Skin Tone Matters: Racial Microaggressions and Delayed Prenatal Care

Abstract

Introduction: Literature posits that discrimination can be a barrier to racial and ethnic minorities' healthcare use. This study examines the relationship between perceived discrimination in the form of racial microaggressions and delayed prenatal care in African American women. It also investigates whether this relationship is modified by women's shade of skin color owing to societal attitudes and beliefs tied to colorism (also known as skin-tone bias). Methods: Data were collected from a cohort of 1,410 black, African American women in metropolitan Detroit, Michigan, enrolled in 2009−2011 (analyzed between August 2017 and July 2018). Perceived racial microaggressions were assessed using the 20-item Daily Life Experiences of Racism and Bother scale. Logistic regression modeled the relationship between the Daily Life Experiences of Racism and Bother scale and delayed prenatal care, defined as third trimester or no prenatal care entry. Results: Nearly a quarter (24.8%) of women had delayed prenatal care. Logistic regression models showed that a Daily Life Experiences of Racism and Bother score above the median was associated with delayed prenatal care (AOR=1.31, 95% CI=1.00, 1.71). This association was moderated by selfreported maternal skin tone (interaction p=0.03). A higher Daily Life Experiences of Racism and Bother score was associated with delayed prenatal care among African-American women at either end of the color continuum (light brown: AOR=1.64, 95% CI=1.02, 2.65; dark brown: AOR=2.30, 95% CI=1.20, 4.41) but not in the middle (medium brown women). Conclusions: Skin tone−based mistreatment in tandem with racial discrimination in the form of racial microaggressions may influence African American women's use of prenatal care. These findings have implications related to the engagement of women of color, particularly African American women, in healthcare systems and maternal and child health programs.

Patient-Reported Experiences of Discrimination in the US Health Care System

“…Experiences of discrimination in the health care system harm patients by negatively impacting trust, communication, and health-seeking behaviors. 13 , 16 , 32 , 33 Our findings underscore the importance of understanding aspects of patient identity, especially with regard to race/ethnicity, not as risk factors for discrimination or the downstream effects of those experiences; rather, exposure to discrimination and racism are the risks. 34 , 35 The prevalence of discrimination identified in this study points to a need to examine discrimination in the health care system as a risk factor for other negative effects.…”

First Trimester Maternal Vitamin D Status and Risks of Preterm Birth and Small-For-Gestational Age

“…We also included season at blood draw, skin color and ethnicity, since these were hypothesized to be strongly related to vitamin D status and there is increasing evidence of an association with perinatal outcome. Seasonal variations in respiratory and viral infections, as well as in the temperature, impact on preterm birth [37][38][39][40], while skin color is related to ethnicity, which has an independent effect on preterm birth and SGA; recent research suggests that skin tone may also be directly relevant to the investigation of perinatal outcomes [41][42][43].…”

Colorism and Physical Health: Evidence from a National Survey

“…These studies add to prior research, which has also identified significant direct associations between skin tone (machine or interviewer-rated), systolic blood pressure, hypertension, and cardio-metabolic health (Krieger, Sidney, and Coakley 1998; Wassink et al 2017). In fact, a recent study found links between skin tone and prenatal care (Slaughter-Acey et al 2019). Another recent study found significant associations between skin tone and hypertension between siblings using a family fixed-effects approach that even considered genetic pleiotropy—strong evidence of a robust relationship between being darker skinned and increased risk of hypertension among Blacks (Laidley et al 2019).…”