Assessing the Association Between Perceived Discrimination in Health Care and Postpartum Contraception

Abstract

Objectives:

To assess the association between perceived discrimination in health care and postpartum contraceptive plans among a diverse group of postpartum individuals.

Materials and Methods:

This was a cross-sectional study of individuals postpartum prior to hospital discharge recruited from a single tertiary care hospital between 2021 and 2023. Participants completed a 10-minute electronic survey during their postpartum stay, which included the Perceived Discrimination in Healthcare Scale and questions about their contraceptive plans. The primary exposure was perceived discrimination characterized as no or one experience of discrimination versus multiple experiences of discrimination. The primary outcome was planned tier of postpartum contraceptive efficacy. Multinomial logistic regression was used to examine associations between perceived racial discrimination in health care and planned postpartum contraception.

Results:

Among 482 participants, 21.4% reported multiple discrimination experiences with disproportionately frequent reports among those with Black versus non-Black race (52.4%, p < 0.001). Planned contraceptive method tiers included most effective (43.0%), moderately effective (29.7%), less effective (13.1%), and no contraception (14.2%). Perceived discrimination was not significantly associated with planned contraceptive use (p = 0.371). Multivariable analysis showed nonstatistically significant increased odds for less effective contraception (adjusted odds ratio [OR], 1.46; 95% confidence interval [CI]: 0.71–3.01) and similar odds of no contraception (adjusted OR, 1.09; 95% CI: 0.55–2.17) among those with multiple discrimination experiences.

Discussion:

Higher levels of perceived discrimination were not significantly associated with postpartum contraceptive efficacy tier though wide confidence intervals reflect we were likely underpowered. The prevalence of discrimination warrants intervention. Improving patient–provider communication may reduce perceived discrimination and its potential impact on contraceptive choices.