Perceived Discrimination During Prenatal Care at a Community Health Center

Abstract

Introduction: Discrimination in healthcare is associated with fetal growth restriction, preterm birth, and postpartum depression. A community-based participatory research study was designed to measure perceived discrimination and healthcare quality during prenatal care and delivery by a community health center, where the majority of patients served belong to historically marginalized ethnic and racial groups.

Methods: A 34-question phone survey was administered to women 18 years and older who received prenatal care at the study site during 2020-2021. The primary outcome was perceived discrimination during obstetric care, measured by the 7-question Discrimination in the Medical Setting (DMS) survey. Secondary outcomes included the association of race with perceived discrimination, quality of care, trust of healthcare providers, and perceived control over medical choices.

Results: Ninety-seven women completed the survey, 95 of whom were women of color. The sample was dichotomized into Black (n = 49) and non-Black (n = 46). Perceived discrimination for all participants was 21% (20/95), with 31% (15/49) of Black women reporting any discrimination during prenatal care and delivery. Compared to other women of color, Black women reported higher rates of perceived discrimination (31% vs 11%, aOR 3.9 [1.2-12.1], p < 0.05), lower control over health choices (84% vs 98%, aOR 0.1 [0.0-0.8], p < 0.05), and were more likely to perceive lack of respect (12% vs 2%, p = 0.045).

Conclusion: Although perceived discrimination at this community health center was low compared to prior studies, Black women experienced higher rates of discrimination than other women of color.

Keywords: Birth outcomes; Community health center; Perceived discrimination.