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

      Abstract

      Objective

      : 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.

      Results

      : 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).

      Conclusion

      : 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.

      Implications

      : 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.

      Keywords

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