Anti-Black Medical Gaslighting in Healthcare: Experiences of Black Women in Canada.

BACKGROUND: Stereotype about Black people contribute to nurses and healthcare providers gaslighting and dismissing of their health concerns. Despite the popularity of the term medical gaslighting in mainstream literature, few studies have explored the experiences of Black women during pregnancy and childbirth. PURPOSE: This paper aims to provide an in-depth insight into Black women's experiences of anti-Black medical gaslighting when accessing care during pregnancy and childbirth. METHODS: Utilizing qualitative methods, we conducted 24 semi-structured interviews with Black women in the Greater Toronto Area. We used thematic analysis to ground the data analysis and to generate insight into Black women's experiences. RESULTS: Three overarching themes: 1) Not Being Understood: Privileging of Medical Knowledge Contributing to the Downplaying of Health Concerns, 2) Not Being Believed: Stereotypes Contributing to Dismissive Healthcare Encounters and 3) Listen to Us: Turning off the Cycle of Medical Gaslighting. These themes highlight ways anti-Black medical gaslighting manifests in Black women's healthcare encounters to create differential access to treatment and care. CONCLUSIONS: Anti-Black medical gaslighting contributes to differential access to treatment and care. Improving equitable access to treatment and care must involve addressing structural and epistemic biases in healthcare and fostering a culture of listening to humanize the experience of illness.

"There is nothing to protect us from dying": Black women's perceived sense of safety accessing pregnancy and intrapartum care.

Pregnancy and childbirth have become a dangerous journey for Black women as harrowing stories of death and near-death experiences resonate within Black communities. While the causes of pregnancy-related morbidity and mortality are well documented, little is known about how Black Canadian women feel protected from undesirable maternal health outcomes when accessing and receiving pregnancy and intrapartum care. This critical qualitative inquiry sheds light on Black women's perceived sense of safety in accessing pregnancy and intrapartum care. Twenty-four in-depth interviews were conducted with Black women who were pregnant or had given birth. Five interconnected themes were generated through thematic analysis: (1) There is a lot of prejudice towards us, (2) We are treated as sick bodies, (3) There is a lot of stereotypes towards us, (4) Our care is lacking in quality, and (5) We feel unsafe in the healthcare system. These themes highlight the perils faced by Black women accessing pregnancy and intrapartum care. The right to safe motherhood and equitable care for Black women should be a national priority in Canada to avert a looming crisis.

Obstetric racism and perceived quality of maternity care in Canada: Voices of Black women.

BACKGROUND: Obstetric racism in healthcare encounters impact on access to quality maternal healthcare for Black childbearing women yet remains underexplored in Canada. Understanding the experiences of Black Canadian women is critical to inform policy and create targeted interventions to address obstetric racism and advanced maternal health equity. OBJECTIVE: The aim of this study was to explore the experiences of obstetric racism and its influence on perceived quality of maternity care among Black women in Toronto, Canada. DESIGN: Qualitative research was conducted using a critical qualitative inquiry approach. METHODS: We conducted a semi-structured interviews with 24 Black women who were pregnant and/or have given birth in the last 3 years. The interviews explored their experiences seeking care during pregnancy/childbirth and perceived quality of care. RESULTS: Two themes were generated through the process of thematic analysis: (1) Manifestations and Impacts of Obstetric Racism and (2) Strategies for Addressing Obstetric Racism. Narratives of being dismissed, objectified, dehumanized, trauma and paternalism were reflected in the accounts of the participants. These experiences undermined the quality of care, hindered therapeutic relationships and contributed to mistrust. CONCLUSION: Black women understood the nature and impact of obstetric racism as it relates to the quality of maternal health care, their safety, and well-being. Participants recommended the need for anti-Black racism training specific to caring of Black childbearing women and increasing Black healthcare provider representation in perinatal settings as strategies to address obstetric racism. Investment in Black maternal health research is urgently needed to generate meaningful evidence to inform policy and interventions to advanced maternal health equity.

HIV-Response Intergenerational Participation Intervention Among Black Men in Ontario, Canada: Protocol for a Pilot Intervention Study.

