Reclaiming Narratives of Empowerment around Black Maternal Health: A Strengths-Based, Community-Informed Focus Group Study

Abstract

Objectives:

Research on Black maternal populations often focuses on deficits that can reinforce biases against Black individuals and communities. The research landscape must shift towards a strengths-based approach focused on the protective assets of Black individuals and communities to counteract bias. This study engaged the local Black community using a strengths-based approach to discuss the assets of Black maternal populations and to inform the design of a future clinical trial focused on reducing Black maternal health disparities.

Design:

Guided by the Theory of Maternal Adaptive Capacity, we conducted three purposive focus group sessions with Black adult community members. The focus groups were semi-structured to cover specific topics, including the strengths of the local community, strengths specific to pregnant community members, how the strengths of community members can support pregnant individuals, and how the strengths of pregnant community members can facilitate a healthy pregnancy. The focus group interviews were transcribed verbatim and analyzed using thematic content analysis.

Results:

Three focus group sessions were conducted with sixteen female individuals identifying as Black or African American. Central themes include (1) the power of pregnancy and motherhood in Black women, (2) challenging negative perceptions and media representation of Black mothers, (3) recognizing history and reclaiming cultural traditions surrounding birth, and (4) community as the foundation of Black motherhood.

Conclusion:

Black community members identified powerful themes on Black maternal health through a strengths-based lens. These focus groups fostered relationships with the Black community, elucidated possible solutions to improve Black women’s health and wellness, and offered direction on our research design and intervention.

Introduction

Black women possess many individual strengths, deep community ties, and a rich cultural heritage that has fortified their well-being and the health of their communities. These strengths, which promote good health and prevent disease can be referred to as protective assets (1,2). Despite the increasing awareness of Black maternal health disparities, little attention is given to the protective assets that help keep Black women and their communities healthy.

Black women in the United States are three times more likely to die from pregnancy-related complications compared to white women, and this statistic continues to increase (3,4). The prevailing narrative about Black maternal health has placed the onus for these grim statistics on Black women themselves, often ignoring the impact of systemic racial inequities (5,6). Only recently have studies begun to recognize the far-reaching implications of systemic racism, which impacts individual stress, hinders access to quality healthcare, and perpetuates educational and resource-based disparities, thereby creating and exacerbating maternal health disparities (7–13).

Despite the emerging acknowledgment of social and systemic factors impacting Black maternal health disparities, the majority of existing research is problem-centric, frequently relying on quantitative, correlational studies like vital statistics updates (14). While these forms of research are important, they tend to capture headlines while lacking the nuance required to understand the underlying causes or context of Black maternal health disparities. For example, researchers may report associations between poor Black maternal health and poverty. Without further exploration of causality or context, these findings are susceptible to public misinterpretation, and can be easily misinterpreted as critiques of individual behavior, thereby reinforcing ‘mother blame’ narratives and stereotypes in Black maternal health (14,15). Such a restricted viewpoint not only distorts the true nature of the problem but also diminishes public interest and resource allocation aimed at mitigating these disparities (15,16).

The initial perspective through which researchers approach a problem can be so influential that it dictates the range of solutions later considered (17). The self-reinforcing cycle of defining the problem, asking limited questions, and arriving at negative conclusions can be described as a ‘looping effect’ (18). This looping effect is particularly pronounced in maternal health disparities, where harmful stereotypes and misapplied social determinants can skew public understanding to a deficit discourse about Black birthing people (1,6). A more balanced approach would consider how Black individuals and communities promote and maintain wellness. By reframing the problem and asking more inclusive research questions that recognize and celebrate the protective assets and capabilities within Black women and their communities, we can break this self-reinforcing cycle and consider a broader range of factors and potential solutions to maternal health disparities (1).

