Insurance-Based Discrimination During Prenatal Care, Labor, and Delivery: Perceptions of Oregon Mothers
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The purpose of this study was to improve understanding of who experiences insurance-based discrimination during prenatal care, labor, and delivery and how their health care may differ from that of other women. We pooled data from the 1998–1999, 2000, and 2001 Oregon Pregnancy Risk Assessment Monitoring System and conducted univariate, bivariate, and multivariate analyses. The women who perceived that they had been treated differently by health care providers during prenatal care, labor, or delivery based on their insurance status were largely a lower income group. Insurance-based discrimination was significantly associated with lower annual household incomes, being unable to pay bills during pregnancy, and being without employer-sponsored insurance for their baby’s delivery, when adjusted for other factors. Insurance-based discrimination was less likely among Hispanic mothers. With respect to the relationship between insurance-based discrimination and receipt of health care, our findings were mixed. Insurance-based discrimination was not significantly associated with the number of topics covered by providers during prenatal care. In contrast, insurance-based discrimination was significantly associated with fewer breastfeeding support actions taken at the hospital and with having had a provider discuss birth control after delivery among women with employer sponsored insurance. These findings draw attention to the need to better understand women’s experiences and perceptions of insurance-based discrimination during prenatal care, labor, and delivery.
KeywordsDiscrimination Insurance Pregnancy Risk Assessment Monitoring System (PRAMS) Prenatal care Maternity care
- 5.De Marco, M., Thorburn, S., & Zhao, W. (2008). Perceived discrimination during prenatal care, labor, and delivery: An examination of data from the Oregon Pregnancy Risk Assessment Monitoring System, 1998–1999, 2000, and 2001. American Journal of Public Health, 98, 1818–1822.CrossRefPubMedGoogle Scholar
- 6.Gee, G. C., Ryan, A. R., Laflamme, D. J., & Holt, J. (2006). Self-reported discrimination in mental health status among African descendants, Mexican Americans, and other Latinos in the New Hampshire REACH 2010 initiative: The added dimension of immigration. American Journal of Public Health, 96, 1821–1828.CrossRefPubMedGoogle Scholar
- 11.Ren, X. S., Amick, B. C., & Williams, D. R. (1999). Racial/ethnic disparities in health: The interplay between discrimination and socioeconomic status. Ethnicity and Disease, 1999(9), 151–165.Google Scholar
- 12.Schuster, M. D., Collins, R., Cunningham, W. E., Morton, S. C., Zierler, S., Wong, M., et al. (2005). Perceived discrimination in clinical care in a nationally representative sample of HIV-infected adults receiving health care. Journal of General Internal Medicine, 20, 807–813.CrossRefPubMedGoogle Scholar
- 17.Burgess, D. J., Ding, Y., Hargreaves, M., van Ryn, M., & Phelan, S. (2008). The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample. Journal of Health Care for the Poor and Underserved, 19, 894–911.CrossRefPubMedGoogle Scholar
- 19.Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.Google Scholar
- 20.Oregon Department of Human Services. Oregon PRAMS: First Year Report, 1998–1999, Appendix B: PRAMS 1998–1999 Data Collection Methodology. Available at http://oregon.gov/DHS/ph/pnh/prams/9899/9899appb.shtml. Accessed on January 1, 2006.
- 22.National Research Council. (2004). Measuring racial discrimination. Panel on methods for assessing discrimination. In R. M. Blank, M. Dabady, & C. F. Citro (Eds.), Committee on National Statistics, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.Google Scholar