What to expect when you're expecting racism

HARTFORD — Mental-health clinicians and birth workers across Connecticut are confronting the hidden psychological toll of racism in pregnancy, as new national reporting and statewide data link chronic discrimination to higher rates of anxiety, depression and trauma responses among expecting parents of color.[1][3] The conversation, elevated in a recent NPR episode that examined how racial discrimination and structural racism shape the physical and emotional experience of pregnancy, is sharpening focus on Black women and other marginalized groups who report heightened vigilance and stress from the earliest weeks of prenatal care through the postpartum period.[1][3] Advocates said the emerging research and storytelling underscore an urgent need for trauma-informed, culturally responsive mental-health support in a state where Black women already face significantly higher risks of pregnancy-related complications and death.[3][5]

In the NPR transcript, Black women described bracing themselves for racist encounters in exam rooms and hospital corridors, detailing how subtle slights and overt bias left them feeling unsafe during a time that is supposed to be joyful.[3] National studies cited in the reporting found that experiences of racial discrimination during pregnancy predict subsequent increases in depressive and anxiety symptoms, especially among Black and Latina women, according to research on discrimination across pregnancy and the postpartum period.[1] “When you’re pregnant and Black, you don’t just worry about the baby’s health; you worry about whether people will listen to you if something goes wrong,” one participant said in the NPR episode, describing a constant state of hypervigilance that can persist long after delivery.[3]

Connecticut’s own data mirror those national concerns, showing persistent racial gaps in maternal outcomes that experts say are inseparable from the stress of racism and discrimination in health care settings.[3][5] A 2025 “Maternal Health Equity” blueprint from the Connecticut Health Foundation reported that Black women in the state are at three times greater risk of death from pregnancy-related causes compared to non-Hispanic white women, a disparity leaders attributed in part to systemic racism, unequal access to quality care and the cumulative impact of discrimination on physical and mental health.[3] Statewide, after a complication-free delivery, Black women are twice as likely as white women to be readmitted to a hospital within 30 days, according to coverage by the Connecticut Mirror on racial gaps in pregnancy-related outcomes.[5] “These numbers are not about individual choices,” said Patricia Baker, former president and CEO of the Connecticut Health Foundation, in earlier reporting. “They are about structures, policies and biases that make pregnancy more dangerous and more stressful for Black women.”[3][5]

Clinicians and reproductive mental-health specialists said chronic exposure to racism can intensify normal pregnancy worries into clinically significant anxiety, depressive symptoms and trauma responses.[1][7] Research involving predominantly Black and Latina young women found that within-person increases in discrimination during pregnancy were followed by increases in depressive and anxiety symptoms over time, suggesting that each discriminatory encounter can add to a growing mental-health burden, according to a study published in the journal Social Science & Medicine.[1] National advocates with the National Alliance on Mental Illness have described racism as a “public health threat” that creates “significant — and unacceptable — mental health inequities” for people of color, including those navigating pregnancy and new parenthood.[7] “The body doesn’t forget these experiences,” said Dr. Lisa Wexler, a Hartford-based perinatal psychiatrist with Hartford HealthCare’s Reproductive Mental Health Center. “We see trauma-like responses, sleep disturbances and intrusive worries that trace back not only to medical events, but to how people were treated because of their race.”[8]

Stories gathered in the NPR episode detailed how racism during prenatal visits can alter fundamental aspects of care, from whether patients feel safe disclosing symptoms to how quickly providers respond to warnings signs.[3] Several women described hesitating to report pain, contractions or mental-health concerns for fear of being dismissed, judged or labeled “difficult,” a pattern national surveys have documented among Black, Hispanic and multiracial mothers.[2][3] The American College of Obstetricians and Gynecologists has reported that about 4 in 10 Black, Hispanic and multiracial mothers say they experienced discrimination during maternity care, compared to 3 in 10 mothers overall, and that 1 in 3 in these groups reported mistreatment, including having their concerns ignored or being shouted at.[2] “If you already expect racism, you might downplay symptoms just to get through the appointment,” said one NPR interviewee. “That can be dangerous, but it’s a survival strategy when you don’t feel believed.”[3]

Connecticut doulas and community health workers said they regularly witness the emotional fallout from these experiences, particularly among Black parents who enter pregnancy with a history of discrimination in workplaces, schools and health systems.[3][4] The state’s Commission on Human Rights and Opportunities has warned that discrimination related to pregnancy, childbirth or related conditions—including postpartum depression—remains unlawful in employment and other settings, reflecting broader state efforts to protect pregnant people from bias and stereotyping.[4] Yet advocates said legal protections alone do not shield patients from subtle racial bias during medical encounters, such as assumptions about pain tolerance, family support or substance use.[2][3] “Our clients talk about going into labor already exhausted by racism,” said Jasmine Jones, a New Haven doula who works primarily with Black and Latina families. “By the time they reach the hospital, they’re not just managing contractions—they’re managing fear that they won’t be taken seriously.”[3][5]

Health systems in Hartford, New Haven and other Connecticut cities have begun to build specialized mental-health services for pregnant and postpartum patients, with a focus on those at higher risk of complications and psychological distress.[3][8] Hartford HealthCare’s Reproductive Mental Health Center, based at the Institute of Living, offers intensive outpatient programming for individuals experiencing acute or complex mental-health needs during pregnancy and after childbirth, including anxiety, depression and trauma linked to medical and social stressors.[8] Clinicians there said they are increasingly incorporating screening questions about racism and discrimination into their assessments, recognizing that these experiences can be central to understanding a patient’s symptoms. “We ask not only, ‘How was your birth?’ but, ‘How were you treated?’” said Dr. Wexler. “For many patients of color, those are very different questions with very different answers.”[8]

Public-health leaders said the NPR reporting provides a powerful narrative lens for Connecticut’s ongoing work to reduce maternal health inequities, complementing local data with lived experiences that illuminate the psychological dimensions of racism in pregnancy.[3] The Connecticut Health Foundation’s blueprint calls for addressing discrimination in health care, diversifying the perinatal workforce, and strengthening economic security for families as part of a broad strategy to close racial gaps in maternal mortality and morbidity.[3] Experts said trauma-informed, culturally responsive care—including mental-health services, doulas, and patient advocates trained to recognize racial stress—will be critical to easing the emotional burden on expecting parents of color. “We cannot separate mental health from maternal health,” said Baker. “When racism shapes pregnancy, it shapes outcomes. Our systems have to respond to both.”[3][5]

As Connecticut moves forward with implementation of its maternal health equity recommendations, clinicians and advocates said they hope stories like those shared on NPR will continue to inform training, policy and practice across the state.[3] Hospital leaders have discussed expanding bias training, embedding mental-health professionals into prenatal clinics, and partnering with community doulas to ensure patients of color have trusted support throughout pregnancy and postpartum care, according to local planning documents and interviews.[3][5][8] For many Black women and other marginalized parents, the goal is not only surviving childbirth but doing so without the lingering psychological scars of racism. “The future we’re working toward is one where no one walks into a prenatal visit expecting discrimination,” Jones said. “They should be expecting respect, safety and care.”[3][5]