BACKGROUND: Preterm birth (PTB
<
37 weeks completed gestation) is a significant public health problem with both acute and long-term ramifications for individuals and families. Despite decades of research, inequities in health outcomes persist in the United States such that Black women are nearly 1.6 times more likely to experience PTB compared to white women. In order to adequately address persistent inequities in PTB, more must be understood from the nuanced experiences of Black women. The purpose of this qualitative study was to explore how pregnant Black women perceive the aetiology of PTB. METHODS: Data were collected as part of the Biosocial Impact on Black Birth (BIBB) study which prospectively explored the structural and maternal factors on birth outcomes among self-identified Black women between the ages of 18 and 45 who had singleton pregnancies and were between 8- and 30-weeks' gestation. Semi-structured interviews were conducted remotely using telephone, were anonymized and transcribed, and analysed using thematic analysis. RESULTS: A total of 61 participants completed interviews. Three main themes developed: (1) Doing Too Much
(2) Black Women Have it Harder
and (3) Patriarchy and Privilege. CONCLUSION: There is a complex and layered structure in place for Black women which reinforces that the responsibility for PTB belongs to those who experience it the most. Although study participants alluded to the structural vulnerabilities and intersectional stigma, participants turned inward to themselves and to their group identity to explain PTB.