Black Adolescent Females’ Perceptions of Racial Discrimination When Accessing Reproductive and General Health Care

Abstract

The Institute of Medicine defines health disparities as "racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention" (Smedley, Stith, & Nelson, 2003). In this case, discrimination at the individual patient-provider level is thought to manifest as differences in care resulting from biases, prejudices, and stereotyping in clinical communication and decision making. There is evidence that patients who perceive racial discrimination are more likely to report adverse health outcomes. Previous work has found that minority adults who report ever experiencing discrimination, being prevented from doing something, being hassled, or made to feel inferior in various situations have greater physical and psychiatric symptoms than their counterparts who did not report this experience (Borrell, Kiefe, Williams, Diez-Roux, & Gordon-Larsen, 2006). In addition, individuals who report experiencing discrimination at any time during their lifetime have been found to have poor adherence to treatment, worse health outcomes, and delays in seeking medical care (Casagrande, Gary, LaVeist, Gaskin, & Cooper, 2007). The work of Dr. David Williams (2012) and others has continued to demonstrate a clear relationship between minority race and poorer health outcomes. Racial inequities and disparities are evident in the timing of disease onset (earlier for minorities), severity and progression of disease (more severe for minorities), the effects of some risk factors (less exposure to the risk factor has a greater impact on minorities), and the persistence of health disparities over time (resulting in a lower life expectancy for minorities vs. non-minorities). Racial discrimination is reported frequently by African American adolescents, similar to their adult counterparts (Fisher,

Racism in Health Services for Adolescents: A Scoping Review

“…In some cases, racism was explored in relation to other forms of oppression. For example, 4 articles explored sexism, 50,57,58,61 2 articles examined classism, 50,61 and one article addressed colorism. 57…”

“…Racism was most commonly examined in general health care such as check-up visits with general practitioners ( n = 5; 38%) 20,53,60–62 including both general mental health care 52 and psychiatric counseling and care 54,56,58,62 (see Table 2). Racism was explored in a variety of other health care settings but with less frequency, including reproductive health, 50,57 autism diagnosis and care, 51 vaccine access and uptake, 53 medical research on vaccines, 53 pediatrician services, 55 and school health services. 62 Across these health care contexts, interpersonal racism between health practitioners and youth was most explored.…”

“…60 Patients also shared their perception of receiving less respect from health professionals or receiving “unfair” treatment when accessing or using services. 20,55,57 Although past examples of systemic racism in health care are well known, only 2 (15%) of the 13 included articles 53,58 drew a direct connection between systemic and historical racism in health care and diminished trust of the healthcare system.…”

“…72 In several studies, health care providers were viewed as gatekeepers to treatment 52,54 and directly contributing to (in)equitable care and treatment based on antecedent racial biases. 50,54,57,61 The impact of health care provider bias on provider-patient interactions and clinical judgment are well-documented in the literature. 27,73,74 In this way, our review indicates a current emphasis on interpersonal racism in the extant literature.…”

Veterans’ perceptions of racial bias in VA mental healthcare and their impacts on patient engagement and patient-provider communication

“…Studies have also shown that contextual factors, such as levels of historical knowledge of racism, previous past experiences of racism, and diversity policies, shape individuals' perceptions of racism [56][57][58][59]. For example, Blacks tend to compare racial progress to ideal standards of equality, while Whites tend to compare racial progress to the past, considering how much things have improved.…”