Preconception care is designed to ensure that women begin pregnancy at optimal health by having received proper chronic and sexual transmitted infection screenings, provider counseling about necessary health improvements, and treatment for conditions or illnesses that may impact the likelihood of a healthy pregnancy or childbirth. This type of care is especially important for Black women who continue to face disproportionate risk of pregnancy-related death in the United States. Due to the higher maternal mortality rates among Black women, a more targeted investigation and implementation of consistent care prior to pregnancy is needed.
My dissertation thematically examines the trends, knowledge, and experiences of preconception care among Black women who reside in the United States. I investigated the offer, reception, and administration of preconception care services using a mixed methodology approach. First, I analyzed preconception care reception among Black women using 2016-2021 PRAMS (Pregnancy Risk Assessment Monitoring System) data. This secondary analysis concluded that hypertensive Black women had 21% decreased odds of receiving preconception care, compared to their non-hypertensive counterparts despite their diagnosis of hypertension. Second, I developed and preliminarily validated the Preconception Care Health Knowledge Scale, which was designed to assess a woman’s knowledge level of the preconception care services needed for a healthy pregnancy. By community validation, psychometric validation, and content validation, I established that the instrument, once revised, will be suitable for assessing the knowledge of preconception care among Black women in the US. Third, I conducted a qualitative study that analyzed the healthcare experiences of Black women who began pregnancy with hypertension. Through semi-structured interviews, the participants identified Health Literacy and Knowledge, Provider Counseling, Provider Interaction, and Provider Race/Ethnicity as the most impactful themes related to their overall healthcare. The participants were knowledgeable about their hypertensive condition and expected their healthcare providers to inform them about the risks associated with beginning pregnancy with hypertension. However, several participants reported not being properly diagnosed with hypertension prior to pregnancy, which resulted in delayed treatment and increased the potential for adverse outcomes stemming from pregnancy-related hypertensive disorders.
My findings address critical gaps in the literature on the use of preconception care as a method to prevent maternal morbidity and mortality among Black women. I found Black women’s preconception care treatment to be inconsistent, especially among women who were hypertensive. These findings inform the development of frameworks, interventions, and policy to reduce the disproportionate and unnecessary maternal morbidity and mortality among Black women in the United States.