About 1 in 5 mothers report mistreatment during their maternity care, with that number bumping up to 30% for those who are Black, Hispanic and multiracial, according to a new report from the Centers for Disease Control and Prevention (CDC).
Though about 91% of 2,402 surveyed mothers said they were satisfied with their pregnancy care, 9.7% said they had been ignored or had a request for help refused by a healthcare provider during pregnancy.
Nearly 7% reported being shouted at or scolded by a healthcare provider, 5.1% said their physical privacy was violated, 4.6% said that a provider threatened to withhold treatment or forced them to accept unwanted treatment and 4% said their personal information was shared without consent, among other forms of mistreatment.
The respondents were surveyed in April by strategic communications firm Porter Novelli and, due to sampling methodology, are “likely not representative of the U.S. birthing population,” CDC researchers wrote.
Still, the agency said, the findings suggest that these poor healthcare experiences are keeping mothers from engaging in care and could be a contributor to maternal deaths, which increased from 17.4 deaths per 100,000 live births in 2018 to 32.9 deaths per 100,000 in 2021.
Of particular concern, nearly 45% of respondents said they held back from voicing a question or concern to a provider regarding pregnancy and delivery for a variety of given reasons that ranged from belief that their feelings were normal for pregnancy (28.8% of those who held back) to embarrassment (21.5%) and worries that a maternity care provider may think they were being difficult (20.7%).
“These findings highlight the gaps in delivering respectful maternity care and underscore the need for improvement,” CDC researchers wrote in the agency’s Morbidity and Mortality Weekly Report. “Respectful maternity care is a component of quality care and can be integrated into broader strategies to reduce pregnancy-related deaths.”
The survey’s respondents predominantly (65.5%) reported having their youngest child five or more years prior. Nearly 7 in 10 said they were white, with 10.7% self-identifying as Black, 10.2% Hispanic, 4.8% Asian, 2.8% multiracial and 1.5% American Indian, Alaska Native, Native Hawaiian or Pacific Islander. Over half said they were privately insured, with about a third covered by Medicaid during their youngest child’s delivery.
Reviewing the responses by demographic highlighted higher reports of discrimination among Black (40.1%), multiracial (39.4%) and Hispanic (36.6%) women as compared to white (26%) and Asian (22.6%) women. Additionally, those with no insurance (28.1%) or public insurance (26.1%) more frequently reported mistreatment than those with private insurance (15.9%).
The agency’s report and accompanying Vital Signs article called for more action among providers and other public health entities to tackle maternity care mistreatment and related maternal mortality.
Health systems, the agency said, can invest in hiring and training a diverse workforce conscious of unconscious bias, or encourage patient communication through doulas or midwifery models of care as well as communication campaigns.
“Health professionals interacting with patients at all points of maternity care play a role in improving patient experiences during maternity care and providing respectful maternity care equitably,” agency researchers wrote.
Additionally, “health communication campaigns and community engagement can include the perspectives of patients, families and communities to raise awareness to incorporate the components of respectful maternity care, as well as how pregnant and postpartum women and their support system can communicate their questions and concerns,” they advised.
U.S. maternal mortality rates are higher than those in other wealthy countries and appear to have gotten worse over the past couple of decades and during the course of the COVID-19 pandemic. Additionally, a recent report from March of Dimes suggests that there has been a net increase in the number of “maternity care deserts” across the country since 2020, meaning less access to care and higher risk of poor outcomes.