To counter the effects of a deficit focus, it is essential to emphasize the protective assets of Black individuals and communities and to acknowledge Black individuals as primary sources of knowledge in research. A protective asset or strengths-focused research perspective identifies the factors that contribute to the well-being of Black mothers and their communities without imposing solutions that may be inappropriate or culturally irrelevant (1,2,5). By incorporating individuals’ voices and lived experiences, this research maintains cultural sensitivity while acknowledging the historical and factors that shape the health outcomes of Black women. Strengths-focused research provides a more balanced and accurate portrayal that counteracts the pervasive negative stereotypes and biases that have historically permeated research on Black populations (1,2,5).

Our research team worked with Black community members in a midwestern metropolitan area through focus groups to advise a larger clinical trial focused on improving Black maternal wellness through a strengths-focused perspective (NINR R56NR020707). These focus groups aimed to inform the overall research study design, refine and tailor a strengths-focused intervention on overcoming Black maternal health disparities, and build relationships with the Black community. We chose focus groups to inform our research to ensure that the larger study maintains a strengths-focused lens and remains culturally relevant and acceptable to the target population.

Positionality Statement

Our research team acknowledges the critical importance of positionality in shaping our engagement, analysis, and interpretation of the findings. Our team is composed of members with diverse backgrounds, including individuals who identify as members of the Black community and those who do not. Further some team members are birth workers with firsthand experiences of Black maternal health disparities. This diversity within our team prompted an ongoing reflective practice throughout the research process, where we continuously examined how our personal experiences, beliefs, and social identities might influence our interactions with participants and our interpretations of the data.

We also recognize that our positionality influences the research process and contributes valuable insights. For team members who are part of the Black community, their insider knowledge and lived experiences provided critical context for interpreting the nuances of the discussions. For those outside the community, their perspectives helped in questioning assumptions and exploring the data from different angles. Individuals who were birth workers further offered insider and outsider perspectives when discussing topics related to Black birthing people. This dynamic interplay between insider and outsider perspectives was instrumental in our analysis, enabling a more nuanced and comprehensive understanding of the themes that emerged from the focus group discussions.

Materials and Methods

This qualitative focus group study used a semi-structured interview guide to cover specific topics, including (1) strengths of the local community, (2) strengths specific to pregnant community members, (3) how the strengths of the community members can support pregnant individuals, and (4) how the strengths of pregnant community members can facilitate a healthy pregnancy (Table 1). Before recruitment, we received Institutional Review Board approval from the University of Nebraska Medical Center (0623-22-EX).

Table 1.

Focus Group Interview Guide

Engagement Questions
Question	Probe
Tell me about what you’ve heard about Black pregnant women in the news?	How does this impact our community here?
Why do you think Black pregnant women face these issues?	Based on responses (racism, health care, access, support)
What do you think can be done to improve the health of Black mothers and babies in our community?
Exploration Questions
Question	Probe
What are the strengths of the local Black community?
How do the Black pregnant women and mothers in your community demonstrate strength?	How do these strengths help a Black woman have a healthy pregnancy in our current society?
How can we as a Black community support pregnant women?
If you were to give a message to a Black pregnant woman or mother to help her find her strengths or inspire her, what would you say?
Exit Question
Question	Probe
Is there anything else you would like to say about the things we have talked about today/this evening?

Theoretical Framework

This study was guided by the theory of Maternal Adaptive Capacity, a strengths-focused theoretical framework designed explicitly for maternal health research (2). Maternal adaptive capacity focuses on the protective assets an individual might use to achieve or maintain health during the pregnancy continuum. Adaptive capacity encompasses physiologic, psychological, social, economic, and structural protective assets that enable one to prevent, adapt to, or overcome risks (2). Adaptive capacity can be intrinsic to an individual like a personality trait or genetic variation, or derive from external sources such as social support (2). By starting with focus groups with the Black community we recognize that individual and community protective assets together determine an individual’s adaptive capacity. This research and the intervention it produces aim to strengthen adaptive capacity. In turn, the individual’s adaptive capacity will support their engagement with the intervention, potentially reducing risks for women and thereby improving maternal outcomes (2). Through the theory of Maternal Adaptive Capacity, the protective assets of Black individuals and communities guide maternal health research and counteract the biases often present in research and clinical environments (2).

