High rates of mistreatment found during childbirth

High rates of mistreatment found during childbirth | Image Credit: © Gorodenkoff - © Gorodenkoff - stock.adobe.com.

Mistreatment during childbirth is common, indicating a need for interventions to address structural health system factors adversely impacting childbirth, according to a recent study published in JAMA Network Open.

In the United States, discrimination and lack of care have been linked to disparities in maternal morbidity and mortality. During childbirth, adverse experiences may lead to negative body image, feelings of dehumanization, posttraumatic stress disorder, and changes in future reproductive decisions.

Documentation about mistreatment during childbirth is lacking in the United States. Available data has indicated higher rates of mistreatment among marginalized racial and ethnic groups, as well as individuals with a low socioeconomic status. However, this data is from convenience samples, indicating limitations.

To evaluate mistreatment during childbirth in a large, representative, multistate sample, investigators conducted a cross-sectional study. Data was obtained from the 2020 Postpartum Assessment of Health Survey (PAHS), a survey of birthing individuals 12 to 14 months following livebirth across 6 states.

The PAHS built on the Centers for Disease Control and Prevention (CDC) Pregnancy Risk and Monitoring System (PRAMS), and jurisdictions were included based on PRAMS sample size, meeting CDC PRAMS response rate thresholds, and willingness to collaborate in the PAHS. Individuals who gave birth between January and December 2020 were included in the sampling frame.

Data collection was performed between January 1, 2021, and March 31, 2022. Mistreatment was reported as the primary outcome based on the Mistreatment by Care Providers in Childbirth (MCPC) scale.

Patients were asked about their birthing experience to report if they experienced 7 issues or behaviors from providers. These included abandonment, neglect, breach of confidentiality, lack of consent, physical abuse, verbal abuse, and other mistreatment.

Demographic, social, and clinical covariates were also collected, including race and ethnicity, age, lesbian, gay, bisexual, transgender, queer (LGBTQ) identity, education level, marital or domestic partner status, household income, primary language, insurance coverage, and rural or nonrural geography.

There were 4458 postpartum respondents included in the analysis, aged a mean 29.9 years. Of participants, 54.4% were White, 18.3% Hispanic, 15% Black, and 8.9% Asian.

When giving birth, 58.8% of patients were aged 25 to 34 years, 91.1% were non-LGBTQ, 78% married or in a domestic partnership, 68.5% with an above high school level education, and 82.6% primarily speaking English. Commercial insurance was reported in 58.8%, Medicaid in 37.9%, and being uninsured in 3.2%.

Overall, 13.4% of participants experienced mistreatment. The most common form of mistreatment was being ignored, refused help, or not responded to in a timely manner, reported by 7.6% of patients. This was followed by being shouted at or scolded by 4.1%, any other mistreatment by 2.7%, and threatened to withhold treatment or forced to accept unwanted treatment by 2.3%.

The highest rates of mistreatment at 33.7% were reported among Southwest Asian, Middle Eastern, and North African participants. This was followed by individuals of multiple minoritized races at 16.9%, Black patients at 15.9%, White at 13.3%, Native American at 12.5%, Asian at 11.5%, and Hispanic at 10.8%.

Unadjusted odds ratios (uORs) based on patient characteristics were also reported. The uOR for mistreatment among LGBTQ patients vs non-LGBTQ patients was 2.3. For Medicaid insurance, being married, and speaking Spanish vs English, the uORs were 1.4, 0.8, and 0.5, respectively.

Mistreatment type differed based on patient characteristics. For LGBTQ patients, being threatened with withholding treatment or being forced to accept unwanted treatment was significantly more common. Having physical privacy violated was significantly more common among Southwest Asian, Middle Eastern, and North African patients vs White patients.

These results indicated a high prevalence of mistreatment during childbirth. Investigators recommended interventions be developed to address implicit biases that impact care.

Reference

Liu C, Underhill K, Aubey JJ, Samari G, Allen HL, Daw JR. Disparities in mistreatment during childbirth. JAMA Netw Open. 2024;7(4):e244873. doi:10.1001/jamanetworkopen.2024.4873