The Association of Social Factors, Barriers to Care, and Stress Among Postpartum Women Within Racial Groups

Background: The purpose of this study is to identify barriers to care associated with stress among postpartum women within racial groups. Methods: Paper questionnaires were distributed to English-speaking postpartum women, aged 18 years or older. The questionnaire included demographic questions, a resiliency assessment, and a list of barriers to care. Participants marked which barriers were problematic, including feeling overwhelmed by stress. Results: One hundred and nine completed questionnaires were returned. Participants were 61% White and 27% Black-identifying women. Participants reporting being overwhelmed by stress (SP-stress problem) were similar to participants who were not overwhelmed by stress (NSP-no stress problem) on education and marital status. Overall, the SP group reported more problems with other barriers to care than the NSP group. Within race, Black-identifying and White SP participants reported higher rates of not having enough money (Black-identifying: SP 45% vs NSP 0%; p=.03 and White: SP 31% vs NSP 7%; p=.02) and feeling too tired for everyday activities (Black-identifying: SP 50% vs NSP 0%; p=.01 and White: SP 50% vs NSP 10%; p<.001) than same race participants in the NSP group. Black-identifying SP participants reported higher rates for problems getting places than Black-identifying NSP participants (Black-identifying: SP 40% vs NSP 0%, p=.03). White SP participants had higher rates for problems finding childcare than white NSP participants (White: SP 36% vs NSP 3%; p<.001). Conclusion: This study highlights the differential racial experience of barriers to care among stressed and nonstressed women. Addressing the systemic inequalities underlying psychological stress during the perinatal period is necessary for delivering equitable care.