Research Design

We chose a qualitative focus group research design because it promotes community cohesion for problem-solving and generates new and valuable ideas (19). The focus group work emphasizes depth and nuance rather than quantifiable measurements, making it a valuable tool in exploratory, descriptive, and interpretive research (19,20). Further, focus group work allows group dynamics to collectively explore a topic through interactive discussions among participants (20,21). The goal is to elicit a range of perspectives, generate new insights, and understand group dynamics and shared experiences (20,21). Focus groups are typically conducted with the understanding that the findings represent a collective understanding rather than the individual viewpoints of the participants, an important element of our community-engaged work. We chose to conduct three focus groups in an effort to uncover 80–90% of possible themes (22).

Participants, Setting, and Procedures

Individuals of any sex or gender who were 19 years of age or older, lived within 20 minutes of the midwestern metropolitan area, and identified as Black or African American were purposively recruited for our study. This study was conducted between December 2022 and February 2023. Recruitment materials were distributed via email and poster by the Malone Center. The Malone Center is a Black community center that hosts a Maternal Wellness program for Black, Indigenous, and People of Color (BIPOC) individuals and includes childbirth education, a doula program, and breastfeeding support services. The focus groups were held at the Malone sites in the Lincoln and Omana, NE areas. In this study, demographic segmentation was not pursued as the focus was exclusively on the Black community and engaging directly with Black community members. The decision not to collect demographic data further protected our participants’ anonymity. All research participants provided informed consent.

Each focus group session followed a predetermined structure and was facilitated by a moderator (AE, DO). The moderators were Black women and members of the research team. The moderator’s role was to guide the discussion, encourage active participation, and ensure that all participants had the opportunity to share their perspectives. Each focus group session lasted approximately 60 minutes, allowing sufficient time to explore topics in depth. The sessions were conducted in a comfortable and neutral environment at the community centers to promote open and honest dialogue.

A semi-structured interview guide was developed to provide a framework for the discussion (Table 1). The guide consisted of open-ended questions and prompts designed to elicit participants’ experiences, opinions, and suggestions related to Black maternal health through a strengths-focused lens. The moderator had the flexibility to probe for further clarification or ask follow-up questions to facilitate a comprehensive exploration of the subject matter. The focus group sessions were audio recorded and transcribed verbatim by a third-party, privacy compliant transcription company. Subsequently, the accuracy and consistency of these transcripts were verified by a team member (EM), who cross-referenced the recordings with the transcriptions to ensure fidelity and correctness.

Data analysis

A thematic analysis approach was employed to analyze the qualitative data collected from the focus groups (19,23). Focus group transcripts were first independently coded by two investigators (EM, ES). The transcripts were read and re-read to gain familiarity with the content. Coding was completed manually using standard word processing software. Coding was conducted using an inductive approach, allowing for the emergence of themes and patterns directly from the data. Once independent coding was complete, the independent coders met to discuss the coding framework, representative quotes, and resolve any discrepancies. To ensure rigor and reliability, separate investigators further verified codes (AE, MB). A second meeting was held among all individuals who had coded the data where codes were finalized. A third meeting was held with the original coders (EM, ES) where codes were then grouped into higher-order themes and sub-themes, and their relationships were examined (23,24). Quotations and narrative descriptions were selected to illustrate the identified themes, providing a rich and contextualized representation of participants’ viewpoints (24). Finally, a fourth meeting was held with the research team presenting the quotations, codes, and themes for discussion. Due to manual coding of the transcriptions, coding inter reliability was not assessed. This manual and iterative approach was chosen specifically for its suitability to our focused research questions and its ability to facilitate a deeper, more nuanced understanding of the data. This method aligns with qualitative research norms where the richness and depth of data are often prioritized over statistical measures of reliability (24).

