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

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). 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. 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. 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. Many people of color get treated badly when they visit doctors for birth control. Doctors might be rude to them or make wrong guesses about their personal lives. We tested a survey about how people were treated during birth control visits. The survey was first made in 2003 for Black women, but we wanted to see if it works for more types of people across the United States. We studied answers from people who had talked to doctors about birth control. The questions ask about two things: being treated badly (like being rude or not listening) and unfair assumptions (like wrongly guessing how many kids or sexual partners someone has). People of color faced more unfair treatment than white people. Black people faced the most, especially unfair assumptions about their lives. This survey can help researchers and hospitals spot discrimination in family planning care. It can be used to find problems, test if efforts to improve care are working, and make sure hospitals treat all patients fairly. While this tool cannot stop all unfair treatment by itself, it gives us a way to measure problems and see if things get better over time. The goal is fairer birth control care for everyone.