Quantitative Analysis of Racial Bias and Care Experience for Mothers in Prenatal Care

Background: A profound racial disparity between black and white infant mortality rate due to higher rates of prematurity has persisted over years without identifiable etiology. Qualitative data documents poor care experiences but quantitative data is lacking.

Methods: Our study employed a prospective cross-sectional design occurring at prenatal care sites using a compilation of validated surveys: Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group (CG) and Cultural Competence (CC), Expanded Everyday Discrimination Survey (EEDS) in two tertiary OBGYN hospital-based health centers.

Results: Of 404 participants, 47.0% were black and 40.8% were white with significant differences in education, income, and maternal tobacco use (Table 1). Considering care engagement, black patients were more likely to have a longer history with their provider, see their usual provider, receive timely care, but were more likely to have negative communication experiences and less trust in their providers (Table 1). Although those reporting racial discrimination in their daily life were more likely to be black, there was no difference in race for those who reported racial discrimination in clinic (Table 2). Those black and white patients who experienced racial discrimination in clinic, rated trust in their provider in the lower quartile as well as the provider’s quality (Table 2). They also reported negative communication and were less likely to report access to timely care. In multivariate analyses, controlling for race, those who reported racial discrimination in clinic were less likely to experience positive communication, more likely to report negative communication, report lower ranking of trust in and quality of their providers. However, no association was found between experiencing racial discrimination in clinic and experiencing discrimination in daily life due to race or any cause, seeing their usual provider, seeing their provider more frequently, having a longer relationship with their provider, or personal health ratings

Conclusion: Black and white patients have distinct care experiences within the same prenatal care sites. To minimize racial discrimination in clinics, we must address effective communication strategies and development of trust in the clinic. Further research is needed to increase the sample size and with a complementary qualitative study to provide for a deeper understanding of the expectant mothers’ experiences.