BACKGROUND: Black men and their communities are more affected by HIV. Although they constitute less than 5% of the Ontarian population, they accounted for 26% of new HIV diagnoses in 2015, nearly half of which (48.6%) were attributed to heterosexual contact. HIV stigma and discrimination reinforce African, Caribbean, and Black men's HIV vulnerability by creating unsafe environments that deter them from testing and disclosure, resulting in isolation, depression, delayed diagnosis and linkage to treatment and care, and poor health outcomes. In response to these challenges, intergenerational strategies were identified from previous community-based participatory studies as best practices to reduce HIV vulnerabilities and promote resilience among heterosexual Black men and communities. The proposed intervention is premised on this recommendation of intergenerational intervention. OBJECTIVE: The overarching objective is to engage heterosexual Black men and communities in cocreating a community centered, culturally safe intergenerational intervention to reduce HIV vulnerabilities and related health disparities. METHODS: We will engage 12 diverse community stakeholders in Ontario, inclusive of heterosexual Black men, in 8 weekly sessions to evaluate existing evidence of effective HIV health literacy interventions, identify essential and relevant aspects, and work collaboratively to co-design the HIV-Response Intergenerational Participation (HIP) intervention for use with Black men and communities. Next, we will recruit 24 self-identified heterosexual Black men aged 18-29, 29-49, and ≥50 years. We will pilot and evaluate the HIP intervention with 24 heterosexual Black men from these 3 age groups (split as 2 events: a total of 12 participants in person in Toronto and 12 participants on the web in Windsor, London, and Ottawa). We will use the data obtained along with questionnaires from validated scales and focus groups to evaluate the effectiveness of HIP. The data will include HIV knowledge, perceived stigma toward people living with HIV, acceptance and uptake of HIV testing, preexposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and condom use. We will also collect data related to perceptions about system-level factors such as discrimination, socially misconstrued masculine identity, etc. Quantitative analysis will essentially be a univariate descriptive analysis. We will use thematic analysis to highlight the results of the focus group discussions. Finally, we will disseminate the evaluation results and engage researchers, leaders, Black men, and communities to expand the project team and scale up the intervention in Ontario and across Canada. RESULTS: Implementation commences by May 2023, and by September 2023, we should have produced, among others, an evidence-informed HIP intervention that can be adapted for use by heterosexual Black men and communities beyond Ontario. CONCLUSIONS: The pilot intervention will strengthen critical health literacy and build resilience against HIV through intergenerational dialogue among heterosexual Black men of all ages. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/48829.

'No other alternative than to compromise': Experiences of midwives/nurses providing care in the context of scarce resources.

Midwives and nurses play a critical role in safeguarding the lives of women in resource-constrained African countries. Working within the context of scarce resources may undermine their moral agency and hinder their ability to care. The purpose of this paper is to understand the influence of resource scarcity on midwifery and nursing care and practice. A critical ethnography was conducted in the obstetric department of three tertiary-level facilities in Ghana. Purposive sampling was used to recruit 30 midwives and nurses and semistructured interviews, field notes and documentary materials were used to generate in-depth understanding. Ethical approval was granted from Canada and Ghana and written, and ongoing informed consent was obtained from the participants. Five conceptual themes depicting the impact of scarce resources on midwifery and nursing care were discovered: compromised care, constrained care, dehumanized care, missed care and disengaged care. Improving the maternal health of women and averting avoidable maternal morbidity and mortality require governments and institutions to invest in health infrastructure that will support the delivery of ethical and safe midwifery care for women in their most vulnerable period.

An examination of the moral habitability of resource-constrained obstetrical settings.

BACKGROUND: While there have been studies exploring moral habitability and its impact on the work environments of nurses in Western countries, little is known about the moral habitability of the work environments of nurses and midwives in resource-constrained settings. RESEARCH OBJECTIVE: The purpose of this research was to examine the moral habitability of the work environment of nurses and midwives in Ghana and its influence on their moral agency using the philosophical works of Margaret Urban Walker. RESEARCH DESIGN AND PARTICIPANTS: A critical moral ethnography was conducted through the analysis of interviews with 30 nurses and midwives, along with observation, and documentary materials. ETHICAL CONSIDERATIONS: After receiving ethics approval, signed informed consent was obtained from participants before data collection. RESULTS: Five themes were identified: (1) holding onto the values, identities, and responsibilities of being a midwife/nurse; (2) scarcity of resources as limiting capacity to meet caring responsibilities; (3) gender and socio-economic inequities shaping the moral-social context of practice; (4) working with incoherent moral understandings and damaged identities in the context of inter- and intra-professional relationships; and (5) surviving through adversity with renewed commitment and courage. DISCUSSION: The nurses and midwives were found to work in an environment that was morally uninhabitable and dominated by the scarcity of resources, overwhelming and incoherent moral responsibilities, oppressive conditions, and workplace violence. These situations constrained their moral agency and provoked suffering and distress. The nurses and midwives negotiated their practice and navigated through morally uninhabitable work environment by holding onto their moral values and commitments to childbearing women. CONCLUSION: Creating morally habitable workplaces through the provision of adequate resources and instituting interprofessional practice guidelines and workplace violence prevention policies may promote safe and ethical nursing and midwifery practice.