Apparently socioeconomic factors determine who has an epi - things like race, income and level of education, and not necessarily insurance coverage - and researchers determined that nearly one fifth of women from the poorest neighborhoods were "41 percent less likely to have an epidural" than their more wealthy counterparts.
The study noted that epidural use was less frequent at smaller community hospitals than at larger teaching hospitals, but weren't sure why this income and education disparity was also common at those smaller hospitals. I can venture a guess that perhaps doctors at smaller facilities had less access to an on-call anesthesiologist and thus had lower epidural rates overall, perhaps.
I have a couple of problems with this study. Namely, were these poorer women first-time mothers? Had they labored previously? Do we really know WHY these women refused an epi, or are researchers just speculating? I think, if nothing else, the perceived take home message of this study is going to be that "women are dumb if they refuse an epidural." They're already often treated that way by medical professionals and other women.
One part of the study caught my attention: "Women with more education may know more about epidurals and be more open to having one," the study speculates. That part makes me laugh - because if anyone really knew about epidurals and their risks, they'd probably NEVER want one.
Perhaps these women had supportive female family members who raised them with the belief that childbirth is painful, but worth it. That your body can handle it. That it's often just something we innately do as women and then we move on. Not, "You're gonna need that epidural, honey!"
Less education should not imply no education, though. And they didn't specify to what degree these women were educated. One thing that strikes me, though, is those seemingly "disadvantaged" women were probably better off in the long run and might have had a better birth experience overall. It also proves that more education is not necessarily better.