Inequitable Screening for Pregnancy Intention by Race, Insurance, and Site of Care in Two High-Volume Urban Obstetric Hospitals.

Abstract

Background: In the United States, public health efforts are focused on reducing unintended pregnancy. Yet, differences in rates of unintended pregnancy, abortion, and unintended births by race are driven by a combination of patient-, health system-, and provider-related factors. Despite this complicated scaffolding underpinning pregnancy intention, patients are often screened for pregnancy intention or planning when they have a positive pregnancy test. We hypothesized screening may vary by patient and health system characteristics. Objective: To identify associations between patient and health system characteristics and receiving screening for pregnancy intention or planning. Study Design: We performed a secondary analysis of a retrospective cohort study of all singleton deliveries in 2019 at two Philadelphia hospitals. Our primary outcome was the presence or absence of pregnancy intention screening by the clinical team. We used logistic regression to determine patient and hospital characteristics associated with screening for pregnancy intention. Results: We identified 9,672 deliveries, 48% of births were among Black individuals, 91% were non-Hispanic, and 45% had public or no insurance; of all births, 33% were screened for pregnancy intention or planning. Patients were more likely to be asked if their pregnancy was intended if they were: Black (2.38 [2.10-2.750]) or publicly insured or uninsured (2.78 [2.43-3.20]). The hospital site where the patient received care was the primary driver of whether a patient was asked about pregnancy intention (10.59 [9.35-12.0]). After accounting for the hospital sites, patients of Black race remained significantly more likely to be screened than White patients. Conclusions: Inequities in pregnancy intention or planning screening were driven by differences in institutional practices and patient race. These findings underscore the need for equitable screening practices that ensure all patients receive high-quality, unbiased, and patient-centered reproductive care.