Disparities in Autonomy during Pregnancy in Canada: Findings from the national RESPCCT Study
Bibliographic record
Abstract
ABSTRACT Background Very little is known about how childbearing people in Canada experience decision-making during pregnancy, and whether experiences of autonomy differ by personal characteristics and context of care. Methods Using national survey data, we examined associations between autonomy (measured with the validated My Autonomy in Decision-Making (MADM) scale and 1) participant characteristics, and 2) contextual factors including timing of prenatal care initiation, and length of appointments. We calculated the odds of high autonomy and 95th confidence intervals among subgroups, controlling for pregnancy year, repeat observations, and gravidity. Analyses were stratified by provider type (midwives or physicians). Findings A total of 5389 participants reported 7049 interactions with healthcare providers in Canada between 2009 and 2022. The odds of high autonomy were significantly lower among Indigenous (AOR=0.73; 95 % CI: 0.59-0.90) and Middle Eastern participants (AOR=0.57; 95 % CI: 0.39-0.83), among younger participants (≤25 years; AOR=0.47, 95 % CI: 0.36-0.62), and people with a disability (AOR=0.77, 95 % CI: 0.61-0.98), lower educational attainment (AOR=0.37, 95 % CI: 0.27-0.50), and insufficient income (AOR=0.47, 95 % CI: 0.36-0.62). In addition, participants who identified as recent immigrants (AOR=0.60, 95 % CI: 0.37-0.97), and people needing two or more social services during pregnancy (AOR=0.33, 95 % CI: 0.22-0.50), with high risk pregnancies (AOR=0.46, 95 % CI: 0.39-0.0,54), pre-pregnancy BMI > 30 (AOR=0.78, 95 % CI: 0.66-0.91), history of substance use disorder (AOR=0.68, 95 % CI: 0.49-0.95) and higher levels of discrimination (AOR=0.69, 95 5 CI: 0.57-0.83) were less likely to report high autonomy. Factors associated with higher odds of autonomy included midwifery (versus physician care), early entry into prenatal care, sufficient appointment time, and access to a preferred prenatal provider. Conclusions Minoritized and socioeconomic disadvantage participants reported significantly less autonomy. These differences persisted across models of care, indicating structural inequities in person-centered care during pregnancy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".