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Image from 'The Story of Life' (yes, artist is joking). By permission of the artist.

A major nationwide study of women's experiences during pregnancy and childbirth finds that about one in six pregnant women experience some sort of mistreatment by healthcare professionals, and that women of color are much more likely to get yelled at or scolded. Other factors that lead to poor treatment include disagreeing with a doctor or midwife about the best course of treatment and having a partner who's black -- regardless of the woman's own race. While the study doesn't correlate the shabby treatment with actual maternal or infant health outcomes, it sure seems of a piece with last year's ProPublica/NPR series that reported on the appallingly high maternal death rate for black women, which is four times higher than mortality for white mothers. That public health crisis is finally getting attention from Congress, too.

The "Giving Voice to Mothers" study, focusing on "inequity and mistreatment during pregnancy and childbirth in the United States," was published in the journal Reproductive Health Tuesday, by a team of researchers led by Saraswathi Vedam, of the University of British Columbia in Vancouver, which would explain why the authors keep typing "women of colour." The team developed its questionnaire -- with input from patients -- using seven categories of mistreatment of pregnant women identified in a 2015 study by the World Health Organization. Of the 2,700 women surveyed, the researchers found:


Being shouted at or scolded by a health care provider was the most commonly reported type of mistreatment (8.5%), followed by "health care providers ignoring women, refusing their request for help, or failing to respond to requests for help in a reasonable amount of time" (7.8%). Fewer women reported violation of physical privacy (5.5%), and health care providers threatening to withhold treatment or forcing them to accept treatment they did not want (4.5%).

The results were more pronounced among poor and nonwhite women, which is why America is so great:

Women of colour, women who gave birth in hospitals*, and those who face social, economic, or health challenges reported higher rates of mistreatment. Rates were also increased in women who had unexpected events like cesareans or transfer from community to hospital care; and women who disagreed with a health care provider, about the right care for themselves or the baby, reported the highest rates of mistreatment.

*In the US, this is 98 percent of births, which makes this statistic rather odd. We'll discuss that later!

Indigenous women reported especially poor treatment. Nearly a third (32.8 percent) reported at least one form of mistreatment, with Hispanic and black women also reporting a disturbing amount of mistreatment (25 percent and 22.5 percent, respectively). By contrast, 14.1 percent of white women reported any kind of mistreatment.

And while socioeconomic status mattered, race made a bigger difference, with low-income women of color being far more likely (27.2 percent) to report mistreatment than low-income white women (18.7 percent). When it comes to specific forms of mistreatment, the racial gap was even more pronounced.

[Twice] as many Hispanic and Indigenous women as compared to White women reported that health care providers shouted at or scolded them. Likewise, Black women, Hispanic women, Asian, and Indigenous women were twice as likely as White women to report that a health care provider ignored them, refused their request for help, or failed to respond to requests for help in a reasonable amount of time

In addition to the stats, the report includes some first-person accounts from women, and only a jerk would dismiss these as mere "anecdotal" data:

The doctor who refused to test me for an amniotic fluid leak and instead tested me for an STD test I had already received during the pregnancy. I believe his assumption that I was leaking something due to an STD rather than a pregnancy complication was due to race and put my life and my newborn's life at risk - I went a week leaking fluid after I had went in to get it checked out. I worry that Doctor is still discriminating against other mothers and they are receiving negligent care as well.

Black woman who gave birth in California
I was told I was hurting my children and being selfish because I wanted to have a vaginal delivery. Both children were in head down birth position. I was forced into a cesarean by my OB.

Indigenous woman who gave birth in Texas
The forced episiotomy. The doctor didn't care, refused to give me medication because my episiotomy hurt, Nurse XX from XX told me to get over it and gave me lube & told me to do anal sex instead! That's the care we're getting in Southern California if you are not insured & have to rely on MediCal insurance.

Hispanic woman who gave birth in California
I was offered WIC repeatedly though I explained that I did not qualify. I believe it was because I am Latina and my partner black that we were repeatedly offered WIC.

Hispanic woman with Black partner in New York
When I refused to be induced -- even after I was a couple days "overdue" -- I seriously started to feel like *I* was the problem. It was horrible.

White woman who gave birth in Iowa at 24

The authors also note some characteristics of their study that could mean the results are actually too cheerful: Their survey population tended to be older and of higher than average socioeconomic status, which generally means people get better care (although as ProPublica reported in heartbreaking detail, being well-educated and financially stable doesn't protect black women from dying after giving birth). That socioeconomic skew resulted, in part, from the authors' decision to seek out a big sample of women who gave birth at home or in birth centers. Only about two percent of women have such "community births," while fully half of the participants in the survey had. In general, those moms were far more satisfied with their pregnancy and birth experiences.

As a result, the authors warn, "the logical expectation would be that the entire sample is skewed towards much less mistreatment than the general population." So that's a cheery thought.

The authors recommend improving "systems for monitoring, reporting, addressing, and resolving disrespect and abuse cases," and in general doing more to empower women in their own health care, as well as increasing civic awareness of the problem, not to mention professionals working to take women seriously. Wouldn't that be something!

[Reproductive Health via Maggie Koerth-Baker on Twitter / Illustration via Twitter, from The Story Of Life, by "Chris (Simpsons Artist)," who is definitely just goofing. By permission.]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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