Maternal perspectives of perinatal care through a socio-ecological and critical race praxis lens: a qualitative study

Maternal health disparities are driven by inequitable access to services that promote health and well-being and are grounded in historic racism and gender discrimination. A community-based participatory qualitative study was conducted within historically racial/ethnic underserved communities in Clark County, Nevada. This study employed a phenomenological approach to explore the perspectives of perceived discrimination in perinatal care. In-depth interviews ( n = 10) were conducted utilizing a purposive sample between November 2022 and February 2023. Audio recordings were transcribed and inductively coded following the Public Health Critical Race praxis and the Socio-Ecological Model. Five themes captured women’s experiences navigating perinatal care across socio-ecological levels. Participants described intersectional stressors and coping strategies, as well as feeling talked over rather than engaged in their perinatal care. They highlighted how institutional policies and procedures constrained their autonomy and access, while structural and environmental conditions shaped service utilization. Across all socio-ecological levels, women identified systemic racism embedded within perinatal care systems as a pervasive influence on their experiences. Women described experiencing discrimination in perinatal care as a product of multilevel influences, including dismissive interpersonal interactions, restrictive institutional practices, structural barriers, and pervasive systemic racism. These interconnected themes shaped their perinatal experiences and may contribute to persistent maternal health inequities. Efforts to address disparities during the perinatal period should focus on interventions that shift care delivery to culturally sensitive, person-centered models.