August 24, 2023 – One in five women report abuse by medical professionals during pregnancy and childbirth – an issue that people of color are even more likely to face, according to a study published Tuesday by the CDC.
The new CDC Vital signs The report comes from a survey of 2,400 women who were asked about the medical care they received during their most recent pregnancies. Thirty percent of black women surveyed reported assault, as did 29% of Hispanic women, 27% of multiracial women, 18% of white women, 20% of American Indian/Native Hawaiian/Pacific Islander/Alaska Native women , and 15% of Asian women.
“I have had thousands of experiences and opportunities to witness maternal care during pregnancy, birth, and postpartum. Not all of that care was respectful,” CDC MD Wanda Barfield said during a media call Tuesday. “As a mother and as a Black woman, I was fortunate to have an OB/GYN who saved my life and the life of my son because he respectfully listened to my concerns while I was pregnant.”
“Yet this report provides evidence that many women are having experiences that are truly unacceptable,” she said.
The abuse described in the report includes name-calling or name-calling, rejected and unanswered requests for help, threats to withhold treatment and invasion of physical privacy. The CDC analyzed data from the Porter Novelli View Moms survey that took place this year from April 24 to 30.
Survey respondents also reported discrimination based on health insurance status. Twenty-eight percent of women without insurance and 26% with public insurance said they received inadequate care, while 16% with private insurance reported the same.
“Overall, the most common reasons for reported discrimination were age, weight and income, with the most common reason varying by race and ethnicity,” said Barfield, director of the CDC’s Division of Reproductive Health at the National Center for Chronic Disease Prevention and Health promotion.
According to the report, the study represents a small part of a much larger problem: U.S. maternal mortality rates pale in comparison to those of other high-income countries. These deaths have been increasing since 2018, According to the CDCand in 2021, the mortality rate was 32.9 deaths per 100,000 live births, up from 23.8 in 2020 and 20.1 in 2019. In 2021, the maternal mortality rate for Black women was 69.9 deaths per 100,000 live births.
The CDC’s own Shalon Irving, PhD, a renowned epidemiologist, died in 2017 from complications of high blood pressure three weeks after her daughter’s birth. Irving, who was black, had been dismissed by doctors when she insisted something was wrong.
The report’s findings come as no surprise, as the United States lags behind in maternity accommodations compared to other developed countries, says Catherine Cansino, MD, clinical professor of obstetrics and gynecology at UC Davis Health.
The average paid maternity leave worldwide is 29 weeks, according to data from the World Policy Analysis Center. In the US, there is no federal law requiring a specific amount of paid parental leave.
According to a December 2022 report, most new mothers in developed countries receive at least half their salary during maternity leave. Organization for Economic Co-operation and Development (OECD).
“Overall, in our society, our voices are not necessarily heard as strongly and we have to stand up for ourselves,” Cansino said. “Women and people of color, and especially people who identify in that intersectionality, it’s going to be very difficult to navigate.”
The report outlines several measures that could improve maternity care for patients, including hiring providers with ethnic and racial backgrounds that reflect the patient population, the use of doula and midwifery care, and more training for doctors and nurses.
“As a health care community, we must do better in providing impartial and respectful maternity care to all mothers,” CDC Chief Medical Officer Deborah Houry, MD, said during Tuesday’s telephone briefing. “We know that actions such as hiring and retaining a diverse workforce and offering training to healthcare providers on unconscious bias and stigma can help improve the quality of care.”
D’Angela Pitts, MD, director of maternal health equity at Henry Ford Health in Detroit, said even the subtlest changes in doctor-patient interactions can make a big difference. For example, she encourages residents to ask patients and their loved ones: “What questions do you have?” instead of: “Do you have any questions?” This prevents patients from remaining silent despite their concerns – something almost half (45%) of survey respondents reported doing.
Pitts said it’s also important for health care professionals to point out abuse when they see it.
“We need to hold each other accountable as providers,” she said. “If you hear a colleague say something, speak up and say, ‘I think I would have done that differently.’”