Research Division, Guttmacher Institute, New York, NY, United States of America.
PLoS One. 2024 Oct 11;19(10):e0312111. doi: 10.1371/journal.pone.0312111. eCollection 2024.
While many frameworks exist for building person-centered and equitable systems of contraceptive care, evidence indicates that the reality of patients' experiences of care is often not in alignment with these ideals. Historical and current contexts of racism in the healthcare system contribute to negative perceptions and experiences of care, as well as reduced care-seeking behavior, for those who identify as Black, Indigenous, and people of color (BIPOC). Our objective in this analysis is to examine whether people's past experiences of contraceptive care are a driver of subsequent barriers to contraceptive access, and whether this relationship differs across racial and ethnic identity. We draw on panel data from five waves of surveys collected between 2018-2023 among patients ages fifteen and older seeking family planning care at sites that receive public funding for these services in Arizona, Iowa, and Wisconsin. Overall and stratified by race/ethnicity, we examine cross-sectional and longitudinal associations between patients' experiences of high-quality, person-centered contraceptive care and three contraceptive access outcomes: use of preferred contraception, satisfaction with contraceptive method, and experience of no barriers to accessing preferred contraception. We find longitudinal associations between patients experiencing higher-quality, more person-centered contraceptive care and subsequent satisfaction with contraceptive methods. Among non-Hispanic white-identifying patients, we find similar associations between shifting to higher-quality contraceptive care and use of preferred contraception, but we find no statistical relationship between experiencing higher-quality care and subsequent contraceptive outcomes for patients who identify as Black, Indigenous, or Person of Color (BIPOC). Highlighting the dissonance between clinical guidance for quality contraceptive care and patient experiences of care, and especially whether similar experiences across racial and ethnic identity lead to differential outcomes, is a crucial step toward bringing contraceptive care systems into alignment with principles of sexual and reproductive health equity.
虽然有许多框架可用于构建以人为本和公平的避孕护理系统，但有证据表明，患者的护理体验现实往往与这些理想不符。医疗保健系统中存在的历史和当前种族主义情况导致那些自认为是黑人、原住民和有色人种（BIPOC）的人对护理的看法和体验负面，以及寻求护理的行为减少。我们在这项分析中的目的是检验人们过去的避孕护理经历是否是随后获得避孕机会的障碍的驱动因素，以及这种关系是否因种族和族裔身份而异。我们借鉴了 2018 年至 2023 年期间在亚利桑那州、爱荷华州和威斯康星州接受公共资金提供这些服务的地点寻求计划生育护理的 15 岁及以上患者的五次调查的面板数据。我们总体上并按种族/族裔进行分层，研究了患者对高质量、以人为本的避孕护理的体验与三种避孕机会获取结果之间的横断面和纵向关联：首选避孕方法的使用、对避孕方法的满意度以及获取首选避孕方法无障碍的体验。我们发现，患者经历更高质量、更以人为本的避孕护理与随后对避孕方法的满意度之间存在纵向关联。在非西班牙裔白人患者中，我们发现从较低质量的避孕护理转变为更高质量的避孕护理与首选避孕方法的使用之间存在类似的关联，但我们发现，对于自认为是黑人、原住民或有色人种（BIPOC）的患者，经历更高质量的护理与随后的避孕结果之间没有统计学关系。强调临床指导的高质量避孕护理与患者护理体验之间的不和谐，尤其是不同种族和族裔身份的患者是否有类似的体验导致不同的结果，是使避孕护理系统与性健康和生殖健康公平原则保持一致的关键步骤。
