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The transition to parenthood can be a challenging time for the relationships of new parents and result in declines in relationship satisfaction. Although a robust literature has identified characteristics that predict changes in relationship satisfaction during this period, the relationships of Black mothers postpartum remain understudied. To address this gap, we examined a set of relational, individual, and external characteristics as predictors of relationship satisfaction trajectories over the first four months postpartum. First-time Black mothers (N = 93, 22.6% married, 52.7% cohabiting, 24.7% not cohabiting) reported on relational, individual, and external characteristics at 1 week postpartum and their relationship satisfaction at 1, 8, and 16 weeks postpartum. Mothers who reported more commitment and partner support were higher in initial satisfaction, as were mothers who were married or cohabiting with a partner (relative to mothers who were not cohabiting with their partner). Mothers with clinically significant depressive symptoms at 1 week postpartum had lower initial relationship satisfaction than mothers without clinically significant depressive symptoms. Mothers' sleep difficulties and experiences of racial discrimination were associated with changes in relationship satisfaction over time; mothers experiencing more sleep difficulties and racial discrimination experienced larger declines in satisfaction. These findings offer new insights into risk and protective factors associated with relationship satisfaction among Black mothers during the early postpartum period and can inform multicomponent interventions to enhance their relationship functioning.

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OBJECTIVES: Black mothers experience markedly disproportionate maternal morbidity and mortality in the United States, with racism often cited as the root cause manifesting through several pathways. The study examined Black mothers' perceived provider communication, support needs, and overall experiences in the neonatal intensive care unit (NICU). DESIGN: This study used grounded theory embedded in the Black feminist theoretical (BFT) framework to generate new ideas grounded in the data. Data was collected through semi-structured interviews using videoconferencing, with questions related to the mother's overall NICU experiences, communication within the NICU, and perceived support needs. Data were analyzed using thematic analysis. RESULTS: Twelve mothers participated in the study; most were married (n = 10), had a cesarean birth, had a previous pregnancy complication (e.g., diabetes, hypertension), had attained a graduate degree or more (n = 9), earned an annual household income of $75,000 or more, and were between 35-44 years of age (n = 7). Three broad domains with several accompanying themes and sub-themes were identified, explicating the mother's experiences in the NICU. Specifically, factors influencing NICU hospitalization for mothers included maternal care/nursing experiences, interactions in the NICU, and the perceived support need that might attenuate negative care and birthing experiences. . CONCLUSION: The study adds to the growing literature championing Black maternal health equity and multilevel quality improvement strategies to foster equitable maternal health. Our study reinforces the need for racially congruent interventions and policy reformations to protect Black birthing people regardless of socioeconomic factors and social class using life course, holistic approaches, and intersectionality mindset. Importantly, using the BFT, this study calls for culturally sensitive research to capture the nuances associated with the multiplicity of experiences of Black people.

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Guided by the Family Stress Model for minority families, the present study examined the potential buffering effect of resting respiratory sinus arrythmia (RRSA), cognitive reappraisal, and mindfulness on the association between political climate stress (PCS) and anxiety symptoms in a sample of Latina and Black mothers. Participants were 100 mothers living in the southeastern United States. Mothers reported on PCS, cognitive reappraisal, mindfulness, and symptoms of anxiety. RRSA were measured during a resting task. Moderation analyses tested the influence of these three factors (RRSA, cognitive reappraisal, mindfulness) on the relation between PCS and anxiety. Results showed that the relation between PCS and anxiety symptoms was strongest at low levels of RRSA and cognitive reappraisal. At high levels of these two factors, there was no association between PCS and anxiety symptoms. Mothers with high levels of RRSA and cognitive reappraisal may be able to interact with and evaluate environmental stimuli in such a way that allows for adaptive adjustment, buffering against the negative impact of PCS. RRSA and cognitive reappraisal may be important targets of interventions designed to address the rising rates of anxiety symptoms in Latina and Black mothers.

