Racial Discrimination in Family Planning Settings: Measurement, Care Quality, and Autonomy in the U.S. South Restricted; Files Only
Luke, Alina (Spring 2026)
Abstract
In reproductive healthcare, discriminatory experiences reduce an individual's ability to achieve reproductive autonomy. Understanding how discrimination operates in these settings and its relationship to health and healthcare outcomes is essential. Research shows that providers demonstrate bias in their interactions with patients and that people of color receive lower-quality care than their white peers. This dissertation seeks to validate a measure of discrimination in family planning settings and examine the relationship between racial discrimination in these settings and person-centered contraceptive care and contraceptive autonomy. I utilized Levesque's patient-centered access to care framework as well as a reproductive justice lens to guide the study design, analysis, and interpretation.
Data for the first study came from the nationally representative Person-Centered Contraceptive Access Metrics Survey (n=3,059). I performed exploratory factor analysis and tested reliability and known-groups validity. I identified two factors (general and stereotype-based discrimination) and retained seven scale items. The measure demonstrated strong reliability (coefficient omega 0.97) and goodness-of-fit (TLI=0.988, RMSEA=0.066).
The second and third studies used cross-sectional data from a sample of people of color in the U.S. South who may become pregnant and sought family planning services in the past year (n=335). Aim 2 assessed the relationship between lifetime racial discrimination in family planning settings and person-centered contraceptive counseling (PCCC). Over two-thirds of respondents reported at least one type of discrimination, which was associated with receiving person-centered contraceptive counseling, with each one-unit increase in mean discrimination score associated with 74% lower adjusted odds of excellent PCCC. In Aim 3, I examined the relationship between the discrimination measure and use of preferred contraceptive method and satisfaction with one's current method. For each one-unit increase in mean discrimination score, use of preferred method had 51% lower odds, and higher method satisfaction had 35% lower odds.
Lifetime experiences of racial discrimination in family planning settings are common, especially among people of color in the U.S. South. These experiences are consequential and strongly tied to the quality of family planning care and to the enactment of contraceptive autonomy. Multilevel intervention is called for, including trauma-informed care approaches, structural competency, and institutional and governmental policy changes.
Table of Contents
Table of Contents
Chapter 1. Introduction 1
Introduction 1
Theoretical and Conceptual Frameworks 3
Discrimination in Healthcare Settings 14
Measurement of Discrimination in Family Planning Settings 24
The U.S. South Context 28
Person-Centered Contraceptive Care 37
Contraceptive Autonomy 41
Gaps in the Literature 45
Dissertation Overview and Aims 47
References 50
Chapter 2. Experiences of Discrimination in Reproductive Healthcare: A Psychometric Evaluation of a Discrimination Measure for Family Planning Settings 66
Abstract 66
Background 68
Methods 73
Results 78
Discussion 88
Conclusions 96
References 97
Appendix 102
Chapter 3. Lifetime Experiences of Racial Discrimination and Person-Centered Contraceptive Care in Family Planning Settings in the U.S. South 104
Abstract 104
Introduction 106
Methods 110
Results 115
Discussion 125
References 132
Appendix 138
Chapter 4. Lifetime Experiences of Racial Discrimination and Contraceptive Autonomy Outcomes Among People of Color in the U.S. South 139
Abstract 139
Introduction 141
Methods 144
Results 150
Discussion 158
References 165
Appendix 169
Chapter 5: Conclusion 170
Introduction 170
Summary of Findings 170
Strengths and Limitations 172
Implications and Future Directions 176
Conclusion 183
References 185
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File download under embargo until 27 May 2032 | 2026-04-02 15:05:28 -0400 | File download under embargo until 27 May 2032 |
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