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Measuring Mistreatment in Maternity Care: a Groundbreaking Study by Every Mother Counts, the University of British Columbia and Community Partners

Disrespect and abuse during pregnancy and childbirth has become recognized as a significant contributor to poor health outcomes, particularly in low- and middle-income countries. In lower-resource settings, mistreatment during pregnancy and childbirth is shockingly common and leads to both short and long-term health effects, ranging from pain and suffering in the short-term, to post-traumatic stress disorder in the long-term. Our Giving Voice to Mothers Study: inequity and mistreatment during pregnancy and childbirth in the United States, a collaborative effort by the University of British Columbia, Every Mother Counts, and other collaborating partners, was published today in the Journal of Reproductive Health.

The first of its kind in the U.S., the study aimed to apply a framework previously used in low- and middle-income countries—a framework developed by the World Health Organization to measure quality of maternal and newborn care, focused on “the extent to which health care services provided to individuals and patient populations improve desired health outcomes and are safe, effective, timely, efficient, equitable, and people-centered.”

Although the issue of disrespect and abuse in maternity care has gained significant recognition around the world in recent years, the topic has remained underrecognized in the U.S. The understanding of disparities based on race, ethnicity, and income has grown, but systematic measurements of women’s experience of care and the factors influencing their experiences have never been conducted. The extent of disrespect and abuse in a high-income country like the U.S. has been difficult to grasp.

In what is the largest study examining mistreatment during pregnancy and childbirth in the U.S, the Giving Voice to Mothers study reveals insights from a national survey that was created with input from a diverse group of women who had recently given birth, and identified research areas that are understudied, including non-consented care, responsiveness of care providers, and access to options for care. The study surveyed 2,700 women and mistreatment included physical, sexual and verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers, and poor health system conditions and constraints.

Mistreatment in childbirth

The findings of the study are striking—17.3 percent of women reported experiencing one or more types of mistreatment and percentages were even higher for women of color compared with white women. Among mothers with low socioeconomic status, 18.7 percent of white women reported mistreatment compared to 27.2 percent of women of color. Indigenous women were the most likely to report experiencing at least one form of mistreatment by health providers, followed by Black and Hispanic 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. Overall, the findings of the study confirm and quantify what we hear from community members: that mistreatment is experienced more frequently by women of color, in hospital settings, and among those with a lower socioeconomic status. Cases of mistreatment were also linked to unexpected obstetric interventions and situations where families had a difference of opinion with their provider.

The implications of this study can’t be overstated. It allows us to begin to quantify and define the lived experiences of mistreatment and disrespect across groups, providing the opportunity to use this data to address health disparities. We have also gained a better understanding of the varying degrees of maternity care experiences and the factors influencing them, and can see a more comprehensive picture. This study has demonstrated that disrespect and abuse exists in high-income settings just as it does in low- and middle-income countries, that it can be measured, and most importantly, that the information can lead us towards solutions. The next step will be to incorporate these indicators as performance measures to incentivize and expand access to the practices and settings that optimize pregnancy-related care.

Read the full article in The Journal of Reproductive Health.