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Black mothers and children experience significant health disparities in the USA. These health disparities have been attributed, in part, to experiencing racism in healthcare. This study aimed to explore how experiences of healthcare discrimination and mistreatment experienced by Black mothers may influence COVID-19 vaccine beliefs and decision-making for themselves and their families. From April 2021 to November 2021, we conducted 50 semi-structured interviews among Chicago residents. Ten participants self-identified as female and with reported children; these data were extracted from the larger sample for data analysis. Interview content included perceptions and experiences with the COVID-19 vaccine and experiences with healthcare discrimination, mistreatment, and medical mistrust. Interview transcripts were transcribed verbatim and coded using the MAXQDA 2022 qualitative software. Themes were identified using a team-based thematic analysis to understand how experiences of racism in healthcare may influence COVID-19 vaccine decision-making. Four themes were generated from the data: (1) experiences of healthcare discrimination and mistreatment, (2) distrust and fears of experimentation, (3) the influence of discrimination and distrust on COVID-19 vaccine decision-making, and (4) overcoming vaccine hesitancy. The results of this study highlight the current literature; Black mothers experience racism and discrimination in healthcare when seeking care for themselves and their children. It is evident in their stories that medical racism and historical medical abuse influence vaccine decision-making. Therefore, healthcare and public health initiatives should be intentional in addressing past and present racism in healthcare to improve vaccine distrust.

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The Child Feeding Questionnaire (CFQ) is a well-established tool used to assess parental beliefs, attitudes, and child feeding practices, with a focus on childhood obesity proneness. To date, there is no French version of the CFQ, nor any Canadian studies assessing its construct validity. The aim of this study was to assess the construct validity and the reliability of a French version of the CFQ among Black mothers (n = 136) of school-aged children living in Ottawa (Canada). The final best fitting model included 7 factors, 20 items, and 1 error covariance. This model was retained as the final model as it (1) excluded two items with very low factor loadings; (2) had the lowest χ2, AIC, BIC, RMSEA, and SRMR values; and (3) had CFI and TLI values ≥ 0.95. Internal consistency ranged from poor to good; the restriction subscale had the lowest internal consistency, followed by the perceived responsibility, pressure to eat, perceive child weight, concern about child weight, and monitoring scales, respectively. Our results showed that a seven-factor model with minor modifications was best fitted to the current data. Future studies are needed to test the validity and reliability of the CFQ in other population groups and among fathers.

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Title: "I think that some culturally sensitive mental health information could have been provided": What Black mothers with preterm infants want for their mental health care: A qualitative study. Background: In the United States, preterm birth (PTB) rates in Black women are 50% higher than in non-Hispanic White and Hispanic mothers. Existing discriminatory sociohistorical and contemporary health care practices have been linked to the alarmingly higher rates of PTB among Black families. While it is well-known that PTB is associated with increased mental health (MH) problems, Black women experience elevated MH burdens due to inequities along the care continuum in the neonatal intensive care unit (NICU). Consequently, culturally responsive MH care holds promises to achieve maternal MH equity. This study aimed to explore the available MH services and resources in the NICU for Black mothers with preterm infants. We also sought to discover potential recommendations and strategies for MH programs through a cultural lens. Materials and Methods: Semistructured interviews were conducted with Black mothers with preterm infants using a Grounded Theory approach embedded in the Black feminist theory. Results: Eleven mothers who gave birth to a preterm infant between 2008 and 2021 participated in this study. Eight women reported not receiving MH services or resources in the NICU. Interestingly, of the three mothers who received MH referrals/services, two did so one-year postbirth and did not utilize the services. Three main themes emerged: stress and the NICU experience, coping mechanisms, and culturally appropriate MH care with diverse providers are needed. Overall, our finds suggest that MH care is not prioritized in the NICU. Conclusion: Black mothers with preterm infants encounter numerous negative and stressful experiences that exacerbate their MH during and beyond the NICU. However, MH services in the NICU and follow-up services are scarce. Mothers in this study endorsed creating culturally appropriate MH programs that addresses their unique intersections.

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This study employs multi-level and mixed-methods approaches to examine how structural violence affects the health of low-income, single Black mothers. We use multilevel regression models to examine how feeling "trapped" in racially segregated neighborhoods with high levels of violence on the South Side of Chicago affects mothers' (N = 69) reports of posttraumatic stress disorder and depressive symptoms. The relationship between feeling "trapped" and variations in expression of mRNA for the glucocorticoid receptor gene NR3C1 using microarray assays was also examined. The regression models revealed that feeling "trapped" significantly predicted increased mental distress in the form of PTSD, depressive symptoms, and glucocorticoid receptor gene regulation. The mothers' voices revealed a nuanced understanding about how a lack of financial resources to move out of the neighborhood creates feelings of being "trapped" in dangerous situations.

