The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States

Abstract

Background Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)–US study. Methods Our multi-stakeholder team distributed an online cross-sectional survey to capture lived experiences of maternity care in diverse populations. Patient-designed items included indicators of verbal and physical abuse, autonomy, discrimination, failure to meet professional standards of care, poor rapport with providers, and poor conditions in the health system. We quantified the prevalence of mistreatment by race, socio-demographics, mode of birth, place of birth, and context of care, and describe the intersectional relationships between these variables. Results Of eligible participants ( n = 2700), 2138 completed all sections of the survey. One in six women (17.3%) reported experiencing one or more types of mistreatment such as: loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help. Context of care (e.g. mode of birth; transfer; difference of opinion) correlated with increased reports of mistreatment. Experiences of mistreatment differed significantly by place of birth: 5.1% of women who gave birth at home versus 28.1% of women who gave birth at the hospital. Factors associated with a lower likelihood of mistreatment included having a vaginal birth, a community birth, a midwife, and being white, multiparous, and older than 30 years. Rates of mistreatment for women of colour were consistently higher even when examining interactions between race and other maternal characteristics. For example, 27.2% of women of colour with low SES reported any mistreatment versus 18.7% of white women with low SES. Regardless of maternal race, having a partner who was Black also increased reported mistreatment. Conclusion This is the first study to use indicators developed by service users to describe mistreatment in childbirth in the US. Our findings suggest that mistreatment is experienced more frequently by women of colour, when birth occurs in hospitals, and among those with social, economic or health challenges. Mistreatment is exacerbated by unexpected obstetric interventions, and by patient-provider disagreements. Electronic supplementary material The online version of this article (10.1186/s12978-019-0729-2) contains supplementary material, which is available to authorized users.

Racism, Bias, and Discrimination as Modifiable Barriers to Breastfeeding for African American Women: A Scoping Review of the Literature

“…The focus of the study was to apply these domains to describe women's experiences of health care providers’ behaviors. Women of color (African American, Asian, Indigenous, and Hispanic) reported inequitable perinatal care more often than white women (23.8% vs 14.1%, respectively) . When stratified by race, the differences in mistreatment were more explicit among women of color compared with white women.…”

“…When stratified by race, the differences in mistreatment were more explicit among women of color compared with white women. For example, African American (12.8%), Asian (13.3%), Hispanic (12.2%), Indigenous (10.9%) women noted that their health care provider ignored

them or refused their requests for information compared with 5.6% of white women . Twice as many women of color (12.8%) reported being shouted at or scolded by their health care provider compared with white women (6.4%) .…”

“…For example, African American (12.8%), Asian (13.3%), Hispanic (12.2%), Indigenous (10.9%) women noted that their health care provider ignored

them or refused their requests for information compared with 5.6% of white women . Twice as many women of color (12.8%) reported being shouted at or scolded by their health care provider compared with white women (6.4%) . However, regardless of race, few women reported instances of mistreatment based on the other domains: physical or sexual abuse and privacy violation.…”

“…Women of color (African American, Asian, Indigenous, and Hispanic) reported inequitable perinatal care more often than white women (23.8% vs 14.1%, respectively). 7 When stratified by race, the differences in mistreatment were more explicit among women of color compared with white women. For example, African American (12.8%), Asian (13.3%), Hispanic (12.2%), Indigenous (10.9%) women noted that their health care provider ignored ✦ African American women persistently have breastfeeding rates significantly lower than those of women from other racial and ethnic groups.…”

Unplanned Out-of-Hospital Birth—Short and Long-Term Consequences for the Offspring

“…Similarly to previous publications [1,4], we found the risk of perinatal mortality to be up to 3 folds higher in out-of-hospital deliveries compared with in-hospital deliveries. While elective home birth as a pre-planned event attended by trained midwives and physicians may have comparable outcomes to planned in-hospital birth [10][11][12][13], the accidental, un-intended out-of-…”