Missed Conversations: Educational Opportunities in Pelvic Floor Counseling During Obstetric Care for Minority Mothers in Urban and Suburban Communities

Background: Pelvic floor health is a foundational component of women’s reproductive well-being, particularly in the context of pregnancy, delivery, and postpartum recovery. Disorders such as urinary incontinence, pelvic organ prolapse, and peripartum musculoskeletal dysfunction are prevalent, with far-reaching implications for maternal quality of life and long-term gynecologic health. Despite the clinical importance of pelvic floor conditions, structured education regarding risk factors, prevention, and management remains conspicuously absent from routine obstetric care. This gap in knowledge is even more pronounced among African American and minority women, who experience higher rates of adverse maternal outcomes and face systemic barriers to equitable healthcare. Prior studies have linked disparities in health education access to limited provider communication, cultural stigma, and structural inequities in care delivery. However, few investigations have focused specifically on pelvic floor health literacy within these populations. This study aimed to address these gaps by examining pelvic floor knowledge among women of various backgrounds in both urban and suburban clinical settings. Objectives: The primary objective of this study was to assess the level of pelvic floor health knowledge among African American and minority women of reproductive age. Secondary aims included evaluating whether demographic variables such as race/ethnicity, educational attainment, and geographic setting (urban vs. suburban) were associated with differing levels of awareness; determining whether increased formal education correlated with improved knowledge of pelvic floor risks and resources; and identifying common deficits in provider-patient communication regarding pelvic floor health. The study further sought to explore how these disparities may influence peripartum outcomes and contribute to broader patterns of inequity in maternal healthcare access and education. Methods: A cross-sectional survey study was conducted between January and March 2024 in multiple outpatient obstetrics and gynecology clinics in both urban and suburban regions of North Louisiana. Women aged 18–49 presenting for routine or prenatal visits were invited to participate. The survey instrument included demographic questions and a 15-item awareness-based and knowledge assessment focused on patient understanding of pelvic floor function, risk factors, and access to care. Survey responses were anonymized and analyzed using descriptive statistics, frequency distributions, and cross-tabulations to examine associations between demographic variables and knowledge outcomes. Results: Fifty participants completed the survey. Forty-two percent self-identified as African American, and more than 90% identified as part of a racial or ethnic minority group. Education levels ranged from less than high school to postgraduate degrees, with a majority reporting some college education. Survey data suggested significant gaps in pelvic floor health awareness across the entire sample. Seventy-four percent of respondents were unaware of the existence or role of pelvic floor physical therapy. Similarly, 72% had not identified childbirth as a risk factor for pelvic floor dysfunction, and 60% had little to no understanding of general pelvic floor risks, including those associated with prolonged labor or assisted delivery. Importantly, no statistically significant difference in knowledge scores was observed between urban and suburban participants, suggesting that suburban residence does not confer a protective effect in terms of pelvic health education. Furthermore, while 46% of respondents had completed some college education and 28% had a high school diploma or less, knowledge levels remained uniformly low. Even among those with higher education, understanding of pelvic floor anatomy and available treatment options was limited, indicating that formal education alone does not predict awareness of this topic. Notably, respondents across all educational levels and locations reported minimal provider engagement and discussion of pelvic floor health during prenatal or postpartum care. Several participants indicated they had only learned about pelvic floor dysfunction informally, through social media or peer conversations, rather than from medical professionals. This trend reflects missed clinical opportunities for early intervention, especially in populations already at risk for obstetric complications. Additionally, cultural stigmas and taboos surrounding topics such as incontinence and gynecologic dysfunction may inhibit open discussion, both within clinical encounters and among peer networks. Conclusion: This study identifies a critical and persistent deficit in pelvic floor health knowledge among African American and minority women, irrespective of geographic setting or education level. The findings challenge assumptions that suburban residence or higher educational attainment may compensate for systemic deficiencies in reproductive health education. The absence of standardized pelvic floor education in clinical encounters represents a structural failure with measurable implications for peripartum outcomes.