Investigating the prevalence of medical mistrust amongst pregnant and perinatal women

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SUMMARY / ABSTRACT OF PARENT GRANT Crisis pregnancy centers (CPCs) are non-profit organizations with the mission of supporting pregnant people in not having an abortion. To this end, CPCs offer free services (e.g., urine pregnancy tests, non-diagnostic ultrasounds, and peer counseling on a limited range of pregnancy options) and the opportunity to earn infant- related material items by attending classes. Public funding increasingly plays an important role in CPC functioning. In Ohio, state funding of CPCs increased from $1 million to $7.5 million in 2019. Despite advertising the provision of health procedures and receiving state funding and endorsement, CPCs typically do not employ medical staff and are not licensed as medical facilities. Per a recent U.S. Supreme Court case, CPCs are not compelled to disclose that they are not medical facilities. Professional medical organizations warn of possible health risks of CPCs; however, to date, little research has been conducted on their possible effects. We conducted two preliminary studies in preparation for this project. First, in our population-based survey, we found that attending a CPC is common, with 14% of women 18-45 years of age in Ohio reporting ever CPC attendance. Attendance was more common among non-Hispanic Black people and those of low socioeconomic status. Second, by conducting in-depth interviews with CPC staff and clients, we found that clients often attend the CPC for pregnancy confirmation and some perceived the CPC to be a medical clinic that provides early pregnancy care. This project seeks to quantify health-related outcomes associated with attending a CPC and, among those attending a CPC, disparities in services received. Specifically, we will use survey data to address three aims: 1) To assess whether delayed entry into prenatal care is more common among people who had previously attended a CPC for the current pregnancy relative to non- attendees; 2) To assess whether the pregnancy options counseling provided at CPCs differs by client demographics (e.g., race/ethnicity, marital status, and religion) after controlling for client pregnancy plans before the CPC visit; and 3) To assess the prevalence and patterns of medical mistrust among prenatal patients overall and among the subset who attended a CPC. To address these aims, we will survey 400 patients who recently entered into prenatal care. The sample will include 200 women who had attended a CPC before entering into prenatal care and a comparison group of 200 women who had not attended a CPC before entering into prenatal care. We will use frequency matching for enrollment (age and race/ethnicity) and matching with propensity scores during the analysis to reduce bias. In addition, we will conduct follow-up interviews with 40 participants who express medical mistrust 4) To assess racial differences in the patterns and typology of medical mistrust. While CPC literature has been expanding in recent years, almost no quantitative data has been published on CPC clients. We expect this project will yield fundamental evidence on the possible consequences of CPC attendance among pregnant people.