Communication influences on US Black Women’s  Pregnancy Risk Perceptions and Related Behavioral Responses

Pregnancy poses unjust dangers to Black women in the United States, who are currently faced with higher rates of maternal mortality and pregnancy-related adverse events than women of other races. The maternal mortality ratio for non-Hispanic Black women is 41.4/100,000 compared with 13.7/100,000 for White women (Hill et al., 2022). Although there are available statistics and other forms on expert knowledge on these dangers, risk perceptions and related behaviors are derived from subjective individual interpretations within a dynamic communicative context. While there is extensive evidence on the dangers pregnancy and childbirth pose to Black women, less is known about Black women’s conceptualizations of their own risks, the role of communication (with their healthcare providers and other sources), and the ways in which they enact agency in response to these risks. Using a multi-methodological approach that draws on in-depth interviews, qualitative network analysis and an environmental scan, this dissertation foregrounds Black women’s own narratives to explore the social construction of pregnancy risk, the role of communication with healthcare providers in the amplification or attenuation of these risks, and the broader communicative context that shapes Black women’s pregnancy experiences. In doing so, this study found that Black women’s pregnancy risk perceptions are socially constructed through communication in a socio-political context shaped by gendered racism, and Black women enacted agency in response to these risks in a variety of ways constrained by gendered racism, including intentional decision-making, extensive research, and self-advocacy. Insights from in-depth interviews and the qualitative network analysis were contextualized in an environmental scan that included a review of relevant policies, interviews with community leaders, and a review of community organizations efforts to support Black women. This dissertation concludes with a discussion of contributions to theory and insights for Black women, healthcare providers, community organizations, media and policy makers.