatal care delivery, policy, and funding decisions.This three-manuscript dissertation utilized mixed methods to examine the ways in which systemic racism and discrimination are perceived and how it impacts the utilization of perinatal care services in historically marginalized communities. In the first two manuscripts, the perception of discrimination when utilizing perinatal care services among a sample of pregnant people and caregivers of children up to the age of three years old living in the West Las Vegas Promise Neighborhood (WLVPN) are examined and discussed. Taking into account these perceptions and experiences of discrimination, the third manuscript of this dissertation employs a person-centered approach to identify key components of community-based home-visiting perinatal care interventions that address social and structural barriers to care. The findings of the two first manuscripts suggest that perceived discrimination in everyday and healthcare settings during perinatal care is significantly influenced by race/ethnicity and social and structural determinants of health within a historically marginalized community in Clark County, Nevada. The results of the third manuscript suggest key components, concepts, and areas such as community based participatory research principles, multisectoral collaboration, and sustainable funding sources for further exploration that may mitigate social and structural barriers to perinatal care utilization. This study sheds light on the intricate relationship between experiences of racism and maternal health outcomes in perinatal settings. The findings emphasize the need for person-centered, culturally sensitive interventions aimed at addressing the unique social and structural barriers to care experienced by historically marginalized communities to improve maternal health outcomes across the lifespan.