Graduation Year
2025
Document Type
Dissertation
Degree
Ph.D.
Degree Name
Doctor of Philosophy (Ph.D.)
Degree Granting Department
Public Health
Major Professor
Dinorah Martinez Tyson, Ph.D., MPH, MA
Co-Major Professor
Roneé E. Wilson, Ph.D., MPH, CPH
Committee Member
Richard Powis, Ph.D.
Committee Member
Jessica Brumley, Ph.D., APRN, CNM
Keywords
Black Feminist Thought, Mistreatment, Pregnancy, Safety Net Clinics
Abstract
Disrespect during pregnancy, labor, and delivery is common in the United States. The Centers for Disease Control and Prevention has estimated that approximately one in five women overall, and over 30% of Black women, report being ignored, dismissed, or verbally mistreated during their care. Public health efforts have primarily focused on individual-level interventions to improve patient-provider communication or reduce provider bias; however, these strategies have been critiqued for their limited scope and effectiveness in shifting outcomes. Instead, researchers and advocates have called for an examination of the structures that shape clinical encounters, including policies, protocols, workflows, and organizational culture. This Black feminist-informed Institutional Ethnography examines how institutional policies and discourses shape Black women’s experiences of high-risk prenatal care within a high-volume safety-net clinic. Data include semi-structured interviews with patients, providers, staff, and reproductive justice leaders; approximately 140 hours of observation; and review of key clinical and institutional texts. Findings were organized across six meta-themes: (1) Constructing the ‘High-Risk’ Pregnancy; (2) Profit and Loss: The Commodification of Pregnancy Risk; (3) Navigating Invisible Tethers to the Bureaucratic State; (4) The Labor of Care: Black Women’s Refusal and Compliance Work; (5) Consequences of Noncompliance: Enforcing Order in Disordered Systems; and (6) Envisioning the Future of Care. Together, these themes trace how pregnancy risk is constructed and coordinated, commodified and contested, and ultimately reimagined. The study highlights how institutional conditions, rather than individual behaviors, can produce experiences of (dis)respectful care and offers insights into policy and practice changes that can support care rooted in reproductive justice.
Scholar Commons Citation
Harris, Nicole L., "The Ruling Relations of Care: An Institutional Ethnography of High-Risk Prenatal Care Experiences" (2025). USF Tampa Graduate Theses and Dissertations.
https://digitalcommons.usf.edu/etd/11084
