One in Eight Report Mistreatment During Childbirth, Study Says

Mistreatment and discrimination during childbirth are rampant in the United States, according to a new study — impacting more than 13% of birthing individuals.

Discrimination and a lack of respect during childbirth are said to be associated with disparities in maternal mortality and morbidity, and a new study has found that this kind of mistreatment is quite common — particularly among the LGBTQ+ community and other marginalized groups.

The study, published in JAMA Network Open Thursday, aimed to determine how often birthing individuals in the U.S. experience mistreatment by health care professionals during childbirth. The findings suggest that 13.4% of study participants, or one in eight, reported being mistreated during childbirth, with some groups facing a higher risk of such treatment.

Individuals who were found to be at a higher risk of mistreatment included those who were unmarried; were Medicaid insured; were lesbian, gay, bisexual, transgender, or queer identifying; had obesity; had a history of substance use disorder, mood disorders, or intimate partner or family violence; or had an unplanned cesarean birth.

In terms of race and ethnicity, Southwest Asian, Middle Eastern, or North African respondents were the most likely to report mistreatment, followed by Black individuals and people of multiple minoritized races.

Researchers conducted the cross-sectional using representative survey data collected from respondents to the 2020 Pregnancy Risk and Monitoring System in six states and New York City. All respondents had a live birth in 2020 and participated in the Postpartum Assessment of Health Survey at 12 to 14 months postpartum.

Data were collected from January 1, 2021, to March 31, 2022, from 4,458 postpartum individuals, representing 552,045 people who had live births in 2020.

According to the study, the most common type of mistreatment reported was being “ignored, refused request for help, or failed to respond in a timely manner.” This was followed by being “shouted at or scolded” by health care clinicians, any other mistreatment, and having health care clinicians threaten “to withhold treatment or force you to accept treatment that you did not want.”

Of the seven jurisdictions included, mistreatment rates ranged from 9% in Kansas to 16.9% in New York City.

Notably, researchers found that LGBTQ respondents were twice as likely to experience any mistreatment compared with non-LGBTQ respondents.

In 2021, the Centers for Disease Control and Prevention reported a steep rise in maternal mortality rates, from 861 deaths in 2020 to 1,205 in 2021. As mistreatment by health professionals during birth is often associated with negative maternal health outcomes, the authors suggest new approaches are needed to address the ways in which prejudices influence the birthing experience and impact the treatment received by those giving birth.

“These results suggest that structural social stigmas permeate the birth experience and shape how care is received, highlighting the need for patient-centered interventions to improve childbirth experiences,” the authors wrote. “There is a need for the development and evaluation of patient-centered, multifaceted interventions that address implicit biases, cultural competence, health care workforce conditions, the inclusivity of clinical settings, and other structural factors, including health system factors, to improve childbirth experiences.”

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