Mothers of colour experience high rates of mistreatment by providers during childbirth

Mothers of colour experience less respect and autonomy and more mistreatment than white women during childbirth, according to new research from the University of British Columbia.

In a study published today in Reproductive Health, community members worked with researchers to survey 2,700 women across the United States on their experience of care during childbirth. While 17 per cent of all women reported experiencing one or more types of mistreatment, incidents of mistreatment were higher for women of colour.

The study is the largest looking at mistreatment during childbirth. Mistreatment included verbal abuse, stigma and discrimination, failure to meet professional standards of care, delays and refusals of care and poor rapport between women and health-care providers and health system conditions and constraints.

"Until now, most of the studies on respectful care in pregnancy and childbirth have been carried out in low-resource countries," said lead author Saraswathi Vedam, professor of midwifery in the UBC faculty of medicine. "This study shows that mistreatment is also a problem in high-resource countries, and that in the U.S., people of colour face significantly higher rates of mistreatment. We know that there are more adverse maternal and newborn outcomes in black and Indigenous communities, but until now we have not explored these factors as linked to quality of care."

Researchers worked with a diverse group of women who had recently given birth, to develop the survey questions for the study. They identified areas that have not previously been examined such as non-consented care, responsiveness of health-care providers and access to options for care. After conducting the survey, the researchers quantified the prevalence of mistreatment by race, socioeconomic demographics and how and where women gave birth.

"Our findings suggest that there is a huge equity problem when it comes to women's childbirth experiences in the U.S.," said Vedam, who also has a faculty appointment in the school of population and public health at UBC. "Poor treatment due to institutional racism, implicit bias and lack of access to models of care such as midwives and home birth, mean that childbirth is a very different experience for women of colour."

Among mothers with low socioeconomic status, 18.7 per cent of white women reported mistreatment compared to 27.2 per cent of women of colour. Indigenous women were the most likely to report experiencing at least one form of mistreatment by health-care providers, followed by Hispanic and black women. Being shouted at or scolded by a health-care provider was the most commonly reported type of mistreatment, followed by delaying or refusing requests for care. Delays and refusals are particularly significant given that black birthing mothers in the U.S. and their babies have the highest rates of death from pregnancy-related complications.

The researchers found that women were less likely to experience mistreatment if they were white, had a vaginal birth, gave birth at home or in a freestanding birth centre (not a hospital), had a midwife and/or were older than 30.

As stated by birthing families that responded to the U.S. study can be found at the Birth Place Lab website.

Vedam is currently examining experiences of pregnancy and birth care, particularly in disadvantaged populations, across Canada.

The study was co-authored by researchers from UBC, the University of California Davis School of Medicine, the University of California San Francisco, Oregon State University, Bastyr University and Boston University, as well as from Every Mother Counts in New York City and Young Women United in Albuquerque, New Mexico. It was funded by the New Hampshire Charitable Foundation Transforming Birth Fund.

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