“NOBODY WILL SEE PAST MY BLACKNESS; THEY WILL ONLY SEE A LOUD BLACK WOMAN”: EXAMINING HOW GHANAIAN IMMIGRANT WOMEN IN THE UNITED STATES COMMUNICATE THEIR MATERNAL HEALTHCARE EXPERIENCES

Abstract

Maternal mortality in the United States continues to rise, with Black and immigrant women facing the highest risks due to mistreatment, structural racism, and systemic health disparities. Yet, research often overlooks the distinct experiences within these broad categories. This dissertation focuses on Ghanaian immigrant women, a growing African immigrant population in the U.S., to examine how they communicate their maternal healthcare experiences. Using the Culture-Centered Approach (CCA) and the Situational Theory of Publics (STP), the study explores how culture, structure, and agency shape communication in a healthcare system not designed for their needs.Based on 23 in-depth interviews with Ghanaian immigrant women across the United States, the study investigates five core questions: (1) what problems Ghanaian immigrant women face when receiving maternal care, (2) what constraints they encounter when attempting to address their maternal healthcare problems, (3) how they communicate their problems and the barriers in addressing these problems, (4) how Ghanaian immigrant women perceive and make sense of their maternal healthcare experiences, and (5) how they perceive their involvement in maternal healthcare and how does this perception influence their communication. Findings show that women frequently encounter structural and interpersonal barriers, including high costs, limited provider access, long wait times, inadequate communication, and experiences of racial bias. Cultural factors, such as deference to authority, modesty norms, and community-based decision-making, also shape how women respond to these challenges. Many participants described enduring poor treatment without complaint, not because they lacked awareness but because they perceived speaking up as unsafe or futile. Others sought support through informal networks, such as family members, friends, and online groups, rather than directly engaging with healthcare providers. The study reveals that although women feel deeply invested in their maternal care, their involvement is often expressed through quiet, cautious, and strategic forms of communication. Silence, for many, is not a sign of disengagement but a protective response rooted in cultural norms, past experiences, and fear of judgment or immigration-related consequences. By integrating CCA and STP, the study demonstrates how culture, structure, and perceived agency interact to shape maternal healthcare communication. It challenges dominant models that equate empowerment with assertiveness and emphasizes the legitimacy of less visible forms of agency. The findings underscore the need for healthcare systems to recognize diverse communication styles, reduce structural barriers, and involve immigrant communities in the design of care. Ultimately, the study contributes to a more inclusive and context-sensitive understanding of maternal health equity.