Results

This study included three semi-structured focus groups, each including 4–8 members. A total of sixteen female individuals identifying as Black or African American participated. Four themes emerged from focus group participants’ discussions of Black maternal health framed within the strengths-focused framework of maternal adaptive capacity. These themes include (1) The power of pregnancy and motherhood in Black women, (2) Challenging negative perceptions and media representation of Black women, (3) Recognizing history and reclaiming cultural traditions surrounding birth, and (4) Community as the foundation to Black motherhood.

Theme 1. The Power of Pregnancy and Motherhood in Black Women

The most prevalent theme throughout each focus group was how pregnancy and motherhood are empowering experiences for Black women, especially within the current Black maternal health crisis. Women discussed how they can use their pregnancy and maternal experiences to challenge systemic racism and control their own narratives. “But taking that control of, ‘I’m educated on this, on my options, on what I can control or not control.’ And I feel like that already... I know for myself that makes me feel some kind of empowerment.”

There were many examples of Black women empowering themselves through education, asking questions, and asserting their agency in the birthing process and how through these processes they can give birth on their terms: “You are not one foot in the grave, because that’s what my mother told me when I was pregnant. She’s like, ‘Remember, when you give birth yous one foot in the grave because women die when they have babies.’ And I was absolutely mortified when she told me that. But I had education, I knew that it can go either way. But I had support, I made sure I had the support that I wanted, and I had the birth experience that I wanted both times.”

Further discussion focused on reminding Black pregnant women of their inherent goodness and power, “Whenever I see a pregnant person, I’m always incredibly joyful, and I express my joy to them exuberantly. Remember that you are more powerful than you can ever imagine. And that they are literally holding and creating life within their body.”

Within this theme, several discussions occurred, noting that Black women continuing to have babies and having healthy pregnancies were acts of resistance to the systemic racism Black women face. One participant stated, “The most powerful thing you can do is have a healthy pregnancy and a healthy birth, and that’s where your power is. I mean, that’s the strength. That’s our fight back.” In one discussion, participants pointed out that learning self-advocacy was an empowering way to have a healthy pregnancy, even when the system does not always expect or even want that for Black women. “I think you really have to learn to become an advocate for yourself. Once you set your mind to knowing, “I want to have a healthy birth, and this is my plan.” Another focus group member responded, “We definitely have to start saying that more. This is my plan. I want a happy, healthy birth. This is what you need to do.” Other participants agreed, “Definitely, putting our foot down, and speaking things into existence, right? Like, ‘We are going to have healthy pregnancies and births.’” Another participant spoke about the power of Black women continuing to have pregnancies and how the community will support them and celebrate them for this act of resistance against the negative narrative surrounding Black maternal health. “I think their strength is they are continuing to have babies. You know what I mean? Regardless of socioeconomic status, they’re continuing to have babies. And I think in spite of the statistics, in spite of the systemic racism, in spite of, in spite of, in spite of, they’re continuing to have babies, to seek out resources, and to ask for help, which I think is huge.”

Theme 2. Challenging Negative Perceptions and Media Representation of Black Mothers

Focus group participants addressed the need to challenge and change the media’s negative portrayals of Black mothers. One participant noted, “I feel like the way that things are worded in the news is more of shaming the moms rather than saying, ‘These are the things that are happening to moms.’ Instead of saying, ‘There’s no support for Black pregnant women.’ It’s like, ‘Black pregnant women are not seeking help or are not attending these things.’ It’s almost like they’re saying, ‘These moms are not actually looking to do the best that they can.’” Participants also discussed how a narrative of negativity about individual Black women surrounds Black maternal health. As a result of this narrative, individual Black women confront these characterizations and their implications in their everyday interactions, “Black moms is always seen as a villain or always seen as neglectful compared to a white mom.”

Participants noted the importance of celebrating and talking about the joy they experience as Black mothers as a way of changing the narrative surrounding Black maternal health, “The more we talk about it, the more we normalize it, because white people can be desensitized to our strength and our passions, and they don’t hear the passion of motherhood and the joys of it.” One participant expressed by improving maternal wellness in their own Black community, they will not be a part of the statistics, “They’re going to always scream these statistics in the media, but we can be the change.”

