Experiences of discrimination in reproductive healthcare: a psychometric evaluation of a discrimination measure for family planning settings.

BACKGROUND

Experiences of discrimination in healthcare settings contribute to inequities in healthcare access and outcomes. Black, Latina, and Indigenous communities have lower levels of trust in reproductive healthcare due to a longstanding history of abuses. In this context, discriminatory behaviors by providers may be particularly problematic. This study aimed to test the psychometric properties of a nine-item measure of lifetime experiences of discrimination in family planning settings developed by Thorburn Bird and Bogart (2003).

METHODS

Data came from the nationally representative Person-Centered Contraceptive Access Metrics Survey (unweighted N = 3,059). We performed exploratory factor analysis using principal axis extraction and Promax rotation, assessed reliability using coefficient omega, and employed weighted linear regression to test known-groups validity.

RESULTS

We identified two factors and retained seven scale items. The two factors, general healthcare discrimination and stereotype-based discrimination, were consistent with the scale’s original 2005 validation with African American women. The measure demonstrated strong reliability (coefficient omega 0.97) and goodness-of-fit (TLI = 0.988, RMSEA = 0.066). Known-groups validity testing indicated that people of color experienced higher levels of discrimination in family planning settings compared to white respondents.

CONCLUSIONS

This updated validation with a nationally representative sample confirms the scale’s utility for assessing discrimination in family planning settings and identifying the relationship with healthcare outcomes. The measure provides a tool to support research on the prevalence of discrimination and its impact on reproductive autonomy, including preferred method use and access to care. The scale may aid the assessment of clinic procedures and interventions promoting equitable access to high-quality reproductive healthcare.