Racism in obstetric care: a psychometric study of the Gendered Racial Microaggressions Scale among Global Majority birthing people in obstetric contexts.
Humans
Female
Psychometrics
Racism
/ psychology
Pregnancy
Adult
United States
Reproducibility of Results
Surveys and Questionnaires
/ standards
Hispanic or Latino
/ psychology
Male
Young Adult
Healthcare Disparities
/ ethnology
Aggression
/ psychology
Black or African American
/ psychology
Delivery, Obstetric
/ psychology
Gendered racial microaggressions
Health equity
Intersectionality
Measure and assessment development
Mental health
Postpartum health
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
28 Jun 2024
28 Jun 2024
Historique:
received:
12
01
2024
accepted:
14
06
2024
medline:
29
6
2024
pubmed:
29
6
2024
entrez:
29
6
2024
Statut:
epublish
Résumé
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.
Identifiants
pubmed: 38943057
doi: 10.1186/s12884-024-06642-5
pii: 10.1186/s12884-024-06642-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
448Subventions
Organisme : NIH HHS
ID : 1R01MD016029-02S
Pays : United States
Organisme : NIH HHS
ID : 1R01MD016029-02S
Pays : United States
Organisme : NIH HHS
ID : 1R01MD016029-02S
Pays : United States
Organisme : NIH HHS
ID : 1R01MD016029-02S
Pays : United States
Organisme : NIH HHS
ID : 1R01MD016029-02S
Pays : United States
Organisme : NIH HHS
ID : 1R01MD016029-02S
Pays : United States
Organisme : NIH HHS
ID : 1R01MD016029-02S
Pays : United States
Organisme : NIH HHS
ID : 1R01MD016029-02S
Pays : United States
Organisme : NIH HHS
ID : 1R01MD016029-02S
Pays : United States
Organisme : NIH HHS
ID : 1R01MD016029-02S
Pays : United States
Organisme : NIH HHS
ID : 1R01MD016029-02S
Pays : United States
Organisme : NIH HHS
ID : 1R01MD016029-02S
Pays : United States
Informations de copyright
© 2024. The Author(s).
Références
Colen S. Stratified reproduction and West Indian childcare workers and employers in New York. In: Feminist anthropology: a reader. Malden; Oxford: Blackwell Pub; 2006. p. 380–96. (Blackwell anthologies in social & cultural anthropology).
Howell EA, Egorova NN, Balbierz A, Zeitlin J, Hebert PL. Site of delivery contribution to black-white severe maternal morbidity disparity. Am J Obstet Gynecol. 2016;215(2):143–52.
pubmed: 27179441
pmcid: 4967380
doi: 10.1016/j.ajog.2016.05.007
Howell EA, Egorova NN, Janevic T, Balbierz A, Zeitlin J, Hebert PL. Severe maternal morbidity among hispanic women in New York City. Obstet Gynecol. 2017;129(2):285–94.
pubmed: 28079772
pmcid: 5380443
doi: 10.1097/AOG.0000000000001864
Leonard SA, Main EK, Scott KA, Profit J, Carmichael SL. Racial and ethnic disparities in severe maternal morbidity prevalence and trends. Ann Epidemiol. 2019;1(33):30–6.
doi: 10.1016/j.annepidem.2019.02.007
Howland RE, Angley M, Won SH, Wilcox W, Searing H, Liu SY, Johansson EW. Determinants of Severe Maternal Morbidity and Its Racial/Ethnic Disparities in New York City, 2008–2012. Matern Child Health J. 2019;23(3):346–55. https://doi.org/10.1007/s10995-018-2682-z .
doi: 10.1007/s10995-018-2682-z
pubmed: 30712089
Janevic T, Zeitlin J, Auger N, Egorova NN, Hebert P, Balbierz A, et al. Association of race/ethnicity with very preterm neonatal morbidities. JAMA Pediatr. 2018;172(11):1061–9.
pubmed: 30208467
pmcid: 6248139
doi: 10.1001/jamapediatrics.2018.2029
Crear-Perry J. Rewire News Group. Race isn’t a risk factor in maternal health. Racism is. 2018. Available from: https://rewirenewsgroup.com/2018/04/11/maternal-health-replace-race-with-racism/ . Cited 2023 Nov 3.
Davis DA. Reproducing while Black: the crisis of Black maternal health, obstetric racism and assisted reproductive technology. Reprod Biomed Soc Online. 2020;11:56–64.
pubmed: 33305027
pmcid: 7710503
doi: 10.1016/j.rbms.2020.10.001
McLemore MR, Altman MR, Cooper N, Williams S, Rand L, Franck L. Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth. Soc Sci Med. 2018;201:127–35.
pubmed: 29494846
doi: 10.1016/j.socscimed.2018.02.013
Maharaj S, Campbell-Stephens R. Toronto Star. Sachin Maharaj: we are not visible minorities; we are the global majority. 2021. Available from: https://www.thestar.com/opinion/contributors/we-are-not-visible-minorities-we-are-the-global-majority/article_0432d86d-51a6-5928-9c74-0dc2d4244631.html . Cited 2023 Nov 3.
