When Is Health Care Actually Going to Be Care?" The Lived Experience of Family Planning Care Among Young Black Women

Family planning care (FPC) visits are intended to provide education and opportunities for women to obtain family planning services, including hormonal medications. Structural barriers, sociocultural barriers, and mistreatment by the health care system may perpetuate the numerous health inequities surrounding reproductive health and pregnancy among young Black women. Although Black women use family planning services and receive family planning counseling more than other reproductive-age women, research has shown they rate their FPC encounters more poorly than White women. In addition, the combination of multiple marginalized identities such as Black racial identity, young age, and low socioeconomic status may exacerbate racial inequities in care. A more comprehensive understanding of young Black women's FPC experiences may be leveraged into high-value practice and policy to address structural barriers. This mixed methods qualitative study aimed to describe the lived experience of FPC through an intersectional lens with an emphasis on the patient-provider relationship. Women were recruited through social media, email blasts to African American organizations in the region, word of mouth, and in-person recruitment at local events. To be eligible, participants must self-identify as Black women, be between the ages of 18 and 29 years, be US residents, and have had an FPC visit in the past 12 months where birth control was discussed. Individuals who were married or had previously given birth were excluded. The study protocol included an online survey with questions about FPC experience followed by a series of 2 interviews within a 2-week time frame. Within the interview, the participant took a storyteller role and was asked to describe the lived experience of FPC. A total of 22 women were included in the analysis, most of whom were college educated (73%), had low socioeconomic status (54%), and had a mean age of 24 years (SD = 3.0). Twelve of the 22 women reported experiencing negative emotional reactance during their most recent FPC visit. Through study interviews, the following experiences were described: silence around sex impedes engagement in care, patient-provider racial concordance as protection from harm, providers as a source of discouragement and misinformation, frustration as a normative experience during FPC visits, decision making excludes discussion and deliberation, medical mistrust is pervasive and part of Black consciousness, and meaningful and empathic patient-provider encounters are elusive. Many women reported disengagement with the health care system and questioning their provider's recommendations leading to seeking information elsewhere after negative interactions at their most recent FPC. This study describes the experience of FPC among young Black women and sheds light on how health systems can enhance the relationship with FPC providers to mitigate persistent inequities among this population.