Scoping Review of Microaggression as an Experience of Racism and Perinatal Health Outcomes

Addressing Microaggressions-Building the Foundation for Nurse Leaders

This article examines the methodology and outcomes associated with the development of a synchronous, virtual educational activity designed for nurse leaders to enhance their ability to identify and respond to microaggressions. The engagement strategies and techniques for fostering empathy and awareness discussed can be applied widely. However, they are particularly impactful for activities related to diversity, equity, and inclusion, such as this course that focuses on recognizing and effectively managing microaggressions among nursing leaders.

Experiences of Blame Among Pregnant Black Women During Prenatal Care

OBJECTIVE

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.

STUDY DESIGN

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.

RESULTS

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).

CONCLUSIONS

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.

Racism in obstetric care: a psychometric study of the Gendered Racial Microaggressions Scale among Global Majority birthing people in obstetric contexts

In the United States, maternal health inequities disproportionately affect Global Majority (e.g., Asian, Black, and Hispanic) populations. Despite a substantial body of research underscoring the influence of racism on these inequities, little research has examined how experiences of gendered racial microaggressions during pregnancy and birth impact racially and ethnically diverse Global Majority pregnant and birthing people in obstetric hospital settings. We evaluated the psychometric properties of an adapted version of Lewis & Neville's Gendered Racial Microaggressions Scale, using data collected from 417 Global Majority birthing people. Findings from our study indicate that our adapted GRMS is a valid tool for assessing the experiences of gendered racial microaggressions in hospital-based obstetric care settings among Global Majority pregnant and birthing people whose preferred languages are English or Spanish. Item Response Theory (IRT) analysis demonstrated high construct validity of the adapted GRMS scale (Root Mean Square Error of Approximation = 0.1089 (95% CI 0.0921, 0.1263), Comparative Fit Index = 0.977, Standardized Root Mean Square Residual = 0.075, log-likelihood c2 = -85.6, df = 8). IRT analyses demonstrated that the unidimensional model was preferred to the bi-dimensional model as it was more interpretable, had lower AIC and BIC, and all items had large discrimination parameters onto a single factor (all discrimination parameters > 3.0). Given that we found similar response profiles among Black and Hispanic respondents, our Differential Item Functioning analyses support validity among Black, Hispanic, and Spanish-speaking birthing people. Inter-item correlations demonstrated adequate scale reliability, α = 0.97, and empirical reliability = 0.67. Pearsons correlations was used to assess the criterion validity of our adapted scale. Our scale's total score was significantly and positively related to postpartum depression and anxiety. Researchers and practitioners should seek to address instances of gendered racial microaggressions in obstetric settings, as they are manifestations of systemic and interpersonal racism, and impact postpartum health.

Recommendations to improve maternal health equity among Black women in "The South": A position paper from the SNRS minority health research interest & implementation group

Black women in the United States experience a higher maternal mortality rate compared to other racial groups. The maternal mortality rate among non-Hispanic Black women is 3.5 times that of non-Hispanic White women and is higher in the South compared to other regions. The majority of pregnancy-related deaths in Black women are deemed to be preventable. Healthy People 2030 directs healthcare providers to advance health equity through societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. The Southern Nursing Research Society has put forward this position paper to provide recommendations to improve maternal health equity among Black women. Recommendations for nurses, multidisciplinary healthcare providers, policymakers, and researchers are discussed.

Interpreting Microaggression as a Determinant of Wellbeing

Despite the increasing interest in exploring microaggression in the humanitarian context, there remains uncertainty on its mechanism for affecting life outcomes. There is a lack of studies on ethnic and racial minorities in non-western countries. The current research explores dimensions and manifestations of microaggression and how they affect wellbeing in a multicultural setting. The study uses a qualitative approach with 15 focus group discussions (FGDs) and 66 participants conducted in 4 provinces of South Africa: Gauteng (k = 6), North-West (k = 3), KwaZulu-Natal (k = 3), and Western Cape (k = 3). The recorded FGDs were transcribed using the intelligent verbatim technique. The transcripts were then analysed using a phenomenological approach. Data analysis was done stepwise using the deductive coding technique. Results show that participants' perception of the dimensions of microaggression varies depending on the manifestation as verbal, behavioural, or systemic. Furthermore, variations in patterns and reactions to dimensions of microaggression were linked with participants' racial identity. It further confirms that experiencing discrimination is associated with poorer wellbeing. Connectedness to the ingroup provides stability and certainty in multi-group societies due to the group rivalry that pervades such societies.

Measures of Racism and Discrimination in Preterm Birth Studies

OBJECTIVE

Preterm birth (any birth at less than 37 weeks of gestation) disproportionally affects Black birthing people and is associated with adverse perinatal and fetal health outcomes. Racism increases the risk of preterm birth, but standardized measurement metrics are elusive. This narrative synthesis examines literature on measures of racial discrimination used in preterm birth research.

DATA SOURCES

Six databases (CINAHL, Cochrane, EMBASE, PubMed [MEDLINE], Scopus, Web of Science) and ClinicalTrials.gov were searched. Search terms were categorized into three groups (racism terms, measurement terms, preterm birth terms) to identify original research articles that explored associations between racism and preterm birth. English-language, original research articles with U.S. populations were included.

METHODS OF STUDY SELECTION

Studies were excluded if conducted in only White populations, if only paternal factors were included, or if only racial differences in preterm birth were described. Articles were independently reviewed by two blinded researchers for inclusion at every stage of screening and data extraction; a third reviewer resolved discrepancies.

TABULATION, INTEGRATION, AND RESULTS

Sixty studies were included in the final analysis. Articles primarily included measures examining interpersonal forms of racism (n=17) through the Experiences of Discrimination and Everyday Discrimination scales, neighborhood composition (n=22) with the Neighborhood Deprivation Index and the Index of Concentration at the Extremes, policy-level racism (n=12) through institutions such as residential racial segregation or policy inequities, or multiple forms (n=9).

CONCLUSION

Among studies, assessment methods and application of constructs varied. This heterogeneity poses significant challenges to understanding associations between racial discrimination and preterm birth and to describing potential etiologic pathways of preterm birth, which ultimately hinders development of effective intervention. Strategies to capture multilevel exposures to racism require the development and expansion of metrics that are culturally inclusive, empirically valid, and reliable among Black pregnant populations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42022327484.