Studies have consistently shown for decades that the rates of low birth weight, preterm delivery, and the ensuing infant mortality rate are twice as high for African American as for white infants in the United States. Although factors such as adolescent age, poverty, low educational attainment, and late initiation of prenatal care are associated with low birthweight and being African American, the twofold racial disparity persisted even when controlling for these risk factors. African Americans are more likely than whites or Hispanics to use outpatient services than private physicians (Lewin-Epstein, 1991). Continuity of care is often compromised by dependence on outpatient services and emergency rooms. The shortage of African American physicians and lack of private insurance among African Americans may add to dependence on these sources for primary care. Current literature reveals that greater disparity in health care services exists among impoverished African Americans than among impoverished whites. Furthermore, the racial disparity perseveres even among middle class African Americans compared with middle class whites. However, the literature has never explicitly addressed the presence of racism and its affect on the health care delivery system. A qualitative study was developed to explore these issues within the context of prenatal care system. Interviews were conducted with fourteen prenatal and postnatal African American women from 1992 through 1993. The women were recruited from two distinct practices – a family practice group and a city health clinic. Half of the subjects were eligible for Medi-Cal (California based Medicaid program) and half had private health insurance.

Although, overall, the African American women were well educated, their total monthly family incomes were at most $2000-2500. The pregnant African American women perceived that they were stereotyped by the non-African American society as well as the African American society itself. The most common assumptions were that pregnant African American women are young, unmarried, have at least two children, are unemployed and are on welfare. Other less frequent stereotypes were that no father is present in the household, pregnant African American women do not take care of themselves and do not receive proper prenatal care, and that they use illicit drugs. External and internal processing of stereotypes persisted regardless of the socioeconomic status of African American women. Often the women perceived their prenatal care as "indifferent, inaccessible, and undignified."

The implications of the study are strengthened by the fact that the data were independently collected and coded until consensus was obtained to ensure reliability. However, the study contained only 14 participants and only anecdotes and impressions from the subjects are presented. Thus, it is difficult to generalize from 14 pregnant African American women to the larger African American population. Nevertheless, qualitative research contains concepts that quantitative research may not be able to fully capture. Stereotypes must be first acknowledged and confronted before changes in health care practices can evolve. "The stereotypes- those accepted by health workers and those internalized buy the women and families-compromise the quality of care provided and the quality of care received."