Participants discussed that while awareness of Black maternal health disparities was vital to improving health for all Black women, they grew tired of hearing only negative statistics and news stories about Black mothers. One participant stated, “When they talk about Black maternal health nationally, it’s only ever in two-to-three-minute segments. It’s never elaborating on the good and what you can find in your cities.” Participants desired more supportive narratives, acknowledging systemic issues rather than blaming individual Black mothers. Focus group participants expressed a collective desire to refocus the narratives around Black maternal health to focus on the good work that is being done in their community and by Black mothers, like community-based doula support and other informal networks created by Black women, for Black women. Refocusing the narratives would present a more accurate representation of real life, while continuing to maintain awareness of the Black Maternal health crisis: “I think sharing more about what we’re doing now instead of focusing on so much of the negative and all these statistics that we repeatedly keep hearing. If we focus on the negative, that’s what we’re going to put out there. But if we start talking about the services that like the Malone Center are offering, and how Black women are reclaiming our births and how we’re supporting each other. I think if we start making that more well-known, we’re going to be able to start changing that narrative.”

Theme 3. Recognizing History and Reclaiming Cultural Traditions Surrounding Birth

The focus group participants placed a high value on acknowledging history in the Black maternal health experience and reclaiming cultural traditions and ancestral strength: “There has been a huge surge of Black people, in general, working to reclaim our traditions and reclaim our history, and reclaim our culture.” One participant discussed how recognizing their history and reclaiming their tradition grants Black women the confidence to challenge existing narratives and truths about Black maternal health imposed upon them by others: “Because now that we have a better understanding of our history, of our strength as a people, of our customs, our ancestors, and all these things, we don’t necessarily feel like we have to take other people’s word for truth.”

One participant noted the importance of recognizing and reclaiming Black women’s expertise in maternal and infant care: “The first midwives, the first wet nurses, that’s Black women. We revolutionized mother and baby care, and then thanks to a lot of things in America, we lost some of that. I feel like we are regaining that now.” Illustrating the power of ancestral knowledge, one participant who identified as a birth worker, discussed how learning about the influence of ‘granny midwives’ in Black maternal health propelled her forward in pursuing birth work for Black women: “I know when I was doing my initial trainings and learned about how obstetrics and gynecology would be nothing without granny midwives, that made me feel like nobody could stop me.”

Another participant noted that having a better historic and cultural understanding of Black women and birthing spaces was important for Black maternal care. “I think just having the cultural and historic understanding of Black folks in birthing spaces, having providers who understand that nuance in birthing spaces is going to be really important.” Further, this understanding of history, tradition, and the physiological birthing process since the beginning of time, as opposed to the current medical model, empowers Black women in all areas of their life. “I think there’s now this slow and steady undercurrent of folks who are getting back to the root of birth and what birth means and that it isn’t this medical event. It is a physiological event that happens all the time since the beginning of time. And I think people are slowly but surely getting back to the root of that. And because of that, they’re learning that they can advocate. They’re learning to have autonomy. They’re relearning that they have that sense of agency not just in birth but in all areas of their life. And I think that’s really inspiring and motivating.”

Theme 4: Community as the Foundation to Black Motherhood

The concept of community support as the foundation to Black motherhood was a central theme in the focus group discussions, emphasizing that raising children and supporting pregnant women is a collective responsibility for Black communities. “But it’s just that village is everything. And I think, to me, that’s what I’ve always been told, so it’s a Black saying to me. It takes a village to raise a kid and it honestly does take a village because you don’t know what you don’t know.”

