(156) Fear of childbirth among pregnant women: Sociodemographic and discrimination influences in a community sample

Objective:
Tokophobia, high levels of fear of childbirth, is associated with worse maternal and perinatal outcomes. Emerging data suggest that women from marginalized sociodemographic groups are at higher risk for tokophobia. In the current study we examined the role of discrimination in the occurrence of tokophobia which has not been documented in the U.S.

Study Design:
The study included 206 women in the first trimester that were recruited 9/2023-1/2025 at outpatient clinics affiliated with a New York academic medical center. Participants completed a survey including the Everyday Experiences Scale, Discrimination in Medical Settings Scale, and the Fear of Birth Scale. A cutoff score of ≥54 was used to identify tokophobia. Analysis included t tests, Chi-square, and multivariable logistic regression using SPSS 29.0.

Results:
Participants included n=92 (44.7%) nulliparous patients and n=58 (29.9%) reported fear of birth levels indication tokophobia. Additional sample characteristics are in Table 1. Higher rates of tokophobia were observed among nulliparous compared to multiparous participants (45.9% vs. 17.4%)(X²(1)=18.5, p< 0.001). Tokophobia was not associated with any of the sociodemographic factors (Table 1) however, it was associated with significantly higher frequency of everyday discrimination experiences in the past year (p=0.04) and higher frequency of experiences of discrimination in medical settings (p=0.01) (Figure 1). After controlling for parity, frequency of experiencing discrimination in medical settings was associated with double the risk of tokophobia (aOR 2.1; 95% CI 1.2-3.7). General discrimination was not associated with tokophobia after controlling for parity.

Conclusion:
Past experience of discrimination, particularly in medical settings, increases the risk of tokophobia highlighting the importance of patient-centered, culturally sensitive care Future research in diverse samples should examine whether higher rates of tokophobia among Black pregnant women that were observed in other studies is attributable to experiences of discrimination in medical settings.