Examining the Role of Discrimination in Prenatal Care Utilization: A Systematic Review Using the Social-Ecological...

Timely and adequate prenatal care (PNC) is essential for optimizing maternal and infant health outcomes. However, persistent disparities in PNC utilization exist in the United States, particularly among ethnic/racial minority populations. While discrimination has been recognized as a barrier, its multifaceted influence across social and structural contexts remains underexplored. This systematic review, guided by the Social-Ecological Model, synthesizes evidence on how various forms of discrimination affect PNC utilization. We conducted comprehensive searches in PubMed, Web of Science, and CINAHL for peer-reviewed studies published in the United States between 2010 and 2024. After screening 342 records, 11 studies met the inclusion criteria. Five studies employed qualitative methods, five used quantitative methods, and one utilized a mixed-methods approach. Findings revealed that structural discrimination, such as language barriers and institutional policies, was associated with delayed or insufficient PNC utilization. Interpersonal dynamics, including negative patient-provider interactions and implicit bias, discouraged engagement with care. Additionally, intrapersonal factors, like internalized discrimination, shaped perceptions of care quality and trust in healthcare systems. The review highlights how discrimination operates across multiple levels to influence PNC behaviors and outcomes. Addressing discrimination requires culturally responsive care models, provider training in cultural humility, and institutional reforms aimed at equity. Future research should explore protective factors, such as social support and resilience, that may buffer the negative effects of discrimination. Understanding these dynamics is crucial for developing interventions that promote equitable and effective PNC utilization.