Exploratory Study of Race- or Ethnicity-Based Discrimination Among Patients Receiving Procedural Abortion Care



      : Explore relationships of race and ethnicity with experiences of race- or ethnicity-based discrimination during abortion care.

      Study Design

      : English- or Spanish-speaking individuals aged 18-50 completed cross-sectional, self-administered online surveys within 30 days of procedural abortion at five Northeastern U.S. reproductive health clinics from June 2020-February 2021. We considered any affirmative response on the Discrimination in Medical Settings (DMS) scale evidence of race- or ethnicity-based discrimination. We performed bivariate analyses and logistic regression examining discrimination among Black non-Latinx, Latinx any race, Other race non-Latinx compared to White non-Latinx participants. We assessed associations between discrimination and healthcare quality and satisfaction.


      : Participants (n=163) averaged 27(±6) years and self-identified as Black non-Latinx (36.2%), White non-Latinx (28.8%), Latinx of any race (27.0%), and Other non-Latinx (8.0%). Most were publicly insured (52.8%) and <14 weeks gestation (90.8%).Overall, 15.3% reported race- or ethnicity-based discrimination during abortion care with Black non-Latinx more likely to report discrimination (23.7%; OR 7.00, 95%CI 1.50-32.59), while Latinx any race (15.9%, OR 4.26, 95%CI 0.83-21.74) and Other race non-Latinx participants (15.4%, OR 4.09, 95%CI 0.52-32.35) demonstrated statistically non-significant trend toward increased odds of discrimination compared to White non-Latinx (4.3%). Discrimination was associated with negative perceptions of: time with physician (p=0.03), patient care involvement (p<0.05), physician communication (p=0.01), care quality (p=0.02), and care satisfaction (p<0.01).


      : Racially minoritized participants were more likely to report race- or ethnicity-based discrimination during abortion care; Black non-Latinx reported highest odds of discrimination compared to White non-Latinx. Discrimination was associated with unfavorable healthcare quality measures.


      : Race- or ethnicity-based discrimination during abortion care is disproportionately reported by racially minoritized populations, especially Black individuals, compared to White non-Latinx individuals. Discrimination is significantly associated with negative experiences of care. Future work should verify findings in different regions and larger studies, and design and test discrimination-reduction interventions.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Roberts D.E.
        Killing the black body: race, reproduction, and the meaning of liberty.
        1st ed. Pantheon Books. x, New York1997: 373
        • Admon L.K.
        • et al.
        Racial and Ethnic Disparities in the Incidence of Severe Maternal Morbidity in the United States, 2012-2015.
        Obstet Gynecol. 2018; 132: 1158-1166
        • Alexander A.L.
        • et al.
        Examining Disparities in Route of Surgery and Postoperative Complications in Black Race and Hysterectomy.
        Obstet Gynecol. 2019; 133: 6-12
        • Cote M.L.
        • et al.
        The Growing Burden of Endometrial Cancer: A Major Racial Disparity Affecting Black Women.
        Cancer Epidemiol Biomarkers Prev. 2015; 24: 1407-1415
        • Creanga A.A.
        • et al.
        Pregnancy-Related Mortality in the United States, 2011-2013.
        Obstet Gynecol. 2017; 130: 366-373
        • Dehlendorf C.
        • Harris L.H.
        • Weitz T.A.
        Disparities in abortion rates: a public health approach.
        Am J Public Health. 2013; 103: 1772-1779
        • Jain T.
        Socioeconomic and racial disparities among infertility patients seeking care.
        Fertil Steril. 2006; 85: 876-881
        • Petersen E.E.
        • et al.
        Racial/Ethnic Disparities in Pregnancy-Related Deaths - United States, 2007-2016.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 762-765
        • Saraiya M.
        • et al.
        Cervical cancer incidence in a prevaccine era in the United States, 1998-2002.
        Obstet Gynecol. 2007; 109 (Pt 1): 360-370
        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics.
        CA Cancer J Clin. 2019; 69 (2019): 7-34
        • Stewart S.L.
        • et al.
        Disparities in ovarian cancer survival in the United States (2001-2009): Findings from the CONCORD-2 study.
        Cancer. 2017; 24 (123 Suppl): 5138-5159
        • Jackson-Bey T.
        • et al.
        Systematic review of racial and ethnic disparities in reproductive endocrinology and infertility: where do we stand today?.
        F&S Reviews. 2021; 2: 169-188
        • Burgess D.J.
        Addressing racial healthcare disparities: how can we shift the focus from patients to providers?.
        J Gen Intern Med. 2011; 26: 828-830
      1. Gee, G.C. and C.L. Ford, STRUCTURAL RACISM AND HEALTH INEQUITIES: Old Issues, New Directions. Du Bois Rev, 2011. 8(1): p. 115-132.