Scott KA, Davis D. Obstetric racism: naming and identifying a way out of Black women’s adverse medical experiences. Am Anthropol. 2021;123(3):681–4.
doi: 10.1111/aman.13559
Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90(8):1212–5.
Cole ER. Coalitions as a model for intersectionality: from practice to theory. Sex Roles. 2008;59(5–6):443–53.
doi: 10.1007/s11199-008-9419-1
Collins PH. Learning from the outsider within: the sociological significance of Black feminist thought. Soc Probl. 1986;33(6):S14–32.
doi: 10.2307/800672
Crenshaw K. Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford Law Rev. 1991;43(6):1241–99.
doi: 10.2307/1229039
Sue DW, Capodilupo CM, Torino GC, Bucceri JM, Holder AMB, Nadal KL, et al. Racial microaggressions in everyday life: implications for clinical practice. Am Psychol. 2007;62(4):271–86.
pubmed: 17516773
doi: 10.1037/0003-066X.62.4.271
Sue DW, Alsaidi S, Awad MN, Glaeser E, Calle CZ, Mendez N. Disarming racial microaggressions: microintervention strategies for targets, White allies, and bystanders. Am Psychol. 2019;74(1):128–42.
pubmed: 30652905
doi: 10.1037/amp0000296
Lewis JA, Neville HA. Construction and initial validation of the gendered racial microaggressions scale for black women. J Couns Psychol. 2015;62(2):289.
pubmed: 25867696
doi: 10.1037/cou0000062
Rosenthal L, Lobel M. Gendered racism and the sexual and reproductive health of Black and Latina women. Ethn Health. 2020;25(3):367–92.
pubmed: 29447448
doi: 10.1080/13557858.2018.1439896
Nguyen TT, Criss S, Kim M, De La Cruz MM, Thai N, Merchant JS, Hswen Y, Allen AM, Gee GC, Nguyen QC. Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Women. J Racial Ethn Health Disparities. 2023;10(6):3007–17. https://doi.org/10.1007/s40615-022-01475-4 .
doi: 10.1007/s40615-022-01475-4
pubmed: 36449130
Williams MG, Lewis JA. Gendered racial microaggressions and depressive symptoms among Black women: a moderated mediation model. Psychol Women Q. 2019;43(3):368–80.
doi: 10.1177/0361684319832511
Lewis JA, Mendenhall R, Harwood SA, Browne HM. Coping with gendered racial microaggressions among black women college students. J Afr Am Stud. 2013;17(1):51–73.
doi: 10.1007/s12111-012-9219-0
Le TP, Kuo L, Yamasaki V. Gendered racial microaggressions, feminism, and Asian American women’s eating pathology: an intersectional investigation. Sex Roles. 2020;83(3–4):127–42.
doi: 10.1007/s11199-019-01100-5
Nadal KL, Mazzula SL, Rivera DP, Fujii-Doe W. Microaggressions and Latina/o Americans: an analysis of nativity, gender, and ethnicity. J Lat Psychol. 2014;2(2):67–78.
Crawford AD, Darilek U, McGlothen-Bell K, Gill SL, Lopez E, Cleveland L. Scoping review of microaggression as an experience of racism and perinatal health outcomes. J Obstet Gynecol Neonatal Nurs. 2022;51(2):126–40.
pubmed: 35114165
doi: 10.1016/j.jogn.2021.12.007
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.
pubmed: 18929686
doi: 10.1016/j.jbi.2008.08.010
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
pubmed: 31078660
pmcid: 7254481
doi: 10.1016/j.jbi.2019.103208
Mukkamala S, Suyemoto KL. Racialized sexism/sexualized racism: a multimethod study of intersectional experiences of discrimination for Asian American women. Asian Am J Psychol. 2018;9(1):32–46.
doi: 10.1037/aap0000104
Ghavami N, Peplau LA. An intersectional analysis of gender and ethnic stereotypes. Psychol Women Q. 2013;37(1):113–27.
doi: 10.1177/0361684312464203
Davis DA. Obstetric racism: the racial politics of pregnancy, labor, and birthing. Med Anthropol. 2019;38(7):560–73.
pubmed: 30521376
doi: 10.1080/01459740.2018.1549389
Howell FM. Resistance and gendered racism: middle-class black women’s experiences navigating reproductive health care systems. Psychol Women Q. 2023;25:036168432311681.
