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

Laura B Attanasio,Kimberley H Geissler,Brittany L Ranchoff,Frank T Spradley

doi:10.1371/journal.pone.0253055

Laura B Attanasio, Kimberley H Geissler + Show 2 more

Open Access

https://doi.org/10.1371/journal.pone.0253055

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Journal: PloS one	Publication Date: Jun 23, 2021
Citations: 13	License type: CC BY 4.0

Affiliation: University of Massachusetts Amherst

Abstract

ObjectivePostpartum 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 designData 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.Results90.6% 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%).ConclusionsAmid 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.

Highlights

For the nearly four million people that give birth in the United States each year [1], attending a comprehensive postpartum visit provides an important opportunity to address health issues resulting from pregnancy and birth, develop a management plan for any chronic conditions, and foster health promotion [2]
A 2018 statement from the American College of Obstetricians and Gynecologists (ACOG) reconceptualizes postpartum care as a continuum, a “comprehensive” postpartum visit is recommended by 12 weeks postpartum [3]
Previous research has shown that reasons for not attending a postpartum visit include not feeling that more care is needed, being busy with other things including caring for a newborn, as well as access barriers such as not having insurance or transportation to the appointment [10,11,12,13]

Summary

Introduction

Previous research has shown that women of color, uninsured women, younger women, women with lower socioeconomic status, and women with delayed prenatal care are less likely to attend postpartum visits [4,7,8,9]. Women who experienced discrimination during the childbirth hospitalization were less likely to attend a postpartum visit in a national survey of women who gave birth in 2011–2012 [19]. This association has not been confirmed in a populationbased sample or in more recent years

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