Experiences of Discrimination in Medical Settings in a Pregnant Population with Low Income

Discrimination in medical settings (DMS) has been reported in several contexts; however, little is known about its prevalence in pregnant populations with low income.

We conducted a baseline cross-sectional analysis of participants enrolled in a randomized comparative-effectiveness trial of two forms of enhanced prenatal care among pregnant people in California's San Joaquin Valley with low incomes (the EMBRACE Study). We used the DMS Scale to assess participants' perceived discrimination in medical settings due to race, ethnicity, or color across their lifetime. Demographic and clinical characteristics of participants who had experienced DMS were compared to those of participants who did not report having experienced DMS, using chi-square tests. Predictors of DMS were identified using stepwise logistic regression models.

Most of the 652 participants were of color, identifying as Latine (71.9%), Black (7.2%), or another race/ethnicity (9.8%). Half (49.4%) reported having experienced DMS, with Black participants most likely (68.1%) and Latine participants least likely (44.1%) to report it. In adjusted analyses, Latine participants continued to be less likely to report DMS (aOR:0.48; CI:0.25-0.90), while participants with higher educational attainment (some college aOR:1.84; CI:1.19-2.83; college graduate aOR:2.96; CI:1.53-5.73) and who had experienced discrimination in community settings (aOR:2.98; CI:1.90-4.68) were more likely to have experienced DMS.

Our findings highlight the high prevalence of DMS in a pregnant population with low income. This study adds to existing calls for providers to be mindful of patients' lifetime experiences in the community that may impact their perception of care in medical settings.