Learner Summary

CEU Activity Title: “This year is not about carrying the heaviest burden”: A Qualitative Study on Black Women’s Postpartum Experiences
Author(s): Jeffers, N.K., et al. (2025)
Journal: SSM – Qualitative Research in Health
CE Credits: 1.0
Format: Reading-based CE activity
Sponsor: Integrated Family Wellness Training & Consulting (IFWTC)

Learning Objectives

After completing this CE activity, participants will be able to:

1. Describe how structural racism and historical narratives such as the “strong Black woman” trope shape the postpartum experiences of Black birthing people.
2. Identify provider behaviors and system-level practices that contribute to both care avoidance and positive postpartum outcomes among Black women.
3. Apply culturally responsive, person-centered strategies to improve postpartum care delivery and address barriers to mental and physical health support during the first year after birth.

Summary:

This qualitative study explores how Black women in Washington, D.C. experience the postpartum year through the lens of systemic racism, historical oppression, and cultural expectations. Drawing on Black feminist theory, the authors conducted four focus groups with 23 participants and identified four key themes:

• Historical Weight: Participants described how legacies of slavery, Jim Crow, and the “strong Black woman” stereotype shaped their expectations and experiences of postpartum life.
• Structural Neglect: Most reported receiving only a single six-week postpartum visit that felt dismissive and insufficient, especially in contrast to the multiple well-baby visits.
• Racism in Healthcare: Obstetric racism—dismissal, lack of listening, fear of family policing—often led to avoidance of care and deep mistrust in the medical system.
• Resistance and Joy: Despite these barriers, participants found strength in culturally concordant care, supportive “villages,” and moments of joy with their children. They actively sought better care, resisted harmful narratives, and called for systemic change.

The article underscores the need for a holistic, culturally affirming, year-long model of postpartum care that centers Black women’s lived experiences, not just physical recovery.

Background

Despite growing national awareness of racial disparities in maternal mortality and morbidity, the postpartum period remains a critical blind spot — particularly for Black women. As Jeffers et al. (2025) note, Black women in the U.S. are three to four times more likely to die from pregnancy-related causes than their white counterparts, and are more likely to experience neglect, dismissal, or inadequate follow-up in the postpartum year. These disparities persist regardless of income or education level and are rooted in structural racism, the legacy of medical violence, and contemporary manifestations of obstetric racism (Jeffers et al., 2025; Davis, 2019).

Prior qualitative research with Black women has shown how the “strong Black woman” trope contributes to underreporting of symptoms, reluctance to seek mental health care, and internalized pressure to endure distress without support (Abrams et al., 2019). Jeffers et al. extend this by exploring how these dynamics shape postpartum care-seeking behaviors, including deliberate avoidance of healthcare due to anticipated harm — a form of “racial reconnaissance” described in earlier ethnographic work (Davis, 2019).

While themes of stigma, dismissal, and lack of support also emerge in studies with Latinx, Asian, and other ethnic minority groups (Pilav et al., 2022; Iturralde et al., 2021), Jeffers et al. uniquely foreground the intersections of race, history, and surveillance, particularly around fear of child removal, dismissal of pain, and the erosion of trust in clinical spaces. Moreover, the authors balance critique with resilience, emphasizing moments of joy, village-building, and cultural affirmation often overlooked in deficit-based models.

Methodology

This qualitative study used a community-based participatory research (CBPR) approach informed by Black feminist theory to explore Black women’s postpartum experiences and the impact of racism on care. Between February and May 2022, the research team conducted four virtual focus groups (via Zoom) with 23 self-identified Black women in the Washington, D.C. area who had given birth within the past two years. Participants were recruited through purposive sampling via Black-serving clinics, organizations, and social media.

Focus groups were facilitated by trained Black women researchers with lived experience as mothers, and discussions followed a semi-structured guide. All sessions were audio-recorded, transcribed verbatim, and analyzed using directed content analysis in Dedoose software. The coding process began deductively, using codes derived from Black feminist theory and the study’s research aims. The team then incorporated inductive codes that emerged organically from the transcripts.

After coding the third transcript, the team determined that theme saturation had been reached—no substantially new concepts were emerging. A final fourth group was conducted to confirm saturation. Codes were grouped into categories and refined into thematic findings through iterative team consensus, with regular reflection on positionality and the guiding theoretical framework.

