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Insurance-Based Discrimination During Prenatal Care, Labor, and Delivery: Perceptions of Oregon Mothers

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Abstract

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.

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Acknowledgments

The authors thank Alfredo P. Sandoval for creating the weights used in these analyses and, along with Tina Kent, for collecting, maintaining, and preparing the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) data. We also thank Kenneth D. Rosenberg for offering the data and reviewing the article and Chris Wiesen for providing statistical advice.

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Authors and Affiliations

  1. Department of Public Health, Oregon State University, Corvallis, OR, USA

    Sheryl Thorburn

  2. Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Molly De Marco

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  1. Sheryl Thorburn
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  2. Molly De Marco
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Correspondence to Sheryl Thorburn.

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Thorburn, S., De Marco, M. Insurance-Based Discrimination During Prenatal Care, Labor, and Delivery: Perceptions of Oregon Mothers. Matern Child Health J 14, 875–885 (2010). https://doi.org/10.1007/s10995-009-0533-7

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