From Awareness to Action: Post-Serena Williams Shifts In Pregnancy Risk Perception

Background: Black women face nearly three times the maternal mortality rate of White women (Hoyert, 2022), and even those with access to quality care experience disproportionate mortality and morbidity (Davis, 2019, 2020). In 2018, Serena Williams' account of medical dismissal during childbirth catalyzed national discourse around Black maternal health (Williams, 2018), with media coverage surging from fewer than 500 articles in 2017 to nearly 1,500 by 2019 (Walker & Boling, 2023). No study has examined whether this cultural shift independently predicts pregnancy risk perception and provider selection among Black women. Guided by the Health Belief Model (Champion & Skinner, 2008) and the Reproductive Justice framework (Ross, 2017), this study investigates whether pregnancies after 2018 ("post-Serena") are associated with increased perceived risk and increased selection of identity-concordant providers among Black women in Louisiana.

Methods: This cross-sectional survey was part of a larger sequential mixed-methods study in which qualitative interviews with Black women informed survey development. Participants were 149 Black women in Louisiana who had been pregnant, recruited through community organizations (e.g., Louisiana Doula Network, March for Moms), sororities, and social media with bot-detection protocols (Xu et al., 2022). Data were collected via Qualtrics. Perceived risk was measured using the Perception of Pregnancy Risk Questionnaire (PPRQ; 9 items, α = .94) and a composite of complication concerns (18 items). Provider choice indicated whether participants considered race, culture, or gender when selecting a prenatal provider. The key independent variable was a dichotomous "post-Serena" indicator that distinguished pregnancies in 2018 or later from those before. Covariates included pregnancy planning (London Measure of Unplanned Pregnancy), social support , health-related identity (disability, body size), structural access (Medicaid, WIC), and demographics. Hierarchical OLS regressions predicted perceived risk and stepwise logistic regressions predicted provider choice, with variables entered in theory-driven blocks.

Results: Post-Serena Black women reported significantly higher perceived risk (M = 27.4 vs. 22.5, p = .022, d = 0.38) and complication concerns (M = 58.2 vs. 44.5, p = .002, d = 0.53). They were more likely to select identity-concordant providers (57.5% vs. 35.5%, p = .011), driven by racial concordance (31.5% vs. 13.2%, p = .012). In fully adjusted models, post-Serena pregnancy remained significant (OR = 3.11, p = .009). Medicaid reduced identity-concordant choice (OR = 0.18, p = .005) while WIC increased it (OR = 6.05, p = .001). Body size (b = 4.89, p = .007) and planning actions (b = 2.07, p = .007) also predicted higher perceived risk.

Conclusions and Implications: Media visibility of Black maternal mortality is independently associated with both increase risk awareness and active provider selection, even after accounting for structural, identity, and demographic factors. These findings position cultural knowledge as a cue to action within the Health Belief Model and as resistance within Reproductive Justice. However, awareness alone is insufficient: Medicaid constrained provider choice while WIC expanded it. For practice, results underscore culturally responsive care models supporting Black women's informed decision-making. For policy, findings highlight the urgency of expanding Medicaid provider networks to enable identity-concordant care.