        • Dehlendorf C.
        • Weitz T.
        Access to abortion services: a neglected health disparity.
        J Health Care Poor Underserved. 2011; 22: 415-421
        • Dehlendorf C.
        • et al.
        Recommendations for intrauterine contraception: a randomized trial of the effects of patients' race/ethnicity and socioeconomic status.
        Am J Obstet Gynecol. 2010; 203 (319): e1-e8
        • Lewis T.T.
        • et al.
        Chronic exposure to everyday discrimination and coronary artery calcification in African-American women: the SWAN Heart Study.
        Psychosom Med. 2006; 68: 362-368
        • Trivedi A.N.
        • Ayanian J.Z.
        Perceived discrimination and use of preventive health services.
        J Gen Intern Med. 2006; 21: 553-558
        • Williams D.R.
        • Neighbors H.W.
        • Jackson J.S.
        Racial/ethnic discrimination and health: findings from community studies.
        Am J Public Health. 2008; 98 (Suppl): S29-S37
        • Hausmann L.R.
        • et al.
        Impact of perceived discrimination in healthcare on patient-provider communication.
        Med Care. 2011; 49: 626-633
        • Benjamins M.R.
        • Whitman S.
        Relationships between discrimination in health care and health care outcomes among four race/ethnic groups.
        J Behav Med. 2014; 37: 402-413
        • MacDonald S.
        • et al.
        Associations Between Perceived Race-based Discrimination and Contraceptive Use Among Women Veterans in the ECUUN Study.
        Med Care. 2017; 55 (Suppl 9 Suppl 2): S43-S49
        • Benjamins M.R.
        • Middleton M.
        Perceived discrimination in medical settings and perceived quality of care: A population-based study in Chicago.
        PLoS One. 2019; 14e0215976
        • van Daalen K.R.
        • et al.
        Racial discrimination and adverse pregnancy outcomes: a systematic review and meta-analysis.
        BMJ Glob Health. 2022; 7
        • American Association of Gynecologic Laparoscopists (AAGL)
        A.B.o.O.G.A., American College of Obstetricians and Gynecologists (ACOG), American College of Osteopathic Obstetricians and Gynecologists (ACOOG), American Gynecological and Obstetrical Society (AGOS), American Medical Women's Association (AMWA), American Osteopathic Board of Obstetrics and Gynecology (AOBOG), American Society for Colposcopy and Cervical Pathology (ASCCP), American Society for Reproductive Medicine (ASRM), American Urogynecologic Society (AUGS), Association of Professors of Gynecology and Obstetrics (APGO), Council of University Chairs of Obstetrics and Gynecology (CUCOG), Council on Resident Education in Obstetrics and Gynecology (CREOG), Infectious Diseases Society for Obstetrics and Gynecology (IDSOG), National Medical Association (NMA), North American Society for Pediatric and Adolescent Gynecology (NASPAG), Society for Academic Specialists in General Obstetrics and Gynecology (SASGOG), Society for Maternal-Fetal Medicine (SMFM), Society for Reproductive Endocrinology and Infertility (SREI), Society for Reproductive Investigation (SRI), Society of Family Planning (SFP), Society of Gynecologic Oncology (SGO).
        Society of Gynecologic Surgeons (SGS), and Society of OB/GYN Hospitalists (SOGH), Joint Statement: Collective Action Addressing Racism. 2020;
        • Thorburn S.
        • Bogart L.M.
        African American women and family planning services: perceptions of discrimination.
        Women Health. 2005; 42: 23-39
        • Peek M.E.
        • et al.
        Adapting the everyday discrimination scale to medical settings: reliability and validity testing in a sample of African American patients.
        Ethn Dis. 2011; 21: 502-509
      2. Committee Opinion No 700: Methods for Estimating the Due Date.
        Obstet Gynecol. 2017; 129: e150-e154
      3. Bureau, U.S.C. Measuring Racial and Ethnic Diversity for the 2020 Census. 2021 August 4, 2021 [cited 2021; Available from:

        • Saha S.
        • et al.
        Patient-physician racial concordance and the perceived quality and use of health care.
        Arch Intern Med. 1999; 159: 997-1004
        • Bird S.T.
        • Bogart L.M.
        Perceived race-based and socioeconomic status(SES)-based discrimination in interactions with health care providers.
        Ethn Dis. 2001; 11: 554-563
        • Kressin N.R.
        • Raymond K.L.
        • Manze M.
        Perceptions of race/ethnicity-based discrimination: a review of measures and evaluation of their usefulness for the health care setting.
        J Health Care Poor Underserved. 2008; 19: 697-730
        • Cockrill K.
        • et al.
        The stigma of having an abortion: development of a scale and characteristics of women experiencing abortion stigma.
        Perspect Sex Reprod Health. 2013; 45: 79-88
        • Elliott A.M.
        • et al.
        Differences in Physicians' Verbal and Nonverbal Communication With Black and White Patients at the End of Life.
        J Pain Symptom Manage. 2016; 51: 1-8
        • Brown K.
        • et al.
        Black Women's Lived Experiences of Abortion.
        Qual Health Res. 2022; 10497323221097622
        • Gonzalez C.M.
        • et al.
        Patient perspectives on racial and ethnic implicit bias in clinical encounters: Implications for curriculum development.
        Patient Educ Couns. 2018; 101: 1669-1675