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Recording available 2/16-5/2
Recording available 2/16-5/2
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Abstract Award
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Poster Session 1

Category: Health Equity/Community Health

Poster Session 1

(149) Shifting Power Dynamics: Can Enhanced Prenatal Care Models Reduce Experiences of Race- and Ethnic-Based Discrimination?

Wednesday, February 11, 2026
10:30 AM - 12:00 PM  

    Submitting Author(s)

  • Brittany D. Chambers Butcher, MPH, PhD (she/her/hers)

    Associate Professor
    Department of Human Ecology, College of Agricultural and Environmental Sciences, University of California, Davis
    Davis, California, United States

    • Coauthor(s)

  • JJ

    Jessica Johnston, MPH

    Data Analyst
    Department of Human Ecology, College of Agricultural and Environmental Sciences, University of California, Davis
    Davis, California, United States

  • Patience A. Afulani, MBCHB, MPH, PhD (she/her/hers)

    Associate Professor
    Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
    Universiy of California San Francisco, California, United States

    • Presenting Author(s)

  • Bridgette Blebu, PhD, MPH (she/her/hers)

    Assistant Professor
    Lundquist Institute for Biomedical Innovation - Harbor-UCLA
    Los Angeles, California, United States

    • Coauthor(s)

  • KC

    Kristin Carraway, MPH

    Project Manager
    Central Valley Health Policy Institute at California State University, Fresno
    Fresno, California, United States

  • KC

    Kimberly Coleman-Phox, MPH

    Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
    San Francisco, California, United States

  • JF

    Jennifer N. Felder, PhD

    Associate Professor
    Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
    San Francisco, California, United States

  • MG

    Mary A. Garza, MPH, PhD

    Central Valley Health Policy Institute at California State University, Fresno
    Fresno, California, United States

  • DK

    Deborah Karasek, MPH, PhD

    Assistant Professor
    Oregon Health & Science University-Portland State University School of Public Health
    Portland, Oregon, United States

  • Daisy León-Martínez, MD (she/her/hers)

    Assistant Professor
    Division of Maternal-Fetal Medicine at the University of California San Francisco
    University of California San Francisco, California, United States

  • CM

    Charles E. McCulloch, BA, MA, MS, PhD

    Professor
    University of California, San Francisco
    University of California San Francisco, California, United States

  • VC

    Venise Curry, MD

    Central Valley Health Policy Institute at California State University, Fresno
    Fresno, California, United States

  • Miriam Kuppermann, MPH, PhD (she/her/hers)

    Professor
    Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
    University of California San Francisco, California, United States

Objective:
To determine whether participation in enhanced group prenatal care (eGPC) reduces experiences of discrimination.

Study Design:
The EMBRACE (Engaging Mothers & Babies; Reimagining Antenatal Care for Everyone) Study is a pragmatic two-armed randomized comparative effectiveness trial of the effect of eGPC versus enhanced Individual prenatal care (eIPC) on depression, patient care experiences, and preterm birth, among Medi-Cal eligible pregnant people in California. The primary outcome of this analysis is self-reported experiences of discrimination based on race/ethnicity/color as measured by the 9-item Discrimination in Medical Settings (DMS) scale (scores ranging 0-4). We employed intent-to-treat principles (ITT) for the primary analysis and secondary analyses based on eGPC and eIPC attendance ( >1 visit;4 visits) and Black and Latine racial/ethnic identity (n=554). Qualitatively trained staff and community members gathered and analyzed qualitative data to support ITT findings among a subsample of 52 Black and Latine participants through audio-recorded and professionally transcribed interviews.

Results:
Over 84% of participants identified as Latine. Participants assigned to eGPC (0.97/4) vs. eIPC (1.1 /4) reported similar DMS scores; however, Black participants (2.1/4) reported higher DMS scores than Latine participants (0.92/4) during prenatal care. Adjusting for language, education, prior pregnancy complications, and prior experiences of DMS, there were no significant differences in occurrences of DMS during prenatal care between eGPC vs. eIPC [aMR: 0.01; CI: -0.37,0.39]. Subgroup analysis suggests eGPC maybe protective for Latine participants. Qualitative data provide insights on potential drivers for experiences of DMS, for example: Patient’s autonomy being overshadowed by provider’s judgement and inattentiveness.

Conclusion:
Findings underscore the lingering effects of institutional racism impacting the quality-of-care Black birthing people receive. Given the limited sample of Black birthing people, this study should be replicated with Black-centered eGPC models.