CDC report: 20% of US women mistreated during maternity care

Key takeaways:

• Black, Hispanic and multiracial respondents reported the highest prevalence of mistreatment and discrimination in maternity care.
• Eliminating biases and bias training may help improve maternity care experiences.

In a recent survey, one-fifth of respondents reported negative health care experiences during their pregnancy and delivery, according to a newly released CDC Vital Signs report.

The CDC held a media briefing to discuss the findings and how to ensure pregnant women receive respectful and adequate maternity care in the U.S.

“This is unacceptable. We know mistreatment and discrimination can have a negative impact on the quality of maternity care,” Debra Houry, MD, MPH, chief medical officer at the CDC, said during the briefing. “We have to encourage a culture of respectful maternity care. This should be part of greater efforts to improve quality by standardizing care to reduce complications and deaths related to pregnancy and delivery.”

According to Houry, more than 80% of pregnancy-related deaths are preventable and women from certain racial/ethnic minority groups are at higher mortality risk compared with others.

“It’s critical that we health care providers in the room make sure that we’re taking the time to build trust by actively listening and being culturally aware of the people we’re serving,” Wanda Barfield, MD, MPH, FAAP, director of the division of reproductive health at the CDC, said during the briefing. “All health care staff play an important role in improving patient experiences. This will lead ultimately to healthier mothers and babies.”

Mistreatment in maternity care

In the report, the CDC analyzed data from the Porter Novelli View Moms survey administered in April and examined experiences of mistreatment, discrimination and reasons for restricting oneself from communicating questions or concerns during pregnancy and delivery. In total, 2,407 U.S. mothers responded to the survey.

Of all respondents, 69.6% were white, 10.7% were Black, 10.2% were Hispanic, 4.8% were Asian, 2.8% were multiracial and 1.5% were American Indian, Alaska Native, Native Hawaiian or Pacific Islander. Most respondents had private health insurance (56.5%) and 32.6% had Medicaid insurance at the time of delivery.

Of the respondents, 20.4% reported experiencing at least one form of mistreatment while they were receiving maternity care. The most reported mistreatment experiences were being ignored by health care providers (9.7%), being shouted at or scolded (6.7%), having their physical privacy violated (5.1%) and being threatened with withholding of treatment or being forced to accept treatment they did not want (4.6%).

The highest prevalence of mistreatment was reported among Black (30%), Hispanic (29.3%) and multiracial (27.3%) respondents. For insurance, 28.1% of respondents without health insurance and 26.1% of those with public insurance reported mistreatment.

“This report provides evidence that many women are having experiences that are truly unacceptable,” Barfield said. “Every mother deserves respectful and fair and equal care during their pregnancy and delivery.”

Reports of discrimination

Also in the report, 28.9% of respondents reported experiencing at least one form of discrimination during their delivery or maternity care. Of these, the highest prevalence of discrimination was reported by Black (40.1%), multiracial (39.4%) and Hispanic (36.6%) respondents. The most common reasons for discrimination reported were age (10.1%), weight (9.7%) and income (6.5%). These reasons varied by race and ethnicity. The most common reasons for discrimination reported by Black respondents were weight (13.2%), race, ethnicity or skin color (12.9%) and age (12.8%). The most common reasons for discrimination reported by multiracial respondents were age (16.7%), difference in opinion about the right care for themselves or their offspring (12.1%), race, ethnicity or skin color (10.6%), income (10.6%) and substance use (10.6%). The most common reasons reported for discrimination by Hispanic respondents were age (11.4%), weight (10.2%) and income (8.9%).

Overall, 44.7% of all respondents reported restricting themselves from asking questions or relaying concerns with their provider. The most common reasons for not asking questions or relaying concerns included thinking that what they felt was normal (28.8%), feeling embarrassed and not wanting to make a big deal (21.5%), having someone close tell them it was normal (21.2%) and worrying that their provider might consider them difficult (20.7%).

“In terms of thinking about ways that providers can improve, certainly there’s the opportunity to think about bias and institutional bias and bias training,” Barfield told Healio during the briefing. “A diverse workforce also provides the opportunity to gain different perspectives ideally that reflect the population of the patients served. We all have biases, and having an opportunity to work together collectively to reduce those biases are really important in terms of training.”

References:

• Mohamoud YA, et al. MMWR. 2023;doi:10.15585/mmwr.mm7235e1.
• One in 5 women reported mistreatment while receiving maternity care. https://www.cdc.gov/media/releases/2023/s0822-vs-maternity-mistreatment.html. Published Aug. 22, 2023. Accessed Aug 22, 2023.