The Psychology of Black Reproductive Healthcare: Understanding and Transforming Black maternity experiences and maternal health inequities

过去20年来，医疗科学的技术进步大大降低了孕产妇和婴儿死亡率。尽管有这些进步，黑人和白色母亲在分娩过程中的存活率存在很大差异（Knight等人，2021年）。黑人或英国黑人婴儿有超过50%的机会经历围产期死亡（国家产妇审查，2017年）。至关重要的是，种族和种族主义的影响在现有的研究中往往是缺失的，即使种族主义被认为是一种公共卫生危机（Devakumar等人，2020年）。为了增加另一层复杂性，对黑人跨性别者和非二元个体的怀孕旅程及其医疗护理和与医疗服务互动的经验的研究有限（格林菲尔德&达尔文，2020）。围产期服务提供者，虽然高度跨性别和非二元阳性，但也认为顺式异性恋护理模式有助于跨性别恐惧症和排斥性做法（Pezaro等人，2022年）。了解黑人生殖保健的心理学，在公共卫生和心理学研究不足的领域，是改变医疗保健系统和实践的重要关键步骤，以解决医疗保健系统的经验中存在的不平等，并最终减少黑人生育者（包括顺式妇女，跨性别男子和非二元个体）的可避免死亡人数。然而，为了避免嵌入该领域的个性化的、白色西方心理立场（Malherbe等人，2021年），拟议的研究采用了跨学科、心理社会、非殖民化和反种族主义的框架。作为一名可能获得生殖保健服务的黑人英国妇女，并且鉴于我在NHS担任临床研究从业者的经验，我意识到这些种族差异，这个项目对我个人和专业都很重要。此外，黑人妇女的工作通常被排除在对社会问题的学术理解之外，以及学术理论（Reddy & Amer，2022;托马斯，2020）。作为一个服务用户和服务提供者，以及作为一个未来的黑人学者，我试图为自己和我的社区调用临床护理标准的变化。

Technological advancements in medical science in the last two decades have significantly reduced maternal and infant deaths. Despite these advancements, large discrepancies between Black and white mothers' survival of the birthing process exists (Knight et al., 2021). Black or Black-British babies have more than a 50% chance of experiencing perinatal mortality (National Maternity Review, 2017). Crucially, the influence of race and racism is often missing in the existing research, even as racism is argued to be a public health crisis (Devakumar et al., 2020). To add another layer of complexity, there is limited research on the pregnancy journey of Black trans and non-binary individuals and their experiences of medical care and interaction with healthcare services (Greenfield & Darwin, 2020). Perinatal service providers, whilst highly trans and nonbinary positive, shared that a cis-heteronormative model of care contributes to transphobia and exclusionary practices (Pezaro et al., 2022). Understanding the psychology of Black reproductive healthcare, an under-studied area in public health and psychology, is an essential key step in transforming health care systems and practices, to address the inequalities present in the experiences of the health care system, and ultimately reduce the number of avoidable deaths of Black birthing people (including cis-women, trans men and non-binary individuals who birth). However, to avoid the individualised, white Western psychological stance embedded in the field (Malherbe et al., 2021), the proposed study adopts a transdisciplinary, psychosocial, decolonial and anti-racist framework. As a Black-British woman who is likely to access reproductive healthcare services, and who is aware of these racialised disparities given my experience as a Clinical Research practitioner in the NHS, this project is both personally and professionally important to me. Furthermore, the work of Black women is often excluded from academic understandings of social issues, as well as academic theorising (Reddy & Amer, 2022; Thomas, 2020). As both a service user and a service provider, and as a future Black academic, I seek to invoke changes to the standard of clinical care for myself and for my community.