Felt Inequalites: Race, Culture and Emotion in Reproductive Healthcare

Existing explanations of maternal health disparities offer individualistic explanations – this patient has more stress, that doctor has racial bias – for racial disparities in maternal health outcomes. In contrast, we know that it is not just what the individual doctor or patient brings to the health care encounter, but instead that their interaction that has its own shaping impact on healthcare outcomes (Street Jr, Gordon, and Haidet 2007; Heritage and Maynard 2006; Shim 2010). Yet, scholars do not understand why such interactions appear to be going awry. This dissertation investigates Black maternal health disparities by exploring patient-provider interactions for the ways that race and racism permeate interactions and affect emotions, meaning-making and experience. Using extensive qualitative data including 56 in-depth semi-structured interviews with Black obstetric patients and with health providers, as well as 15 months of observations of patient-provider interactions on a hospital maternity ward, I explore the following questions: (1) How is race and class enacted and expressed in emotion-laden interactions; 2) how are these emotional interactions shaped by the cultural repertoires and institutional positions of the people involved; and 3) how do Black women across class experience and manage these interactions? I find that black women’s expectations of maternal healthcare are shaped by national media accounts of Black maternal health disparities, local histories of medical racism, and their own previous poor experiences with healthcare. On the other hand, physicians see themselves and their patient care through a lens of heroic efficiency, as altruistic providers that utilize medical science to save the lives of mothers and their children, often under time constraints. However, they are facing an authority crisis as the social authority of the physician wanes under the weight of shifting medical authority, hospital business practices, and public criticisms. I argue that how physicians attempt to retain their authority inadvertently shapes the care provided to laboring women and in particular harms Black women patients. I explore the mismatch of expectations of birth on labor and delivery and find that while patients and their providers are both invested in the interaction, they seem to diverge on issues of timing, knowledge, and emotional recognition. As a result, Black women continue to feel unseen and unheard in their maternal healthcare experiences. These findings have implications for Black women’s maternal healthcare. Healthcare outcomes are more than just measures of morbidity and mortality but can also have lasting effects on the women themselves and their trust in institutions.