The largest-ever study of mistreatment during childbirth, published last week in Reproductive Health Journal, confirmed that giving birth in the U.S. is dangerous for all women—and especially dangerous for women of color.
The Giving Voices to Mothers survey was the first to apply World Health Organization’s mistreatment criteria to analyze the experience of maternal care in developed nations, and one of the first public health studies to consider intersectionality in its findings. It also comes on the heels of increased reporting on the racial disparities of the maternal death rate in the U.S. Identifying mistreatment is one powerful step towards saving women’s lives.
In addition to the U.S.’ dismal record on maternal health—the nation has the highest maternal mortality rate in the developed world—this study shows that it also has higher rates of mistreatment than some developing countries. Nearly one in five of the 2,700 women surveyed reported experiencing mistreatment from a healthcare provider. Out of seven types of mistreatment, shouting and scolding were the most commonly reported abuses, followed by being ignored or denied when asking for help.
But even women within the study had increased resources. “What we are showing should have been a better story,” Saraswathi Vedam, lead author of the study and professor of midwifery at University of British Columbia, told Ms. “More people in our study had midwifery care, and delivered at homes or at birth centers which are factors associated with less mistreatment, so it could only be worse than this.”
Black, Hispanic, Asian and Indigenous women were twice as likely as white women to report being ignored or refused by health care providers when asking for help. Indigenous women were the most likely of all to report mistreatment, and women of all backgrounds with black partners were also more likely to report mistreatment.
Women living at the intersections of various risk factors—including race, socioeconomic status and histories of abuse and addiction—were significantly more likely to report mistreatment.
One in three of the women surveyed had incomes below the national average of $50,000, and they were twice as likely to report being threatened or shouted at as women with moderate to high socioeconomic standing. These findings were further complicated by racial disparities: 27.2 of low-income women of color reported abuse, compared to 18.6 percent of low-income white women.
Women with pregnancy complications and with histories of substance abuse, incarceration and/or interpersonal violence reported the highest mistreatment rates. Prior to childbirth, they were also most likely to have reduced access to high quality care—which contributes to increased risks for poorer health outcomes.
While relieved that issues of racism, differential access and inequity are finally part of the conversation, Vedam noted that changes in both policy and cultural attitudes are necessary to improve maternal care in the U.S. “We have to see people not as utereses, or not events or vessels for babies,” she declared. “It is a mother-baby diad.”
Vedam also hopes the study encourages more hospitals to fully integrate midwives into their maternal and prenatal care systems, noting Washington’s successful program, and shift toward a holistic, individualized birthing approach driven by person-centered decision making.
“It’s unacceptable that in a high resource country, we normalize certain ways of behaving and forget that we are interacting with someone at a pivotal moment in their life,” Vedam said. “Birth could be transformational. People could actually gain a sense of power and self confidence and capability—and could move into parenting in that way.”
