The recent survey identified blatant disparities, with higher rates of mistreatment among Black, Hispanic, and multiracial women, as well as women with no insurance or public insurance.
A new report from the Centers for Disease Control and Prevention’s (CDC) Vital Signs has underscored longstanding inequities contributing to the maternal health crisis in the United States. Using responses from 2,402 participants of the Porter Novelli View Moms survey from April 24-30, researchers evaluated the level of respectful care in maternal health. A clear takeaway based on the survey results is that many women have experienced mistreatment while receiving maternity care.
“As a health care community, we need to do all we can to make sure we are delivering equitable and respectful care to women during pregnancy and delivery,” said CDC Chief Medical Officer Debra Houry, M.D., M.P.H., in a statement. “Health systems, hospitals, and providers can take steps to improve care and lower the risk of pregnancy-related complications and death for all women. These data show that we must do better to support moms.”
Of the women surveyed, 20.4 percent reported experiences with mistreatment throughout their maternity care, with the prevalence of mistreatment highest among Black (30 percent), Hispanic (29.3 percent), and multiracial (27.3 percent) women. The most common forms of mistreatment reported included receiving no response to requests for help, being shouted at or scolded, physical privacy violated, and being threatened with withholding treatment or pressured into accepting unwanted treatment.
Many women (28.9 percent) have also experienced at least one form of discrimination throughout their maternity care, again with the highest prevalence among Black (40.1 percent), multiracial (39.4 percent), and Hispanic (36.6 percent) women. According to the survey responses, the most common reasons for discrimination were age, weight, and income; however, the reasons varied by race and ethnicity. For Black women, the most common reasons were weight; race, ethnicity, or skin color; and age, whereas multiracial women reported reasons including age; difference in opinion with their caregivers about the right care for themselves or their baby; race, ethnicity, or skin color; income; and substance use. The most common reasons for Hispanic women were age; weight; and income.
When it came to insurance status, mistreatment was more common among women with no insurance (28.1 percent) and women with public insurance (26.1 percent).
The findings underscore the need for improved communication, according to the CDC, as nearly half (44.7 percent) of the women surveyed also reported holding back questions or concerns they had about their pregnancy or delivery. The most common reasons women said they withheld their questions or concerns was due to thinking (or being told by friends or family) that what they were feeling was normal; not wanting to make a big deal out of it or feeling embarrassed talking about it; thinking their provider would think they’re being difficult; feeling their provider seemed rushed; and not feeling confident that they knew what they were talking about.
The CDC made several recommendations to improve the quality of maternity care:
- Health care systems can implement training for providers to recognize unconscious bias and stigma, promote shared decision-making, and improve cultural awareness.
- Providers can engage patients with effective communication and practice active listening to patients’ concerns.
- Health care professionals can promote quality improvement by prioritizing respectful and equitable maternity care for all women.
- Communities can support pregnant and postpartum women by raising awareness of respectful care and promoting health equity.