One participant acknowledged the power of collective advocacy in improving maternal health for Black women, “Because once you feel empowered, once you know like, I have these people to go through. I have this support system. I have all these things. I’m not alone. I’m not the only person vouching for me. I’m not the only person advocating for myself. That, it just takes the stress off your shoulders. It’s a huge weight just being lifted. Because it’s like you don’t have to bear the whole brunt. And that’s oftentimes, what Black women have to do, is bear the entire brunt of not only themselves but their communities and also sometimes other communities.” Further emphasis was placed on the importance of collective strength by celebrating the power of each individual woman and the power of supporting one another: “We are the creators of human beings, so we need to be strong. Our minds need to be strong, our bodies need to be strong, and we are here for each other.”

The importance of Black doulas was a recurrent point of discussion. Discussions arose about the nature of a research study like ours which will incorporate Black doulas and that withholding Black doula care from a study participant would not be appropriate. One participant noted that supporting one another has always been a core feature of Black motherhood, and that it doesn’t only come from an official support person like a doula: “And letting people know that you don’t have to have the title of doula in order to help support a new mom. Aunties have been doing it, grannies, friends. Just building up that community of just being kind and helping moms out in general.” Another participant noted that the joy Black women experience in pregnancy and motherhood grows through community support, “… it’s a different kind of awesome having a baby if you have somebody to walk it with you that is going through the same things as you.”

The importance of community was noted to be especially vital for Black women when they face discrimination or poor care from typical support resources like their medical providers. One participant noted, “And we are very intentional about being supportive of Black women, and the [general] community doesn’t like that because they say all women struggle and need this kind of support. I’m like, “Oh, really? Well, they can go to their doctor, their doctor will help them.” Further, groups discussed how creating support systems creates a lasting impact on the Black community. “I think if we going to make more strides, we have to keep building up those generations to come.” Further, participants felt a call to action within their community to ensure that Black mothers were supported: “If I think, what does support really mean? Because I feel like I say support and it sounds like an idea, but support isn’t something that just lives in your heart or in your head. Support is action.”

Discussion

Black women and their communities possess social, psychological, physiological and economic strengths referred to as protective assets that promote health. Black maternal health disparities are an ongoing problem in the United States, yet most research relating to Black maternal health is focused on deficits instead of on protective assets. We conducted three qualitative focus group discussions with Black community members from a strengths-based perspective, guided by the theory of Maternal Adaptive Capacity, to provide valuable insights for a future clinical trial aimed at addressing and overcoming Black maternal health disparities. Focus group participants offered alternative perspectives and strategies that recognize the power of pregnancy and motherhood in Black women, challenged the negative perceptions and biases about Black mothers in media and research, discussed understanding history and reclaiming cultural traditions surrounding birth, and identified community support as the foundation of Black motherhood.

Participants in the focus groups perceived pregnancy and motherhood among Black women as empowering and transformative, particularly in the context of the ongoing Black maternal health crisis. Instead of viewing pregnancy as a risk, they celebrated Black pregnant women and mothers as powerful creators, viewing Black motherhood as a positive and joyful experience. Participants expressed that the power of Black maternity is expressed through self-determination, self-agency, self-advocacy, and garnering support from others. Moreover, participants identified pregnancy itself as an act of resistance against pervasive narratives that undermine the aspirations of Black women to grow their families, labeling these desires as “risky.” This form of resistance is enacted as Black women educate themselves, ask critical questions, seek supportive networks, and assert their agency during the birthing process. Such proactive steps empower them and enable them to take control of their health and personal stories.

When exploring the strengths and power of Black women, it’s crucial to address the ‘Strong Black Woman’ (SBW) schema (25–27). The SBW schema depicts Black women as exceptionally resilient and self-reliant, often limiting their access to resources and discouraging them from seeking help (25–27). Recognizing both the pressures of the SBW schema is important when discussing the strength and power of Black pregnant women. Our focus group discussions emphasized that in the context of Black maternity, seeking care and support from one another is not only a show of strength but also an exercise of dynamic power. Remaining mindful of the SBW schema while interpreting our findings allows us to celebrate the strength and autonomy of Black women while ensuring they feel empowered to show vulnerability and seek assistance when necessary. This understanding informs our research design, recognizing the capacity of Black women to navigate challenges with agency and power as they guide their families and communities through the transformative experience of maternity and acknowledging the power in seeking necessary care and community support.

