Walsh Alison R, Dove-Medows Emily
Department of Health Behavior and Clinical Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA.
Department of Populations, Systems and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA.
J Racial Ethn Health Disparities. 2025 Mar 19. doi: 10.1007/s40615-025-02392-y.
To measure the prevalence and identify correlates of self-reported experiences of provider-perpetrated blame and self-blame during maternal care among Black women in the US.
This exploratory cross-sectional pilot study surveyed 131 Black adult women who received maternal healthcare in the US within the past 5 years. Participants reported sociodemographics and experiences with maternal care, including provider-perpetrated blame and self-blame during their most recent pregnancy. Bivariate analyses (chi-squared and Kruskal-Wallis tests) were used to assess associations between individual-level characteristics, maternal care characteristics, and self-reported experiences of provider-perpetrated blame and self-blame during pregnancy.
49 (37.99%) of participants reported that at least one maternal care provider had indirectly or directly blamed them for their pregnancy complications, negative outcomes, or risk thereof and 37 (28.24%) reported self-blame. Neither type of blame was significantly associated with demographic characteristics (age, ethnicity, skin tone, education, income, employment). The two types of blame experiences were significantly associated with each other-57.14% (N = 28) of those who reported provider-perpetrated blame reported self-blame as well (p < 0.001). Both blame experiences were positively associated with receiving maternal care from a primary care physician, general practitioner, or family doctor (p < 0.01 for both blame types) and telehealth visits (p < 0.001 for both blame types). Both types of blame were also associated with perceptions that provider-communication was based in stereotypes or assumptions, lacking opportunities for questions, and provided insufficient information for informed decision-making (p < 0.001 for all comparisons).
Experiences of provider-perpetrated blame and self-blame may be highly prevalent in Black women's maternal care. These results suggest that Black women's experiences of provider-perpetrated blame and self-blame in maternal care are correlated with clinical characteristics as opposed to individual-level sociodemographics and may co-occur with negative and disenfranchising maternal care experiences linked to racial bias.
衡量美国黑人女性在孕产护理期间，医护人员归咎及自我归咎的自述经历的发生率，并确定与之相关的因素。
这项探索性横断面试点研究调查了131名在过去5年内在美国接受孕产护理的成年黑人女性。参与者报告了社会人口统计学信息以及孕产护理经历，包括她们最近一次怀孕时医护人员的归咎及自我归咎情况。采用双变量分析（卡方检验和克鲁斯卡尔-沃利斯检验）来评估个体层面特征、孕产护理特征与怀孕期医护人员归咎及自我归咎的自述经历之间的关联。
49名（37.99%）参与者报告称，至少有一名孕产护理人员曾间接或直接因她们的妊娠并发症、不良结局或相关风险而责备她们，37名（28.24%）报告有自我责备。两种责备类型均与人口统计学特征（年龄、种族、肤色、教育程度、收入、就业情况）无显著关联。两种责备经历之间存在显著关联——在报告有医护人员归咎的人中，57.14%（N = 28）也报告有自我责备（p < 0.001）。两种责备经历均与接受初级保健医生、全科医生或家庭医生的孕产护理呈正相关（两种责备类型的p均< 0.01），与远程医疗就诊也呈正相关（两种责备类型的p均< 0.001）。两种责备类型还与认为医护人员的沟通基于刻板印象或假设、缺乏提问机会以及提供的信息不足以做出明智决策的看法相关（所有比较的p均< 0.001）。
医护人员归咎及自我归咎的经历在美国黑人女性的孕产护理中可能非常普遍。这些结果表明，黑人女性在孕产护理中所经历医护人员归咎及自我归咎与临床特征相关，而非个体层面的社会人口统计学特征，并且可能与因种族偏见导致的负面及剥夺权利的孕产护理经历同时出现。