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.
pubmed: 16717171
doi: 10.1001/archinte.166.10.1092
Williams N. The GAD-7 questionnaire. Occup Med. 2014;64(3):224–224.
doi: 10.1093/occmed/kqt161
Howard S, Witt C, Martin K, Bhatt A, Venable E, Buzhardt S, et al. Co-occurrence of depression, anxiety, and perinatal posttraumatic stress in postpartum persons. BMC Pregnancy Childbirth. 2023;23(1):232.
pubmed: 37020205
pmcid: 10074651
doi: 10.1186/s12884-023-05555-z
Simpson W, Glazer M, Michalski N, Steiner M, Frey BN. Comparative efficacy of the generalized anxiety disorder 7-item scale and the Edinburgh Postnatal Depression Scale as screening tools for generalized anxiety disorder in pregnancy and the postpartum period. Can J Psychiatry. 2014;59(8):434–40.
pubmed: 25161068
pmcid: 4143300
doi: 10.1177/070674371405900806
Fleischman EK, Connelly CD, Calero P. Depression and anxiety, stigma, and social support among women in the postpartum period. Nurs Womens Health. 2022;26(2):95–106.
pubmed: 35231418
doi: 10.1016/j.nwh.2022.01.008
Gong J, Savitz DA, Stein CR, Engel SM. Maternal ethnicity and pre-eclampsia in New York City, 1995-2003. Paediatr Perinat Epidemiol. 2012;26(1):45–52.
pubmed: 22150707
doi: 10.1111/j.1365-3016.2011.01222.x
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Br J Psychiatry. 1987;150(6):782–6.
pubmed: 3651732
doi: 10.1192/bjp.150.6.782
Eberhard-Gran M, Eskild A, Tambs K, Opjordsmoen S, Ove SS. Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatr Scand. 2008;104(4):243–9.
doi: 10.1111/j.1600-0447.2001.00187.x
Chaudron LH, Szilagyi PG, Tang W, Anson E, Talbot NL, Wadkins HIM, et al. Accuracy of depression screening tools for identifying postpartum depression among urban mothers. Pediatrics. 2010;125(3):e609–17.
pubmed: 20156899
doi: 10.1542/peds.2008-3261
Shakeel N, Sletner L, Falk RS, Slinning K, Martinsen EW, Jenum AK, et al. Prevalence of postpartum depressive symptoms in a multiethnic population and the role of ethnicity and integration. J Affect Disord. 2018;1(241):49–58.
doi: 10.1016/j.jad.2018.07.056
Kopf J, Zeileis A, Strobl C. Anchor selection strategies for DIF analysis: review, assessment, and new approaches. Educ Psychol Meas. 2015;75(1):22–56.
pubmed: 29795811
doi: 10.1177/0013164414529792
Moody AT, Lewis JA. Gendered racial microaggressions and traumatic stress symptoms among black women. Psychol Women Q. 2019;43(2):201–14.
doi: 10.1177/0361684319828288
Du J, Steinberg JR. Stressful experiences and postpartum depressive symptoms among Asian and Pacific Islander women in the U.S.: the significance of racial discrimination. Stigma Health. 2023;8(1):102–14.
doi: 10.1037/sah0000371
Segre LS, Mehner BT, Brock RL. Perceived racial discrimination and depressed mood in perinatal women: an extension of the domain specific stress index. Womens Health Issues. 2021;31(3):254–62.
pubmed: 33637396
doi: 10.1016/j.whi.2020.12.008
Gelman A, Hill J, Su YS, Yajima M, Pittau M, Goodrich B, et al. Missing data imputation and model checking. 2022. Available from: https://cran.r-project.org/web/packages/mi/mi.pdf .
Chalmers RP. mirt: A multidimensional item response theory package for the R environment. J Stat Softw. 2012;48(6):1–29.
doi: 10.18637/jss.v048.i06
Dunn KJ, McCray G. The place of the bifactor model in confirmatory factor analysis investigations into construct dimensionality in language testing. Front Psychol. 2020;17:11.
Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health. 2022;22(1):988.
pubmed: 35578322
pmcid: 9112453
doi: 10.1186/s12889-022-13122-y
Lewis JA, Williams MG, Peppers EJ, Gadson CA. Applying intersectionality to explore the relations between gendered racism and health among Black women. J Couns Psychol. 2017;64(5):475–86.
pubmed: 29048194
doi: 10.1037/cou0000231
Howell EA, Zeitlin J. Quality of care and disparities in obstetrics. Obstet Gynecol Clin North Am. 2017;44(1):13–25.
pubmed: 28160890
pmcid: 5300700
doi: 10.1016/j.ogc.2016.10.002
Bossick AS, Bossick NR, Callegari LS, Carey CM, Johnson H, Katon JG. Experiences of racism and postpartum depression symptoms, care-seeking, and diagnosis. Arch Womens Ment Health. 2022;25(4):717–27.
pubmed: 35504987
doi: 10.1007/s00737-022-01232-w
Lett E, Hyacinthe MF, Davis DA, Scott KA. Community Support Persons and Mitigating Obstetric Racism During Childbirth. Ann Fam Med. 2023;21(3):227–33.