Gendered Racism Profiles, Resilience, and High-Risk Pregnancies Among Black Women

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ABSTRACT. Black women in the United States are three to four times more likely to die from pregnancy- related causes than White women, a disparity that has persisted for the past five decades. Gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) disproportionately develop in the pregnancies of Black women and negatively impact cardiometabolic health in the years following pregnancy. Gendered racism, a hybrid phenomenon of racism and sexism that interlocks to create a unique form of oppression, is a chronic stressor experienced by Black women and contributes to ongoing health disparities. However, the empirical evidence on the health implications of gendered racism is still nascent. Psychological resilience has been found to protect against adverse pregnancy outcomes, yet Black women benefit less from such resilience assets. A more culturally relevant understanding of resilience incorporating the individual-level (psychological resilience and spirituality) and family-level (family support) will be explored in this study. The overall purpose of this study is to examine the relationships between gendered racism experiences, resilience, and high-risk pregnancies among Black women. Data from the National Longitudinal Study of Adolescent to Adult Health will be used to assess experiences of gendered racism, high-risk pregnancy, and resilience among Black women with at least one pregnancy (N = 2,153). The aims are to: Aim 1. Identify latent subgroups of women with different gendered racism experiences determined by four indicators (structural sexism, interpersonal sexism, structural racism, and interpersonal racism). Aim 2. Determine the relationship of history of a high-risk pregnancy (GDM/HDP, cases vs controls) with gendered racism experiences characterizing the identified latent subgroups, covarying for chronic hypertension, diabetes (type 1 or 2), body mass index, level of education, and income. Aim 3. Describe the association of history of a high-risk pregnancy and gendered racism experiences with sources of resilience (individual and family) during adulthood, covarying for chronic hypertension, diabetes (type 1 or 2), body mass index, level of education, and income. Latent profile analysis will be used to identify subgroups for Black women with different gendered racism experiences. Bivariate and covariate-adjusted multinominal logistic regression approach will be used to determine the association between high-risk pregnancy and gendered racism subgroup experiences. Covariate-adjusted multiple regression will be conducted to examine the relationship of high-risk pregnancy and gendered racism subgroup experiences with resilience. This study uses an innovative methodological approach that integrates both interpersonal and structural gendered racism to quantity the multifaceted nature of oppression experienced by Black women along with a culturally relevant conceptualization of resilience. The findings will enhance the understanding of the health consequences of gendered racism and inform future research on multi-level interventions to combat systemic inequalities and foster resilience.