Participants highlighted the need for more supportive and accurate narratives in the media and academic discussions about Black maternal health, emphasizing the importance of addressing systemic issues rather than placing blame on individual Black mothers for health disparities. They noted how negative media portrayals strengthen stereotypes and negatively influence the treatment of Black pregnant women in healthcare and society. A recent study reported that 63% of Black adults say that news about Black people is often more negative than news about other racial and ethnic groups (28). Additionally, four out of five Black adults report that they often or sometimes encounter racist or racially insensitive portrayals of their race in the news (28). Smith-Shomade critiques media representations of Black women, noting that they are often depicted as inherently problematic (29). These negative media depictions, which may be perceived as factual to the general public or healthcare providers, contribute to negative treatment. Prior work has found that emphasizing deficits reinforces a sense of fatalism and helplessness among Black women (30). This perpetuation of negativity harms Black women’s mental well-being and erodes trust in healthcare providers, which may result in fewer visits for prenatal and postnatal care (31). Participants expressed a desire for more accurate depictions of Black maternal health that recognize systemic issues and emphasizes empowering narratives and the good work that is being done in their community. Shifting the discourse to focus on strengths, while recognizing systemic context and history, could reduce feelings of helplessness and fear of interacting with the healthcare system, while also challenging biases among healthcare providers.

Discussion on recognizing history and reclaiming cultural traditions focused on the significance of understanding and acknowledging the strength and customs of Black female ancestors, particularly in relation to expertise in midwifery, childbirth, and childrearing traditions. Black women have long been pioneers in these domains, offering invaluable knowledge and practices that have sustained communities through generations (31–34). Authors have highlighted how African and African American women’s traditional practices and wisdom in midwifery and maternal care have been systematically undermined by the institutionalization of birth, which marginalizes their contributions (7,32–34). The perseverance and determination of Black women to preserve and pass down these traditions despite systemic obstacles were further discussed, emphasizing their role as keepers of cultural knowledge. The acknowledgment of this history serves as a powerful catalyst for Black women today to advocate for themselves within a medical system with deeply entrenched racist roots (7,30). With growing and compelling evidence of systemic racism present in healthcare and its impact on Black maternal health outcomes, this reclamation of ancestral knowledge and the presence of Black birth workers in maternity care serve as acts of resistance and pathways to improved health outcomes and empowerment for Black women.

The findings of our focus groups help frame our larger research study in a manner that respects and incorporates Black individuals’ and communities’ historical experiences and ancestral perspectives, ensuring that community voices are heard and cultural practices are valued. Further, recognizing historical realities highlights that many Black individuals may have concerns over the current medical system and models of care. Therefore, our intervention should not stem solely from the standard medical model but should additionally incorporate and promote long-standing cultural traditions.

The fourth theme, community support as the foundation of Black motherhood, highlights the vital role of community for Black women in supporting pregnant women and raising children. Focus group participants emphasized the importance of collective effort, referencing the saying, “it takes a village to raise a child.” They discussed how the shared advocacy of the community alleviates individual burdens and fosters collective strength. They discussed how communities can provide practical support through prepared meals, childcare, and other forms of assistance. Participants further reinforced the importance of community in enhancing the joyful experience of Black motherhood. They frequently discussed the power of the Black doula programs, mother support groups, and breastfeeding support groups created through grassroot efforts in their community.

