Rationale: Significant racial disparities in maternal mortality and morbidity rates in the U.S. have persisted over time, with Black women disproportionately bearing the burden. Studies have documented how experiences of structural racism contributes the disparities we see. However, most of these studies have focused on how domains of racism operate simultaneously, yet little is known about how these domains are interconnected and adversely impact health during pregnancy for Black women. To address this gap in the literature, this study explored how various domains of racism interconnect to shape Black women's lived experience during pregnancy, with a particular focus on factors maternal hypertension. Methods: Using a Charmaz grounded theory approach, this study presents qualitative findings from focus groups with Black women living in Greater New Haven, Connecticut and conducted between August 2020 and October 2020. Results: We identified five domains of racism and four ways these domains interconnect. These findings highlight the multidimensional nature of structural racism and the ways interconnected marginalization across domains creates novel pathways that adversely impact health. Conclusions: Our results show how institutions interact at various levels to create distinct health barriers for Black women that need to be addressed through holistic policies and interventions. To truly dismantle structural racism, we must attend to the underlying ideologies that allow these inequities in resources and opportunities to continue, especially capitalism and white supremacy. As we continue to challenge these larger ideologies, policy is a key tool to mitigate the health harms caused by structural racism.
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