Perceived discrimination during the childbirth hospitalization and postpartum visit attendance and content: Evidence from the Listening to Mothers in California survey

Abstract

Objective Postpartum visits are an important opportunity to address ongoing maternal health. Experiences of discrimination in healthcare can impact healthcare use, including postpartum visits. However, it is unknown whether discrimination is associated with postpartum visit content. This study aimed to examine the relationship between perceived discrimination during the childbirth hospitalization and postpartum visit attendance and content. Research design Data were from Listening to Mothers in California, a population-based survey of people with a singleton hospital birth in California in 2016. Adjusted logistic regression models estimated the association between perceived discrimination during the childbirth hospitalization and 1) postpartum visit attendance, and 2) topics addressed at the postpartum visit (birth control, depression and breastfeeding) for those who attended. Results 90.6% of women attended a postpartum visit, and 8.6% reported discrimination during the childbirth hospitalization. In adjusted models, any discrimination and insurance-based discrimination were associated with 7 and 10 percentage point (pp) lower predicted probabilities of attending a postpartum visit, respectively. There was a 7pp lower predicted probability of discussing birth control for women who had experienced discrimination (81% vs. 88%), a 15pp lower predicted probability of being asked about depression (64% vs. 79%), and a 9 pp lower predicted probability of being asked about breastfeeding (57% vs. 66%). Conclusions Amid heightened attention to the importance of postpartum care, there is a need to better understand determinants of postpartum care quality. Our findings highlight the potential consequences of healthcare discrimination in the perinatal period, including lower quality of postpartum care.

Physician Referrals During Prenatal Care

“…Many studies have assessed factors associated with the receipt of adequate prenatal care (Blakeney et al, 2019;Gadson et al, 2017;Kitsantas et al, 2012). However, as evidence has mounted that having the recommended number and sequence of prenatal visits is not sufficient for ensuring good maternal and infant health outcomes (Alexander & Kotelchuck, 2001;Atrash et al, 2008;Noonan et al, 2013;Siddique et al, 2012), attention has turned to examining the content and quality of perinatal care (Attanasio et al, 2021;Coley et al, 2018;Dyer et al, 2018;Geissler et al, , 2020bSword et al, 2012). Referrals are an important element of patient care (Agha et al, 2019;Barnett et al, 2012;Mehrotra et al, 2011) and may contribute to prenatal care quality, but little is known about referrals in this context.…”

Gestações na adolescência e adesão à consulta puerperal

“…A baixa escolaridade é determinante a ser considerada por profissionais. Estudo (29) realizado nos Estados Unidos relacionou baixa escolaridade de puérperas com se sentir discriminadas durante o período de internação e com baixos índices de adesão ao retorno pós-parto.…”

“…As puérperas relataram dificuldades em compreender orientações, não perceberam esforços dos profissionais para adaptar o linguajar, apontando que isso contribuiu na sua decisão em não retornar ao serviço (29) . Embora não tenha sido encontrada associação entre escolaridade e adesão à consulta neste estudo, outros apontam menor adesão em mulheres com baixa escolaridade (18,(29)(30) .…”

Embarazos en adolescentes y adherencia a la consulta puerperal

“…La baja escolaridad es un factor determinante a tener en cuenta por los profesionales. Un estudio (29) realizado en los Estados Unidos relacionó la baja escolaridad de las puérperas con sentirse discriminadas durante el período de hospitalización y con bajas tasas de adherencia al retorno posparto.…”

“…Las puérperas relataron dificultades en la comprensión de las orientaciones, no percibieron los esfuerzos de los profesionales en adaptar el lenguaje, señalando que eso contribuyó para su decisión de no retornar (29) . Aunque en este estudio no se encontró asociación entre la escolaridad y la adherencia a las consultas, otros apuntan a una menor adherencia en mujeres con baja escolaridad (18,(29)(30) .…”