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BACKGROUND: For many years in the United States, there has been an active discussion about whether race concordance between care providers and patients contributes to better health outcomes. Although beneficial provider-patient communication effects have been associated with concordance, there is minimal evidence for concordance benefits to health outcomes. METHODS: A cross-sectional survey was conducted including 200 Black mothers who had given birth within the last 2 years asking about the perceived racial identity of their birth health provider, whether they preferred to have Black women providers, and the intersection between race and gender concordance on birth outcomes. In addition to race and gender concordance, other variables were tested for their impact on birth satisfaction including respect, trust for the care provider, perceived competence, care provider empathy, and inclusive communication. RESULTS: Forty-one percent of the mothers in this study were assisted in birth by a Black woman provider. Although patient-provider concordance did not result in measurable health outcomes, it is clear that compared to other studies of birth satisfaction among Black birthing persons, this study showed relatively higher levels of satisfaction, perceived trust, empathy, perceived provider competence, inclusive communication, and equal respect for both concordant and discordant care providers. CONCLUSIONS: Although many participants showed a preference for race concordance, participants equally valued respect, competence, and trust with their care providers. Further community-based research needs to be conducted to examine whether race, gender, and cultural concordance results in other beneficial health outcomes.

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OBJECTIVES: Previous studies have suggested that often, Black mothers' birthing experiences are not what they expected because of how they were treated by healthcare providers during labor and birth. Our goal in this study was to ask Black mothers who had recently given birth about the quality of their birthing experiences as well as their level of respect from, trust in, and satisfaction with their maternity healthcare providers. DESIGN: This study gathered data from Black mothers (N = 209) who had given birth within the past two years, using a cross-sectional online survey measuring several variables about the birthing experience including types of healthcare provider communication, provider respect for the mother, trust, birth satisfaction, and emotional responses to birth. RESULTS: Provider-centered communication, although preferred by some mothers, was associated with lower birth satisfaction and stronger negative emotions whereas positive birth satisfaction was linked to patient-centered communication which resulted in positive emotions. While most mothers reported overall satisfaction with their birth experience, nearly half reported experiencing some degree of disrespect from their healthcare providers during labor and birth. Moreover, trust and respect mediated the relationship for patient-centered communication with positive emotion and birth satisfaction. Over one-third of participants gave birth with a certified nurse midwife attending. There were no differences in perception of being respected or the quality of birth given the professional identity of the provider as an Obstetrician/Gynecologist or as a midwife. The advice suggested by Black mothers for their healthcare providers was instructive in identifying ways those providers could better serve their patients during birth. CONCLUSION: This study showed that there is still additional work that needs to be done for racial equity and respect during birth. Practical implications for addressing health inequities are discussed.

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OBJECTIVE: Previous studies emphasise the negative psychological and physical consequences of Postnatal Depression (PND) on mothers and children's health. In the UK, around 10-20% of women can be affected by perinatal mental health problems. Minority ethnic groups such as Black African mothers are considered to be at greater risk of developing PND and data estimates that immigrant mothers are twice more likely to develop PND than native mothers. The unique experiences and needs of this culturally diverse group remain little explored in the UK. To address this gap in the literature, this study aimed to explore the lived experiences of First-Generation Nigerian Mothers (FGNMs) who suffered PND, their coping behaviours and treatment experiences in the UK. DESIGN: Six FGNMs with a previous diagnosis of PND and treatment experiences were purposefully recruited from GP practices and social groups attended by Nigerian mothers in the UK. Semi-structured interviews were analysed using Interpretative Phenomenological Analysis. RESULTS: Three master and seven subordinate themes were identified: (i) Socio-cultural factors (Inter-generational transmission; cultural perceptions: shame and stigma; transitions: adjusting to a new culture); (ii) What about me? The neglected nurturer (experiences of treatment; pretending to be OK); and (iii) Loneliness and coping (lack of support from partner; self-reliance). CONCLUSIONS: The study provides evidence about the difficulties encountered by FGNMs in relation to PND, including socio-cultural factors, neglect from family and healthcare professionals, and self-reliance as a coping strategy. Contrary to reports suggesting that Black ethnic groups do not seek help for their mental health needs, participants' accounts indicated that their attempts to engage with professionals were met with unsatisfactory responses. The findings highlight the need to address barriers affecting access to services by fostering a patient-centred and culturally sensitive approach in healthcare teams to effectively engage mothers at an early stage in the detection pathway.

