Declined care and discrimination during the childbirth hospitalization

Laura B. Attanasio, Rachel R. Hardeman

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Many studies have documented poorer patient-provider interactions among people of color compared to Whites, including lower-quality patient-provider communication, less involvement in decision making, and higher chances of perceived discrimination in healthcare encounters. In maternity care, where overuse of medical interventions such as cesarean delivery is a concern, women may try to exert agency by declining procedures. However, declining procedures may brand these women as uncooperative or non-compliant patients. The potential consequences of this are likely worse for women of color, who already expend more effort to manage their image during healthcare encounters in order to avoid stereotypes (e.g. the “angry Black woman”). Using a national sample of women who gave birth in U.S. hospitals in 2011–2012, we examined the relationship between declining procedures and discrimination during the childbirth hospitalization. We found that women who reported having declined care for themselves or their infant during the childbirth hospitalization were more likely to report “poor treatment” based on race and ethnicity, insurance status or having a difference of opinion with a healthcare provider. Moreover, the increase in odds of perceived discrimination due to a difference of opinion with a healthcare provider was significantly larger in magnitude for Black women compared to White women. These results suggest that in the context of childbirth care, women pay a penalty for exhibiting behavior that may be perceived as uncooperative, and this penalty may be greater for Black women.

Original languageEnglish (US)
Pages (from-to)270-277
Number of pages8
JournalSocial Science and Medicine
StatePublished - Jul 2019

Bibliographical note

Funding Information:
We would like to thank J'Mag Karbeah, MPH for her assistance in revising the manuscript. Dr. Hardeman's role in this research was supported by the National Heart Lung and Blood Institute , National Institutes of Health under award numbers R01HL085631 , R01HL085631-S2 , R01HL085631-S3 . Dr. Hardeman is also supported by the Robert Wood Johnson Foundation Interdisciplinary Research Leaders program .

Publisher Copyright:
© 2019 Elsevier Ltd


  • Childbirth
  • Discrimination
  • Patient-provider interaction
  • U.S.
  • Women of color


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