Date of Conferral

3-13-2026

Degree

Ph.D.

School

Health Sciences

Advisor

Hebatullah Tawfik

Abstract

African American women experience disproportionately high rates of preeclampsia in the United States; however, the contributions of prenatal care provider type, health care access, and quality of care to this disparity were insufficiently defined. Guided by the quality health outcomes model, this quantitative case-control study used primary data to examine associations between these factors and the occurrence of preeclampsia among African American women age 18–40 who had given birth within the previous 5 years in Georgia. Descriptive statistics and binary and multinomial logistic regression analyses were conducted. Prenatal care quality was measured using the Quality of Prenatal Care Questionnaire (QPCQ), and demographic information was collected using an anonymous online survey. Health insurance status significantly predicted provider selection, with uninsured women having higher odds of choosing doulas over obstetricians (OR = 2.43, 95% CI [1.18, 5.02], p < 0.01). Rural residence was associated with higher odds of midwife use, though this association was not statistically significant. Provider type was not significantly associated with preeclampsia risk. Higher QPCQ scores were associated with a statistically significant reduction in the odds of preeclampsia (OR = 0.94, 95% CI [0.90, 0.98], p < 0.01). These findings are important for social change because they suggest that the quality of prenatal care is a key protective factor against preeclampsia, whereas provider type alone does not independently influence risk. Improving prenatal care quality and expanding access to culturally responsive, patient-centered care may help reduce maternal health disparities among African American women.

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