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This mixed-methods research study aimed to assess the contribution of interparental relationship quality and paternal support for mothers to maternal mental health among Black parents in a metro area characterized by severe racial disparities. We also explored Black parents' understanding of meaningful paternal support for mothers. Using survey data collected from Black mothers (N = 75), we examined correlations among the study variables, then conducted mediation and moderation analyses to examine whether relationship quality would mediate the association between paternal support and maternal mental health and to test whether relationship quality would moderate the association between paternal support and maternal self-reported overall health. We used inductive thematic analysis to analyze data from focus groups with Black parents (N = 15). We found that mothers' mental health was positively correlated with relationship quality, mothers' subjective health was positively correlated with paternal support, and relationship quality significantly mediates the relationship between paternal support and maternal mental health while controlling for relationship status. Our thematic analysis yielded four themes to characterize meaningful paternal support for mothers and a high quality interparental relationship: (1) Teammates; (2) Multidimensional, everyday support; (3) Communication is key; and (4) Challenge racism and disrupt intergenerational trauma. Findings suggest that paternal support and interparental relationship quality can play a protective role, promoting maternal mental health and wellbeing. Providers of perinatal services should support Black parents to support one another, including as advocates in confronting racism.

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INTRODUCTION: The high rate of maternal mortality among Black women in the United States continues to gain attention; yet research has not yet fully illuminated the precursors to these events, most impactful among them being "maternal near misses." A maternal near miss occurs when a woman nearly dies but survives a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Researchers have focused on reviewing patient medical records after sentinel maternal events to help determine major contributors to them; however, qualitative studies with near-miss survivors, especially among Black women, may be a more useful approach. METHODS: Using a qualitative methodology, we conducted semi-structured interviews with 12 Black women to explore how they perceived the care provided to them during their near-miss experiences. Our study also employed a phenomenology framework to understand the lived experience of Black women who had a maternal near miss in the context of a hospital setting. RESULTS: We interviewed 12 women between October 2020 and March 2021. All participants had a maternal near miss between the years 2010 and 2020 and were aged between 19 and 41 years when they had their near-miss experience. These women identified communication, patient-provider relationship, skills/competency of staff, provider discrimination, systems issues, and emotional distress as major contributors to their experiences. CONCLUSION: Maternal near misses serve as a precursor to maternal mortality events. By listening to patients and their families recount their perspectives on what leads up to these near misses, we can unearth valuable lessons that can aid in the development of strategies and interventions to decrease the numbers of pregnancy-related deaths; especially among Black women who suffer disproportionately from maternal morbidity and mortality. Based on these findings, we recommend that hospitals and OB-GYN practices consider the unique predispositions of their Black patients; account for their own personal biases, revisit the near-miss experiences of past patients to keep patients central to care and build rapport between patients and hospital birthing support staff; and center discussions about improvements in care around racist structures and systems.

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Currently, mothers living with HIV (LWH) are challenged with different infant feeding guidelines depending on the country they are living in. This may contribute to confusion, stress, and mental health issues related to decision-making about infant feeding as a mother LWH. Yet, their male partners as their closest social capital have important roles to play in reducing or aggravating this psychosocial distress. Hence, we describe the role of male partners in supporting mothers who are living with HIV in the context of infant feeding. It is based on the results of a recent study of the socio-cultural context of infant feeding among Black mothers LWH in three countries; Canada, the USA, and Nigeria. The study was a tri-national, mixed-methods, community-based participatory research (CBPR) project, informed by postcolonialism and intersectionality theories. This paper is based on the qualitative component of the study. It was a focused ethnography (FE) involving 61 in-depth individual interviews (IDIs) with Black- mothers LWH. Thematic analysis guided the interpretation of these data, and trustworthiness was established through member-checking. Black mothers LWH acknowledged the various support roles that their male partners play in easing the practical and emotional burdens of infant feeding in the context of HIV. Male partners' roles were captured under three sub-themes: (1) Practical help, (2) Protection of the family, and (3) Emotional support and sounding board. These findings have explicated the evolving ways in which male partners support ACB mothers LWH to promote positive infant feeding outcomes, as well as enhance the emotional and physical well-being of both mother and infant. Our study has explicated the evolving ways in which male partners support Black mothers LWH to promote positive infant feeding outcomes, as well as enhance the emotional and physical well-being of both mother and infant.

