Academic journal article Creative Nursing

Addressing Health Concerns of Pregnant African American Women Using the Lens of Complexity Theory

Academic journal article Creative Nursing

Addressing Health Concerns of Pregnant African American Women Using the Lens of Complexity Theory

Article excerpt

Pregnant African American women are at higher risk for multiple complex health issues, including depression, than their European American counterparts (Canady, Bullen, Holzman, Broman, & Tian, 2008; Martin et al, 2011; Mathews & MacDorman, 2007; Orr, Blazer, & James, 2006; Segre, Losch, & O'Hara, 2006). Various strategies must be used to address depression through preventive care and promotion of access to appropriate mental health services. Nurses and other health care providers need to examine the relationships between the multifactorial problems to improve the health and well-being of pregnant African American women and their unborn children. This article presents a case study demonstrating the use of complexity science theory to understand and prevent poor health outcomes for pregnant African American women with depression and their unborn children.

Keywords: disparities; pregnancy; African American women; complexity science theory; depression; low birth weight

In the United States, racial and class disparities in health are numerous and per- vasive, with African Americans having significantly higher death rates than European Americans (Kung, Hoyert, Xu, & Murphy, 2008; National Center for Health Statistics, 2011). African Americans have the highest prevalence of stroke and of delay in needed medical treatments of all races (National Center for Health Statistics, 2011). Health care disparity concerns for African American women i nclude lack of health insurance, problems accessing financial programs, poor transportation, and lack of health care providers (Baffour & Chonody, 2009). The U.S. Department of Health and Human Services, National Institutes of Health, Office of Extramural Research (2005) considers all pregnant women to be a vulner- able population not only because of risks to the mother but also to the unborn child.


In 2009, 11.44% of babies born to African American women were low birth weight (less than 2,500 g) compared to 5.23% of babies born to European American women (Martin et al., 2011). Low birth weight was one of the top three causes of infant death, at 13.60 per 1,000 live births for non-Hispanic Black mothers compared to the overall U.S. infant mortality rate of 6.78 per 1,000 (Mathews & MacDorman, 2007). Racial discrimination has been found to be associated with low birth weight in babies of urban women of color (Earnshaw et al., 2013). Risk factors for poor perinatal outcomes for minority populations include perceived racial discrimina- tion, poverty, inadequate housing, lack of social support, and late or no prenatal care (Kiely, Davis, Thornberry, & Joseph, 2011).

Racism has been described as a form of stress that can add to the cumulative stress that pregnant African American women experience during pregnancy (Giscombe & Lobel, 2005). Whether racism is a form of stress or exacerbates stress's impact, racism has been associated with adverse birth outcomes (Giscombe & Lobel, 2005).

Racial and ethnic factors play a significant but poorly understood role in pre- term birth (Institute of Medicine, 2006). Infant mortality continues to be statistically high even with intervention efforts because of complex and multifactorial prob- lems such as poverty, lack of access to health care, and racial and ethnic factors (Institute of Medicine, 2006; MacDorman & Mathews, 2009; March of Dimes, 2013; National Healthy Start Association, n.d.).


Pregnant African American women are more likely to experience depressive symptoms than European American women (Canady et al., 2008; Orr et al., 2006; Segre et al., 2006). Researchers found a positive relationship between symptoms of depression and racism, discrimination, and stress among pregnant African American women (Canady et al., 2008; Dailey & Humphreys, 2010; Earnshaw et al., 2013; Ertel et al., 2012). O'Mahen and Flynn (2008) interviewed pregnant women about their beliefs about depression and their perceived barriers to receiv- ing depression treatment. …

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