Native American Pregnant and Postpartum People's Experiences of Discrimination During Perinatal Care: A Qualitative Study

OBJECTIVE: Indigenous pregnant and postpartum people are more likely to experience severe maternal morbidity (SMM) and mortality than non-Indigenous groups. We sought to explore how community and societal factors, culture, and resilience impact Native American individuals' pregnancy experiences and might offer insights to address inequities in SMM. DESIGN: Qualitative study. SETTING: Virtual community focus group discussions. POPULATION: Individuals who self-identify as Native or Indigenous and gave birth in Utah within 5 years prior. METHODS: We partnered with local Tribes and Tribal organisations to virtually conduct 3 focus groups of 3-5 participants and 1 individual interview. Open-ended questions elicited participants' perceptions of their community and health system resources for perinatal care. Interviews were coded and analyses conducted to identify themes. MAIN OUTCOME MEASURES: Native individuals' perceptions of perinatal care focused on interactions with medical providers and the healthcare system. RESULTS: 12 participants enrolled. Participants reported harmful interactions that they believed were due to their Native American heritage. Four key themes emerged: participant experiences of discrimination, stereotyping, cultural dismissiveness, and explicit racism by their medical team. Participants suggested improving community support during and after pregnancy, holding cultural humility trainings for providers, and increasing representation of Native peoples in medicine. CONCLUSIONS: Native respondents endorsed several types of negative interactions with their medical providers during and after pregnancy that could affect their perinatal care. Efforts to reduce provider stigma and bias and improve cultural humility and awareness could improve these outcomes.