Findings and Implications

The following table illustrates how key elements of postpartum care—such as culturally concordant providers, emotional check-ins, and community support—were powerfully noticed by participants both when they were present and affirming, and when they were absent and deeply missed.

To improve care for Black birthing people and address the challenges highlighted in Jeffers et al. (2025), providers can take the following actions — all rooted in participant voices and supported by broader evidence:

• Expand postpartum care beyond the six-week visit: Offer multiple check-ins throughout the first postpartum year to monitor physical, emotional, and social wellbeing.
• Acknowledge and address racism in care: Listen actively, validate lived experiences, and recognize how dismissal and coercion drive care avoidance.
• Screen holistically and with cultural humility: Ask open-ended questions about emotional health, structural stressors, and support needs without judgment.
• Offer culturally concordant care when possible: Recruit and refer to racially and culturally aligned providers and birth workers to increase trust and comfort.
• Encourage rest, vulnerability, and help-seeking: Reframe strength to include asking for support and prioritizing healing—not just endurance.

Surprising but critical insight:

Some participants avoided medical care altogether — even when experiencing concerning symptoms — due to prior experiences of obstetric racism and fear of being harmed or dismissed.

Limitations

Jeffers et al. (2025) acknowledge several important limitations to their study. First, the participant sample was drawn from a single metropolitan area (Washington, D.C.), which may limit generalizability to other regions or rural settings. Second, while participants self-identified as Black women, the study did not include or explore the experiences of gender-diverse birthing people (e.g., nonbinary or transgender individuals). Third, the authors did not analyze how differences in socioeconomic status, birth experience (e.g., cesarean vs. vaginal), or family structure may have shaped participants’ postpartum experiences. Lastly, individuals who experienced pregnancy or infant loss were excluded, which limits applicability to those navigating grief or bereavement during the postpartum period.

IFTWC would note additional limitations not discussed by the authors. While the study provides rich insight into participants’ experiences, it does not stratify responses by healthcare setting or provider type (e.g., hospital vs. midwife-led care), which could have implications for intervention design. Additionally, the range of postpartum timing (up to two years after birth) was not analyzed in depth, potentially obscuring distinctions between acute and long-term postpartum experiences. Participants’ parity (first-time vs. experienced mothers) and health literacy were also not explored as factors influencing care-seeking behaviors. As with all focus group research, social desirability bias may have limited disclosure of stigmatized issues such as suicidal ideation, substance use, or domestic violence. Finally, while the study powerfully centers Black women’s voices, it does not include a comparison group from other racial or ethnic backgrounds, which may limit interpretation of which postpartum challenges are unique to Black birthing people versus systemic across populations.

Citations

Abrams, J. A., Hill, A., & Maxwell, M. (2019). Underneath the mask of the strong Black woman schema: Disentangling influences of strength and self-silencing on depressive symptoms among U.S. Black women. Sex Roles, 80(9–10), 517–526. https://doi.org/10.1007/s11199-018-0956-y

Davis, D.A. (2019). Reproductive injustice: Racism, pregnancy, and premature birth. NYU Press.

Iturralde, E., Hsiao, C. A., Nkemere, L., Kubo, A., Sterling, S. A., Flanagan, T., & Avalos, L. A. (2021).Engagement in perinatal depression treatment: A qualitative study of barriers across and within racial/ethnic groups. BMC Pregnancy and Childbirth, 21, Article 512. https://doi.org/10.1186/s12884-021-03969-1

Jeffers, N. K., Jones, K., Yared, N., Daniels, L., Love, K., Matthews, D., Carr, C., Estime, S., & Scott, K. A. (2025). “This year is not about carrying the heaviest burden”: A qualitative study on Black women’s postpartum experiences. SSM – Qualitative Research in Health, 5, 100266. https://doi.org/10.1016/j.ssmqr.2025.100266

Pilav, S., De Backer, K., Easter, A., Silverio, S. A., Sundaresh, S., Roberts, S., & Howard, L. M. (2022). A qualitative study of minority ethnic women’s experiences of access to and engagement with perinatal mental health care. BMC Pregnancy and Childbirth, 22(1), Article 421. https://doi.org/10.1186/s12884-022-04698-9