The Long-Term Impacts of Reproductive Trauma in Rural Black Birthing Communities and the Role of Religious Involvement

It is well documented that Black birthing people are disproportionately impacted by adverse birth outcomes, including higher rates of severe maternal morbidity (SMM), maternal mortality, and infant mortality rates as compared to other racial groups (Taylor, 2020; Beckford, 2020; Bond et. al., 2021). Comparably, an extensive body of research has thoroughly examined the significance of religious involvement for the physical and mental health of African American populations, which becomes particularly salient in the lives of African American women (Levin et al., 1994; Roth et al., 2011). However, a dearth of research remains regarding the implications of religious involvement for African American women and birthing people, particularly as they navigate the aftermath of surviving pregnancy complications and “near misses” that result from greater exposure to maternal risks (Taylor, 2020). That is, while maternal health disparities are well documented, sociological research has yet to fully excavate the layered aspects of living through acute maternal morbidity risks and subsequently, the task of navigating the long-term impacts of these risks and the ensuing reproductive trauma that follows. In addition, because care fragmentation encumbers the extension of resources beyond the formal postpartum period of six months and more recently, up to one year, many birthing persons forgo formal postpartum support largely due to the siloed characteristics of the current maternal health infrastructure (Gordon et al., 2020). In this way, religious involvement serves as an understudied yet critical resource for navigating aspects of reproductive trauma across the life course.

A growing body of literature recommends interdisciplinary, methodological approaches that center the lived experiences of birthing persons of color to align health equity strategies with those most impacted by ongoing disparities (McCloskey et al., 2021; Sealy-Jefferson, 2022). However, there remains a lack of research pertaining to the long-term impacts of reproductive trauma in racially minoritized populations and more significantly, how religious beliefs may buffer against the lingering impacts of reproductive trauma amid fragmented care systems. While the significance of religious involvement in Black populations is thoroughly documented, less research has assessed how religious involvement shapes the meaning-making practices of Black women and birthing people as they navigate reproductive trauma across the life course. This gap in research becomes more apparent in Black rural communities where racially minoritized populations are more likely to rely on culturally specific religious beliefs as a coping resource rather than opting for formal support with a mental health professional (Rawlings and Bains, 2020).

This study seeks to deepen our understanding of how reproductive trauma is embodied across the life course and how such experiences are both relived and reimagined in Black birthing communities through the ongoing formation of religious involvement. Drawing from a subset of data from a larger in-depth study that includes 29 semi-structured interviews with Black birthing persons in a rural, Southern community, this study investigates how rural Black women and birthing people navigate experiences of reproductive trauma through religious involvement and spiritual practices in light of fragmented medical care infrastructures. By devising a joint, critical application of cumulative inequality (CI) theory, the growing literature pertaining to the “long arm” of religion, and Womanist sociology, we identify religious involvement as a potentially salient, protective resource for the embodied experiences of reproductive trauma in Black rural communities (Henderson, 2016). While often applied separately, we contend that a critical integration of these three perspectives provides an advantageous analytical framework for considering the layered dimensions of cumulative disadvantage in Black birthing communities and the subsequent strategies engaged to cultivate alternative care infrastructures through religious involvement. More importantly, such analytical framing demonstrates how disadvantage may be mutually shaped by the availability of social resources and human agency, specifically analyzing the impact of religious involvement.

In this paper, we first provide a brief definition of reproductive trauma to ground our analysis. In doing so, we build on Janet Jaffe’s foundational work of a reproductive story to outline the conceptual contours of reproductive trauma experienced by Black birthing persons living in rural communities (2017). A reproductive story captures the self-constructed narrative that is critical to one’s identity related to parenthood and birthing preferences. We then synthesize pertinent literature regarding cumulative inequality (CI) theory, Womanist sociology, and the conceptual utility of the “long arm of religion” to demonstrate how experiences of reproductive trauma in Black rural communities are shaped by social inequalities as well as the availability of resources and human agency (Ferraro and Shippe, 2009; Maparyan, 2012; Henderson, 2016). To substantiate such claims, we contextualize the unfolding impact of reproductive trauma and the perceived benefits of religious involvement by first examining the risks involved when rural Black birthing populations enter medical systems and the subset of divergent risks encountered when exiting medical care systems. By identifying the risks involved with entering and exiting care systems, we consider how care fragmentation experienced in rural African American birthing communities may amplify experiences of reproductive trauma and the significance of religious involvement for effectively navigating such experiences beyond the prescribed postpartum period of six months to one year (Gordon et al., 2020; Seng et al., 2009). That is, we demonstrate how experiences of reproductive trauma in Black birthing populations are mutually shaped by fragmented medical care infrastructures and the local care infrastructures that bridge critical gaps in fostering recovery and wellbeing for survivors of reproductive trauma. To the authors’ knowledge, this is the first study to examine how religious involvement impacts reproductive trauma embodied in the lives of Black mothers and birthing people beginning in early adulthood and into later life. By drawing on study findings, we explore how Black birthing persons navigate the long-term impacts of reproductive trauma through four key social processes: delaying individual response to reproductive trauma, managing heightened grief across the life course, reevaluating healthcare utilization, and extending the long arm of religion through organizational and nonorganizational religious support. By drawing on strategies of religious involvement, Black mothers interviewed in this study provided narratives of survival and recovery in light of pregnancy complications, obstetric racism, infancy loss, and near-death experiences related to labor and delivery.