Date of Conferral

4-30-2026

Degree

Ph.D.

School

Health Sciences

Advisor

Jennifer Oliphant

Abstract

This quantitative study examined the association between racial discrimination and pregnancy-related hypertension among women age 18–40 in the United States, and how this relationship is modified by age and the Department of Health and Human Services (HHS) regions (states). Guided by the social ecological model, this research measured whether race, place, and lived experiences of discrimination contributed to disparities in maternal health outcomes. The study utilized the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System data set (2016–2022) which represented 81% of United States live births (n=249,970). The independent variable was self-reported racial discrimination during pregnancy, delivery, or postpartum care, and the dependent variable was pregnancy-related hypertension, analyzed by age category and HHS region (i.e., state). Findings indicated state- specific differences in experiences of discrimination and hypertensive outcomes, highlighting the intersection of structural racism, regional inequities, and maternal health. Logistic regression analyses conducted separately by state indicated no statistically significant associations between self-reported discrimination and pregnancy-related hypertension (ps > .05). Effect sizes varied across states but were generally small (e.g., District of Columbia: OR = 1.25; Michigan: OR = 1.03), with a larger but unstable estimate observed in Washington (OR = 2.88). Model fit was acceptable across all states, with low explained variance (Nagelkerke R² = .0001–.162). The implications for positive social change include advancing respectful maternity care and reducing the persistent maternal health disparities experienced by Black women and other marginalized populations across the United States.

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