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Scholars have begun to address how exposure to vicarious racial violence influences stress and coping processes among Black families in the U.S. Yet, fewer scholars have considered the importance of racial grief as a component of the coping process. The current study drew upon semi-structured interview data from 31 Black mothers in the U.S. (25-52 years; M age = 35 years) to explore how mothers processed and responded to vicarious anti-Black racial violence. We used consensual qualitative research methods and identified the following themes: (a) recognizing the endemic nature of racial violence, (b) feeling frozen in fear after a new case of racial violence, and (c) transforming grief into grievance as a route to racial justice. The findings contextualize Black mothers' concerns about the racial violence that they and their children might experience during their lifetime, and how they channel this grief into actionable change against racial injustice. Authors discuss strengths-based ways to frame the role of grief and loss in the context of racism.

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BACKGROUND: Perinatal quality improvement lacks valid tools to measure adverse hospital experiences disproportionately impacting Black mothers and birthing people. Measuring and mitigating harm requires using a framework that centers the lived experiences of Black birthing people in evaluating inequitable care, namely, obstetric racism. We sought to develop a valid patient-reported experience measure (PREM) of Obstetric Racism© in hospital-based intrapartum care designed for, by, and with Black women as patient, community, and content experts. METHODS: PROMIS© instrument development standards adapted with cultural rigor methodology. Phase 1 included item pool generation, modified Delphi method, and cognitive interviews. Phase 2 evaluated the item pool using factor analysis and item response theory. RESULTS: Items were identified or written to cover 7 previously identified theoretical domains. 806 Black mothers and birthing people completed the pilot test. Factor analysis concluded a 3 factor structure with good fit indices (CFI = 0.931-0.977, RMSEA = 0.087-0.10, R2  > .3, residual correlation < 0.15). All items in each factor fit the IRT model and were able to be calibrated. Factor 1, "Humanity," had 31 items measuring experiences of safety and accountability, autonomy, communication, and empathy. A 12-item short form was created to ease respondent burden. Factor 2, "Racism," had 12 items measuring experiences of neglect and mistreatment. Factor 3, "Kinship," had 7 items measuring hospital denial and disruption of relationships between Black mothers and their child or support system. CONCLUSIONS: The PREM-OB Scale™ suite is a valid tool to characterize and quantify obstetric racism for use in perinatal improvement initiatives.

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In negotiating the anti-Black oppression, Black mothers communicate lessons of resistance in their racial socialization messages to their Black adolescent boys. We investigate whether distinct strategies of resistance for survival, characterized by individual-focused immediate strategies of resistance, and resistance for liberation, strategies of resistance that disrupt systems of anti-Black oppression rooted in furthering collective Black empowerment, are employed in Black mothers' messages to their sons. In this manuscript, we use longitudinal data of Black mothers' of adolescent boys interviews (N = 31) across three time points (6th-11th grade). Our findings indicate the presence of various strategies of resistance for survival and resistance for liberation within Black mothers' preparation for bias socialization.

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Amidst the increasing push to address racial disparities in maternal health equity, fewer studies have considered Black women's perspectives on their needs, concerns, and priorities regarding family planning care. Such evidence might help address the lack of support and information that many Black women report in patient-provider encounters, and broaden empirical knowledge on the contextual factors that influence Black women's reproductive decisions. In the present qualitative study, we explored Black women's pathways to motherhood within a reproductive justice framework. We drew on individual, semi-structured interview data from 31 Black mothers (25-50 years, Mage = 35 years) across the United States. Using consensual qualitative research methods, we elaborated on three themes: (1) intentional family planning, (2) unintended pregnancy, and (3) othermothering. The findings challenge deficit-based stereotypes of Black mothers' reproductive choices and illuminate how health practitioners can facilitate humanizing conversations that prioritize Black women's family planning goals and decision-making.

