Women’s experience of agency and respect in maternity care by type of insurance in California

Declercq, Eugene; Sakala, Carol; Belanoff, Candice

doi:10.1371/journal.pone.0235262

Cited by 27 publications

(28 citation statements)

References 37 publications

(45 reference statements)

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“…Access to community birth is an issue that needs to be addressed. There are both the lack of health insurance coverage for community birth and the very low reimbursement rates at birth centers, which limit birth centers’ ability to care for patients with Medicaid insurance 7,8 . These barriers require a policy response.…”

Section: Can We Influence Decisions About Where To Give Birth In the ...mentioning

confidence: 99%

Systematic Reviews to Inform Practice, July/August 2022

Barger¹

2022

J Midwife Womens Health

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Section: Can We Influence Decisions About Where To Give Birth In the ...mentioning

confidence: 99%

Systematic Reviews to Inform Practice, July/August 2022

Barger¹

2022

J Midwife Womens Health

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“…3 Mistreatment was more common among women of color, including Black, Hispanic, Indigenous, and Asian women, and especially low-income women of color-27% of whom reported mistreatment-compared with lowincome white women (19%). 3 In California, women with Medi-Cal (California's Medicaid) coverage, who are disproportionately Black or Latina, 6 are more likely than women with private insurance to report unfair treatment on the basis of race or ethnicity (6.5% versus 2.3%, respectively), language spoken (7.4% versus 1.7%), and--among English speakers especially--insurance status (9.0% versus 0.7%) during their intrapartum and postpartum hospital visit. 6 Experience of mistreatment and racism can be a deterrent to seeking maternity care, which further perpetuates health inequities.…”

Section: Introductionmentioning

confidence: 99%

“…3 In California, women with Medi-Cal (California's Medicaid) coverage, who are disproportionately Black or Latina, 6 are more likely than women with private insurance to report unfair treatment on the basis of race or ethnicity (6.5% versus 2.3%, respectively), language spoken (7.4% versus 1.7%), and--among English speakers especially--insurance status (9.0% versus 0.7%) during their intrapartum and postpartum hospital visit. 6 Experience of mistreatment and racism can be a deterrent to seeking maternity care, which further perpetuates health inequities. 11,12 Moreover, racism can affect medical decision making 13 and provider-patient communication, 14 which may result in medical emergencies being overlooked.…”

Section: Introductionmentioning

confidence: 99%

“…All childbearing individuals have the right to person‐centered maternity care including, respectful care and freedom from mistreatment 1,2 encompassing abuse, discrimination, neglect, or failure to provide adequate care 3–5 . Yet, not all pregnant persons experience respectful care or are free from mistreatment 3,5–7 . Respectful care safeguards a birthing person’s dignity and privacy, protects against mistreatment, and facilitates informed choice 2 .…”

Section: Introductionmentioning

confidence: 99%

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The role of doulas in respectful care for communities of color and Medicaid recipients

Mallick

Thoma

Shenassa

2022

Birth

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Background Despite the tenets of rights‐based, person‐centered maternity care, racialized groups, low‐income people, and people who receive Medicaid insurance in the United States experience mistreatment, discrimination, and disrespectful care more often than people with higher income or who identify as white. This study aimed to explore the relationship between the presence of a doula (a person who provides continuous support during childbirth) and respectful care during birth, especially for groups made vulnerable by systemic inequality. Methods We used data from 1977 women interviewed in the Listening to Mothers in California survey (2018). Respondents who reported high levels of decision making, support, and communication during childbirth were classified as having “high” respectful care. To examine associations between respectful care and self‐reported doula support, we conducted multivariable logistic regressions. Interactions by race/ethnicity and private or Medi‐Cal (Medicaid) insurance status were assessed. Results Overall, we found higher odds of respectful care among women supported by a doula than those without such support (odds ratios [OR]: 1.4, 95% CI: 1.0–1.8). By race/ethnicity, the association was largest for non‐Hispanic Black women (2.7 [1.1–6.7]) and Asian/Pacific Islander women (2.3 [0.9–5.6]). Doula support predicts higher odds of respectful care among women with Medi‐Cal (1.8 [1.3–2.5]), but not private insurance. Conclusions Doula support was associated with high respectful care, particularly for low‐income and certain racial/ethnic groups in California. Policies supporting the expansion of doulas for low‐income and marginalized groups are consistent with the right to respectful care and may address disparities in maternal experiences.

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“…Full details of the survey methodology are available elsewhere [34]. Data from this survey have previously been used to examine women's experiences in intrapartum care [35][36][37][38]. This study is not considered human subjects research, as it uses publicly available, de-identified data.…”

Section: Introductionmentioning

confidence: 99%

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

2021

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Objective Postpartum 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 design Data 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. Results 90.6% 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%). Conclusions Amid 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.

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Women’s experience of agency and respect in maternity care by type of insurance in California

Abstract: Objective Public insurance (Medicaid) covered 42% of all U.S. births in 2018. This paper describes and analyzes the self-reported experiences of women with Medicaid versus commercial insurance relating to autonomy, control and respectful treatment in maternity care.

Cited by 27 publications

References 37 publications

Systematic Reviews to Inform Practice, July/August 2022

Systematic Reviews to Inform Practice, July/August 2022

The role of doulas in respectful care for communities of color and Medicaid recipients

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

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