Sorting Pregnant Bodies: A Genealogy of Segregated Pregnancy Care

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My research into segregated perinatal care in academic medical centers involves a multi-year, multi-phased research agenda, beginning with an organizational study of academic medical centers and the experiences of maternity care providers and continuing with an institutional analysis of the role of health system financing in the construction and reproduction of segregated perinatal care.

 

Part One: An Organizational Study into the Phenomenon of Separate Perinatal Care

Over the next two years (2023-2025), I will conduct an organizational study of segregated perinatal care within academic medical centers as the physical sites where pregnant patients are assigned to health care providers and perinatal programs, where perinatal care is provided, and where new clinicians are trained. 

 

For this organizational study, I will use grounded theory methods and situational analysis (Clarke, Friese, and Washburn 2017) to examine the processes and actions at the organizational level where laws and policies are interpreted and implemented and where patient intake and provider assignment take place.

 

I will collect organizational documents and conduct semi-structured interviews with clinicians, administrators, and patients at academic medical centers to pursue the following three aims: (1) Identify the criteria used to sort and assign patients into different perinatal clinics or programs and map these patient pathways within the academic medical center; (2) Investigate health care providers’ experiences and perspectives providing perinatal care and training in settings where pregnant patients enrolled in Medicaid are served in separate clinical spaces, provided different standards of care, or assigned to different providers than privately insured patients; (3) Explore how pregnant people experience and navigate the patient intake and provider assignment process in academic medical centers that offer multiple perinatal clinics and programs. This third aim will focus on pregnant patients who “self-sort” into a more desired perinatal clinic or program and how this process connects to race, class, or ethnicity.

 

Part Two: Health System Financing and Segregated Perinatal Care - A History of the Present

I will continue my research by undertaking an institutional and health systems analysis of segregated pregnancy care.  I will investigate and document the legal history and political conditions that contributed to the development and reproduction of segregated perinatal care in the United States. More specifically, I will examine the role of U.S. institutions (state and federal laws, health care financing, health care policies and programs) in the development of separate clinical spaces and standards of care for pregnant people enrolled in public compared to private insurance. I will undertake historical and archival research to trace how segregated health care was legally authorized and maintained through institutional slavery and Jim Crow legislation, how de jure segregation continued through the legal enforcement of residential redlining and racialized occupational categories, and, finally, how de facto health care segregation has been maintained and reproduced through state and federal laws and health system financing so that separate hospitals, clinics, protocols, and standards of care for low-income pregnant people and communities of color continue to be legalized, legitimized, and normalized in this country.