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Introduction: The World Health Organization recommends 6 months of exclusive breastfeeding for infants. Racial disparities exist, where only 27.9% of black women exclusively breastfeed at 6 months compared to 45.1% of white mothers. Previous research suggests that these disparities are due to a variety of factors, including poor paid leave policies, racism, and bias, but few studies have looked specifically at the experience of black millennial mothers. Methods: This qualitative study aimed to understand the racialized experiences of breastfeeding among black millennials and whether or not there are factors to mitigate the effects of racism. Three focus groups were conducted (N = 15) with black millennial mothers. Participants were recruited through social media sites, emails to breastfeeding/black maternal health organizations, and local partnerships. Inclusion criteria included self-identification as a black/African American woman, born between 1981 and 1996, and having at least one child 5 years or younger. Results: Five major themes emerged from the analysis as follows: (1) institutional racism and barriers, (2) challenges to motherhood, (3) black experiences, (4) breastfeeding in the millennial age, and (5) hopes for the community. Results showed that black millennial mothers expressed being treated differently and poorly due to race. While participants reported supporting each other through their breastfeeding journey, this was not specifically a strategy to impact racism/bias. Discussion: Results also showed that black millennials feel a desire to succeed in breastfeeding to change the narrative about past generations. Further research should explore differences between the breastfeeding experiences and perceptions of black millennials in comparison to that of previous generations.

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BACKGROUND: Infant feeding practices are imperative for babies' and mothers' health and emotional wellbeing. Although infant feeding may seem simple, the decisions surrounding it are complex and have far-reaching implications for women globally. This is an especially difficult concern among mothers living with HIV because breastfeeding can transmit HIV from mother to child. This is further complicated by cultural expectations in case of Black mothers living with HIV. This paper discusses determinants of infant feeding practices among Black mothers living with HIV who were on anti-retroviral therapy (ART) in two North American cites and one African city. METHODS: A cross-sectional, multi-country survey using venue-based convenience sampling of Black mothers living with HIV was employed. The effective response rates were 89% (n = 89) in Ottawa, Canada; 67% (n = 201) in Miami, Florida, US; and 100% (n = 400) in Port Harcourt, Nigeria, equaling a total sample size of 690. Data were collected in Qualtrics and managed in Excel and SPSS. Multinomial logistic regression analyses were used to determine the factors influencing the mothers' infant feeding practices (Exclusive Formula Feeding [EFF] = 1; Mixed Feeding [MF] = 2; and Exclusive Breastfeeding [EBF while on ART] =3). RESULTS: The results highlight socio-demographics, EFF determinants, and EBF determinants. The statistically significant determinants of infant feeding practices included national guideline on infant feeding, cultural beliefs and practices, healthcare systems, healthcare personnel, infant feeding attitudes, social support, and perceived stress. Mothers' mean ages were Ottawa (36.6 ± 6.4), Miami (32.4 ± 5.8), and Port Harcourt (34.7 ± 5.7). All sampled women gave birth to least one infant after their HIV diagnoses. Statistically significant (p < .05) determinants of EFF relative to MF were the national guideline of EFF (relative risk [RR] = 218.19), cultural beliefs (RR = .15), received healthcare (RR = 21.17), received healthcare through a nurse/midwife (RR = 3.1), and perceived stress (RR = .9). Statistically significant determinants of EBF relative to MF were received healthcare (RR = 20.26), received healthcare through a nurse/midwife (RR = 2.31), functional social support (RR = 1.07), and perceived stress (RR = .9). CONCLUSION: While cultural beliefs and perceived stress favoured MF over EFF, advice of healthcare workers, and the care received from a nurse/midwife improved EFF over MF. Also while the mothers' perceived stress favoured MF over EBF, advice of their nurses or midwife and the social support improved EBF over MF. The providers advice was congruent with WHO and national guidelines for infant feeding among mothers living with HIV. These results have implications for nursing, healthcare practice, and policies on infant feeding practices for mothers living with HIV.

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Background: Nearly 75% of Black non-Hispanic babies born in 2016 ever breastfed. However, Black mothers still experience barriers to breastfeeding, perpetuating disparities in exclusivity and duration. Subjects and Methods: Using data collected from five focus groups with Black mothers (N = 30) in Washington, District of Columbia during summer 2019, we critically examine the influence of institutionalized and personally mediated racism on breastfeeding. We also explore the counter-narratives Black women use to resist oppression and deal with these barriers. Results: Themes surrounding institutionalized racism included historic exploitation, institutions pushing formula, and lack of economic and employment supports. Themes regarding how personally mediated racism manifested included health care interactions and shaming/stigma while feeding in public. At each level examined, themes of resistance were also identified. Themes of resistance to institutionalized racism were economic empowerment and institutions protecting breastfeeding. Themes of resistance to personally mediated biases were rejecting health provider bias and building community. Conclusions: There are opportunities for health providers and systems to break down barriers to breastfeeding for Black women. These include changes in clinical training and practice as well as clinicians leveraging their position and lending their voices in advocacy efforts.

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