Declined care and discrimination during the childbirth hospitalization

• Published in: Social science & medicine (1982) Vol. 232; pp. 270 - 277
• Main Authors: Attanasio, Laura B., Hardeman, Rachel R.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2019; Pergamon Press Inc
• Subjects: Black people; Black white relations; Brands; Cesarean section; Childbirth; Childbirth & labor; Communication; Decision making; Discrimination; Ethnicity; Gender stereotypes; Health care industry; Health insurance; Health services; Hospitalization; Hospitals; Infants; Medical decision making; Medicine; Mothers; Patient communication; Patient-provider interaction; Patients; Race; Racial differences; Racism; Stereotypes; U.S; White people; Women; Women of color; Womens health; Discrimination; Patient-provider interaction; U.S; Women of color; Childbirth
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2019.05.008

Many studies have documented poorer patient-provider interactions among people of color compared to Whites, including lower-quality patient-provider communication, less involvement in decision making, and higher chances of perceived discrimination in healthcare encounters. In maternity care, where overuse of medical interventions such as cesarean delivery is a concern, women may try to exert agency by declining procedures. However, declining procedures may brand these women as uncooperative or non-compliant patients. The potential consequences of this are likely worse for women of color, who already expend more effort to manage their image during healthcare encounters in order to avoid stereotypes (e.g. the “angry Black woman”). Using a national sample of women who gave birth in U.S. hospitals in 2011–2012, we examined the relationship between declining procedures and discrimination during the childbirth hospitalization. We found that women who reported having declined care for themselves or their infant during the childbirth hospitalization were more likely to report “poor treatment” based on race and ethnicity, insurance status or having a difference of opinion with a healthcare provider. Moreover, the increase in odds of perceived discrimination due to a difference of opinion with a healthcare provider was significantly larger in magnitude for Black women compared to White women. These results suggest that in the context of childbirth care, women pay a penalty for exhibiting behavior that may be perceived as uncooperative, and this penalty may be greater for Black women. •There were no racial/ethnic differences in chances of declining procedures.•Women who declined procedures during birth were more likely to report discrimination.•For women of color who declined procedures, discrimination was particularly likely.