(1008) The Impact of Discrimination on Perceived Control Over Birth

Friday, January 31, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Dana R. Canfield, MD

Maternal Fetal Medicine Fellow
UC San Diego Health
San Diego, CA, United States

Coauthor(s)

MJ

Marni B. Jacobs, PhD

University of California, San Diego Health
San Diego, California, United States
Emmanuel Elijah, BS (he/him/his)

Medical Student
University of California, San Diego
San Diego, California, United States
KG

Karoline Gutierrez, MD

Resident Physician
University of Miami
Miami, Florida, United States
Minhazur R. Sarker, MD (he/him/his)

Fellow
University of California, San Diego
San Diego, California, United States
Rachel L. Wiley, MD, MPH (she/her/hers)

MFM Fellow
University of California, San Diego
San Diego, California, United States
Elizabeth Nicole Teal, MD, MPH (she/her/hers)

Assistant Professor, Division of Maternal-Fetal Medicine
University of California, San Diego
San Diego, California, United States
Cynthia Gyamfi-Bannerman, MD, MS (she/her/hers)

Professor and Chair
University of California, San Diego
San Diego, California, United States

Objective: While studies have linked patient factors with perceived control over delivery, known as labor agentry, and discrimination to poor maternal outcomes, the impact of discrimination on labor agentry is unknown. We examined the association between discrimination, measured by the Everyday Discrimination Scale (EDS), and labor agentry, measured by the Labor Agentry Scale (LAS) a 29-item Likert-scale response survey in which a higher score corresponds with greater agentry.

Study Design: This a prospective cohort study in which patients were recruited at 27-34 weeks GA from high-risk obstetric clinics and completed surveys on health and lived experience, including the EDS. Following birth, they completed the LAS. The cohort was divided into two groups: those who reported experiencing discrimination (EDS≥1, n=28, 47.5%) and those who did not (EDS=0, n=31, 52.5%). Plausible confounders were assessed (Table 1), and linear regression was used to estimate differences in LAS score based on reported discrimination, controlling for significant variables. Correlation analysis was also performed with EDS as a continuous measure calculated as frequency of reported discrimination.

Results: 59 patients were included. Patients experiencing discrimination were younger and more frequently preferred a non-English language. Mean unadjusted LAS was 166.8 (SD 32.9) for patients who did not experience discrimination and 161.1 (SD 23.2) for those who did. Age and preferred non-English language were included in the final model of discrimination and LAS. None of the factors in our final model were significantly associated with LAS (Table 2). There was a weak but significant negative correlation between EDS score and labor agentry, suggesting as frequency of discrimination increased, labor agentry decreased (ρ = -0.28, p 0.03).

Conclusion:

Patients experiencing discrimination had slightly lower labor agentry when controlling for age and preferred language, with a weak but significant relationship noted between discrimination and agentry. Further studies with larger cohorts are needed to further investigate this relationship.