Locked in Perceptions: How Incarceration History Influences Providers’ Perceptions of Patients and Treatment Options

• In Event: 30210 - Shifting Contexts of Clinical Work

Abstract

The incarceration of women in the US has grown more than 7-fold since the 1980s and incarceration has profound implications for women’s health. One potential mechanism linking incarceration to persistent health disparities is stigma, yet it is difficult to find causal evidence of bias during sexual and reproductive healthcare using observational data. This study employs a vignette survey experiment with health service providers (n=150) to understand how incarceration history shapes sexual and reproductive healthcare. Providers assess an otherwise identical patient with endometriosis to be less trustworthy and report less confidence in the patient's expected treatment compliance when the patient has a history of incarceration. Providers rate treatments with greater repercussions for fertility (e.g., hysterectomy and oophorectomy) as more appropriate when the patient has a history of incarceration. When providers are asked to recommend treatments for the patient 26% fewer providers recommended pain medication and 51% more providers recommended a hysterectomy. We find evidence of differential provider perceptions of the patient when the patient has a history of incarceration and that providers report they would pursue different treatment plans. This suggests that the criminal legal system contributes to inequality in fertility and reproductive health.

Authors

• Erin Josephine McCauley, University of California-San Francisco

• Erin Johnson