We cannot fix the maternal mortality problem without fixing the human rights problem at its core.
Awareness of the U.S. maternal health crisis has increased—but a parallel crisis of human rights violations against pregnant and postpartum people remains invisible or misunderstood. By convening two People’s Tribunals to End Obstetric Violence and Obstetric Racism before the end of the year, we aim to change that. The first will happen on Oct. 6 in New York City at the NYU Law School, and the second on Dec. 1 in Memphis, at BRIDGES USA.
We first connected in 2021 after I, Dr. Scott, developed and validated the first and only valid quality instrument to name obstetric racism as an adverse event, and to demonstrate how obstetric racism violates obstetric quality and patient safety among Black mothers and birthing people and their given and chosen kin.
The Patient Reported Experience Measure of Obstetric Racism, also known as the PREM-OB Scale suite, translates the dimensions of and responses to obstetric racism—first defined by anthropologist, doula and public health scholar Dána-Ain Davis—into three independent yet related scores: humanity, kinship and racism, specifically anti-Black racism and anti-Black gendered racism.
We collected data on the 2020 birth experiences of 806 Black mothers and birthing people, representing 348 hospitals across 34 states, including Washington, D.C. Each score varied significantly by socioeconomic factors previously shown to be associated with experiences of racism, including income and education levels.
However, each score of obstetric racism did not vary by self-reported clinical characteristics, including maternal BMI, gestational age and birth type (for example, vaginal or cesarean birth)—demonstrating that the PREM-OB Scale measures obstetric racism independent of clinical risk. Thus, hospital acts of harm as defined by patient-reported experiences of obstetric racism occurred regardless of individual, patient-level characteristics or outcomes.
More importantly, our data demonstrated the ongoing inhumane acts committed against Black mothers and birthing people by hospital clinicians and staff.
Black mothers and birthing people who agreed or strongly agreed with the statement, “The hospital made me feel that because my baby and I survived birth, my experiences in labor, birth, and postpartum did not matter,” were six times more likely to experience disrupted kinship and anti-Black racism and gendered racism, and more than eight times more likely to experience hospitals acts of dehumanization.
Birthing in a community with a support person who is not affiliated or aligned with a hospital significantly decreased hospital acts of obstetric racism across all three independent scores of humanity, kinship and racism, our 2023 publication showed. The decrease in hospital acts of obstetric racism remained significant, even after we controlled for the effect of the relationship status of the Black mother and birthing person.
Our data confirmed a widely unaccepted truth: There is an unrecognized, predictable and preventable manufactured crisis of obstetric racism in this country. I hoped this new data would alarm people in positions of power throughout U.S. hospitals, insurance companies, quality experts and maternity-paternal healthcare professionals to make change—but I knew this alone was not enough. That’s when I connected with Indra Lusero, a human rights attorney with expertise in this field.
I, Indra Lusero, was glad to be connected with Dr. Scott, but was discouraged to report that the pathways for accountability for obstetric racism in the U.S. were slim to non-existent.
In July 2020, I was part of a National Call for Birth Justice and Accountability, where we took out an ad in the NYT framing the maternal health crisis as a human rights crisis linked to the racial reckonings of that summer. The letter we wrote called for among other things, “mechanisms that hold health systems and government accountable for incidents of obstetric violence, mistreatment and human rights violations in childbirth.” It was not clear at the time what those mechanisms could be.
Latin American activists popularized the term “obstetric violence” in the 1990s to call attention to human rights abuses during childbirth. This led to laws across Latin America oriented toward “humanization” of birth, including the first law against obstetric violence specifically (passed in Venezuela in 2007).
Indeed, this is a global issue, as recognized by the U.N. in the 2019 Report of the U.N. Special Rapporteur on Violence Against Women, and made visible by researchers like Dr. Scott, who have worked to categorize and measure these harms. The Giving Voices to Mothers Study released in 2019 confirmed the findings of the U.N. report in the U.S. context: One in six reported experiencing mistreatment, and the rate went up to one in three for people of color.
But I knew that categorizing and measuring these harms was not enough. Efforts to push back through litigation based on individual cases had proven insufficient. (Also, in 2019, a New York court delivered one of its worst decisions in the case of Rinat Dray, who was forced into a C-section, despite explicit refusal noted in her chart.)
Dr. Scott’s insistence that there ought to be a better way catalyzed our effort to call upon the federal Office for Civil Rights within the Department of Health and Human Services to use its power to enforce federal civil rights laws that protect people from unlawful discrimination in health services. Together with over two dozen other experts, we wrote a legal brief, “Mobilizing the Office for Civil Rights’ Authority to Address Obstetric Violence and Obstetric Racism,” and delivered it to the office in July of 2022.
Around that same time, we started planning these tribunals, inspired by the work of Giré, a human rights group in Mexico. We knew our academic research and legal arguments could not go as far as individual stories. We both know personally the motivating impact that even one story of obstetric racism or obstetric violence can have.
People universally feel it in their gut. “This is not okay. This is not okay,” is our mantra, motivating our work and leading us to bring together over two dozen speakers, with their own stories of obstetric racism or obstetric violence, to proclaim to their community with the support of a human rights panel who will amplify it. This happened, and it was not okay.
We ask you to take note, tune in, attend in person and share the invitation with policymakers, hospital administrators, health insurance executives and risk managers. Help us ensure that attention to the maternal health crisis is not wasted on hand wringing, minor clinical modifications, or increased implicit bias training, but instead goes to the root.
We cannot fix the maternal mortality problem without fixing the human rights problem at its core.
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