Research highlights the vital role that community-based support systems, such as doulas, breastfeeding support groups, and mother support circles, play in addressing the unique challenges faced by Black women during pregnancy and postpartum periods (35–37). The presence of doulas and community health workers during the prenatal and postnatal phases can significantly improve health outcomes by providing culturally sensitive care, advocacy, and emotional support, which are crucial for reducing stress and increasing maternal satisfaction (35,38,39). When doulas or other care providers share their clients’ racial or cultural background, a practice known as concordant care, they foster better communication, trust, and understanding (40–43). Concordant care is especially relevant in maternity care, where Black doulas offer culturally tailored support that addresses specific needs and challenges faced by Black women, bridging gaps in the traditional healthcare system (40,43). Other researchers have found that concordant care and community support, including the role of doulas and community health workers, enhances prenatal care, breastfeeding rates, and maternal mental health (40,44). It has also been noted that empowering grassroots initiatives and support groups specifically for Black women foster a sense of belonging, validate experiences, and equips individuals with knowledge and resources often overlooked in conventional healthcare settings (36,37,44). For example, breastfeeding support groups led by and for Black women increase breastfeeding rates and serve as important spaces for sharing knowledge, experiences, and encouragement, reinforcing community bonds and collective empowerment (36)

The joy of Black motherhood, deeply intertwined with community support, illuminates how shared experiences and collective empowerment enrich and affirm the maternal journey. Literature on Black motherhood highlights mothering in the Black community as a revolutionary act of relationality, coexistence, and a commitment to the care of the most vulnerable (45). Such literature agrees with our findings and aligns with the broader scholarly discussions on recognizing and supporting the joy, resilience, and pleasures of Black motherhood as fundamental aspects of Black feminist theory and practice (46,47). Through these lenses, Black motherhood emerges not only as a site of resistance and empowerment but as a celebration of life, community, and the enduring strength of Black women within the complexities of motherhood.

In addition to the findings, as they relate to our research as discussed above, our research team addressed the focus groups’ emphasis on the importance of access to doula care for all Black women who desire it. Based on this community input, we concluded that our research design could not include randomization of Black doula care, as withholding doulas from any study participant would not be ethical or appropriate. The community will inform our research study by recognizing that addressing maternal health disparities requires a comprehensive approach, including individual empowerment, community engagement, support, and doula access for all.

Limitations

Our study was not without limitations. Our study included three groups with two interviewers, which could have created inconsistencies in focus group experience, how questions were posed, or how discussions were facilitated, which can introduce variability in the responses obtained from different groups. Although a sample size of sixteen participants provides in-depth insights, its limited scope in terms of factors like geographic location, ethnicity, and sexual orientation/gender identity restricts the generalizability of the findings to a larger population.

The dynamic of group discussions in focus groups can also lead to issues like groupthink, where dominant voices or prevailing opinions might influence or overshadow more nuanced or dissenting views. This group interaction dynamic can sometimes limit the diversity of perspectives captured.

Conclusion

The findings from this study provide insight and information for the design of our larger study. This information will refine an intervention focused on improving Black maternal wellness where we will incorporate the four identified themes and provide access to Black community-based doulas for all participants. This focus group study may provide insight for others designing research and interventions relating to Black maternal health.

Participants often referred to the empowering and joyful potential of pregnancy and motherhood for Black women. Thus, interventions aimed at improving Black maternal health should be designed to enhance these empowering and joyful experiences and help women leverage them as forms of resistance against systemic racism.

These focus groups highlighted the importance of addressing negative portrayals of Black mothers. To address this, researchers should first reflect on the negative portrayals of Black maternal health and Black mothers in society, in the healthcare system, and within research. In designing research and interventions, researchers should consider whether their studies will allow results that highlight the strengths and assets of Black mothers and communities or reinforce established stereotypes.

Acknowledging history and reclaiming cultural traditions was a recurrent theme in the discussions. Interventions and research should, therefore, focus on culturally sensitive approaches, recognizing the role of history and tradition in Black maternal health. Community support and ‘the village’ concept emerged as an important and empowering central theme to the Black maternal health experience. Future research should explore how this sense of community can be leveraged to improve maternal health outcomes. Overall, these findings offer valuable insights into the importance of reshaping the narrative around Black maternal health, combatting systemic racism in Black maternal health care, and improving health outcomes for Black mothers. Researchers should incorporate these findings into designing future research that can contribute to positive interventions and policy changes relating to Black maternal health.