Listening to Unheard Voices: Addressing Systemic Racism to Improve Maternity Care for Black Women After Perinatal Loss.

Black women in the United States experience inequities in perinatal and neonatal mortality, contributing to psychological stress during and after perinatal loss. This analysis drew on a subset of interviews from a larger qualitative dataset and explored the experiences of 22 Black women who experienced perinatal loss and were pregnant or had given birth after a loss, focusing on feeling unheard by healthcare providers. Semi-structured interviews were conducted, and data were analyzed using descriptive coding and inductive thematic analysis. Three themes emerged: unheard and dismissed concerns, biased and stratified care, and perinatal loss follow-up gaps driving self-advocacy. Women described how systemic racism intensified psychological distress, expressed as heightened anxiety and uncertainty in subsequent pregnancies after perinatal loss. Findings underscore the need for maternity settings to confront racial bias and strengthen cultural safety. Care environments that validate Black women's concerns and act on them may help rebuild trust and improve maternal and newborn outcomes. The study calls for changes in maternity and mental healthcare aimed at addressing systemic racism and strengthening culturally responsive, equitable care. These findings have implications for perinatal public health practice and policy, including surveillance, prevention, and community-responsive approaches to maternity care during and after perinatal loss.