Racism and Quality of Neonatal Intensive Care: Voices of Black Mothers

Abstract

BACKGROUND AND OBJECTIVES: Black preterm infants are more likely to die than White preterm infants within the same NICU. Racism may lead to disparate quality of NICU care contributing to disparities in preterm infant health outcomes. The objective of our study was to understand Black mothers’ perspectives of the impact of racism on the quality of care for Black preterm infants in the NICU and what might be done to address it. METHODS: Using qualitative research methods, we conducted in-depth, semistructured interviews with 20 Black mothers of preterm infants in a single Level IV NICU 6 to 18 months after hospital discharge regarding experiences with disparate quality of NICU care. We developed themes iteratively and conducted interviews until thematic saturation was reached. RESULTS: The majority of mothers believed that racism impacted the quality of NICU care and described examples of racism in the NICU at structural, institutional, and interpersonal levels. Mothers also provided ideas for interventions that would decrease racism and improve quality of NICU care for Black families, including increased Black representation, increased peer support, and improved staff education and training. CONCLUSIONS: Black mothers of preterm infants experienced racism during NICU hospitalization that impacted the quality of care they received. Interventional studies directed toward mitigating these racial disparities may focus on addressing racism during the NICU period and should include input from Black stakeholders at all stages of design, implementation, and analysis.

NANN Membership Recommendations

“…18,19 In a recent qualitative study, Black mothers reported experiencing racism in the NICU at all levels (eg, structural, institutional, and interpersonal) and believe that it impacted the quality of care their infant received. 20 Families report feeling as though nurses disliked them, particularly when that dislike was perceived to be socioeconomically or racially motivated. 21 Fathers generally do not feel included in the care of their hospitalized infants, and Black fathers felt further excluded or unwelcome.…”

“…Furthermore, recent literature documents that families from underrepresented backgrounds and groups experience discrimination, racism, and disrespect in healthcare encounters 18,19. In a recent qualitative study, Black mothers reported experiencing racism in the NICU at all levels (eg, structural, institutional, and interpersonal) and believe that it impacted the quality of care their infant received 20. Families report feeling as though nurses disliked them, particularly when that dislike was perceived to be socioeconomically or racially motivated 21.…”

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“…In addition to the medical complications faced by patients who have SCD, there are additional elements of racism, bias, and discrimination embedded in clinical encounters leading to miscommunication, bias, and imbalances of power. [4][5][6][7] This can manifest as clinicians viewing patients' expression of pain with skepticism, especially if they do not "look" like they are in pain or have been in the hospital frequently for pain crises.…”

Implicit Bias and Health Disparities Education in the Neonatal Intensive Care Unit

“…10 Awareness,identification, and incorporation of actionable strategies to address bias and the health disparities they contribute to are particularly important in the neonatal intensive care unit (NICU), where IB and HD affect both infants and their families. 11 Black birthing persons…”