Associations Between Perceived Race-based Discrimination and Contraceptive Use Among Women Veterans in the ECUUN Study

Abstract

Objective To describe perceived race-based discrimination in VA healthcare settings and assess its associations with contraceptive use among a sample of women Veterans. Methodology This study used data from a national telephone survey of women Veterans aged 18–44 receiving healthcare in VA who were at risk of unintended pregnancy. Participants were asked about their perceptions of race-based discrimination while seeking VA healthcare and about their contraceptive use at last heterosexual intercourse. Logistic and multinomial regression analyses were used to examine associations between perceived race-based discrimination with use of prescription contraception. Results In our sample of 1,341 women Veterans, 7.9% report perceived race-based discrimination when receiving VA care, with blacks and Hispanics reporting higher levels of perceived discrimination than white women (11.3% and 11.2% vs. 4.4%; p<0.001). In logistic and multinomial regression analyses adjusting for race/ethnicity, age, income, marital status, parity, and insurance, women who perceived race-based discrimination were less likely to use any prescription birth control than women who did not (OR:0.65; 95% CI:0.42–1.00), with the largest difference seen in rates of IUD or implant use (OR:0.40; 95%: CI:0.20–0.79). Conclusions In this national sample of women Veterans, over 10% of racial/ethnic minority women perceived race-based discrimination when receiving care in VA settings, and perceived racial/ethnic discrimination was associated with lower likelihood of prescription contraception use, especially IUDs and implants. VA efforts to enhance respectful interactions may not only improve patient healthcare experiences, but also represent an opportunity to improve reproductive health outcomes for women Veterans.

Perceived discrimination in medical settings and perceived quality of care: A population-based study in Chicago

“…Consistent with the current literature, we found that the perception of race-related fear from doctors or nurses toward patients was the least reported type of perceived discrimination [12, 30, 34, 35]. In previous studies, perceiving that providers were “not listening” was the most commonly reported item on the DMS [12, 19, 29, 30, 34]; however, in our study, receiving “poorer services” was most frequently reported.…”

“…Previous studies using the DMS scale reflect a wide range of prevalence rates, from 8% of female veterans [34] to over 60% of those included in a convenience sample of African American adults in northern Ohio [12] and a sample of HIV patients [29]. Consistent with the current literature, we found that the perception of race-related fear from doctors or nurses toward patients was the least reported type of perceived discrimination [12, 30, 34, 35]. In previous studies, perceiving that providers were “not listening” was the most commonly reported item on the DMS [12, 19, 29, 30, 34]; however, in our study, receiving “poorer services” was most frequently reported.…”

Identifying healthcare experiences associated with perceptions of racial/ethnic discrimination among veterans with pain: A cross-sectional mixed methods survey

“…Second, it is troubling that, among our sample of patients with pain, over one in five who perceived discrimination described healthcare experiences in which they felt overtly stigmatized. The prevalence of perceived discrimination observed in this study is within the wide range observed in prior studies that have assessed perceived racial/ethnic discrimination in VA healthcare settings [4,5,[37][38][39]. Although the overall prevalence varies across studies depending on the targeted patient population and the measure used to assess perceived discrimination [5], a common pattern observed across the literature is that racial/ethnic discrimination is more frequently reported by racial/ethnic minority patients compared to White patients, as was the case for our study.…”

Contraceptive Care in the Veterans Health Administration

“…As expected, perceived race-based discrimination was reported by higher proportions of black and Hispanic women compared with white women (11.3 and 11.2% vs. 4.4%, respectively; p < 0.001). 39 These findings underscore the fact that racial differences in contraceptive use are driven by a variety of variables, many of which clinicians may be able to elicit during nuanced counseling to improve the provision of contraceptive care and ensure that method selection is the result of informed and preference-concordant decision making.…”