Maternity Care Experiences, United States, April 2023: The CDC stated in its weekly Vital Signs for the week of August 22, 2023:
From 2018 to 2021, the maternal death rate in the United States increased from 17.4 to 32.9 per 100,000 live births. Native Hawaiian and other Pacific Islander, Black, and American Indian and Alaska Native persons have the highest rates of pregnancy-related deaths. Approximately 80% of pregnancy-related deaths are preventable. Preventing pregnancy-related deaths requires a multilevel approach that includes ensuring quality care for all pregnant and postpartum persons. Standards of quality maternity care include respectful maternity care, defined as “care organized for and provided to all women in a manner that maintains their dignity, privacy, and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labor and childbirth”. Respectful, equitable, and supportive care is included as a component in all Alliance for Innovation on Maternal Health (AIM) patient safety bundles to improve person-centered and equitable care. Negative experiences during maternity care are more prevalent among women from some racial and ethnic minority groups. Maternal mortality review committees have identified discrimination as one factor contributing to pregnancy-related deaths. The concepts of mistreatment, engaging with effective communication, and discrimination have been used to evaluate respectful maternity care.
CDC Survey
CDC analyzed data from the PN View Moms survey, an opt-in consumer audience panel survey of U.S. mothers with children aged <18 years living at home. The survey examined maternity care experiences, including satisfaction with care, experiences of mistreatment and discrimination, and whether respondents held back from asking questions or discussing concerns with health care providers. The option to complete the PN View Moms survey online was shared with 7,607 opt-in panel members; 2,407 (32%) mothers responded. The survey was administered in English during April 24–30, 2023.
Overall, 90.5% of respondents were satisfied with the care they received during pregnancy. Approximately one in five (20.4%) respondents reported experiencing at least one type of mistreatment. The most commonly reported experiences of mistreatment were being ignored by health care providers, having requests for help refused, or not responded to (9.7%); being shouted at or scolded by health care providers (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%). Among respondents who reported any mistreatment, 75.1% were satisfied with the care they received during pregnancy. Black, Hispanic, and multiracial respondents reported the highest prevalences of mistreatment (30.0%, 29.3%, and 27.3%, respectively). Among insurance categories, 28.1% of respondents with no insurance and 26.1% of those with public insurance at the time of delivery reported mistreatment.
Overall, 28.9% of respondents reported experiencing at least one form of discrimination during maternity care, with highest prevalences reported by Black (40.1%), multiracial (39.4%), and Hispanic (36.6%) respondents. Overall, the most commonly reported reasons for discrimination were age (10.1%), weight (9.7%), and income (6.5%); reasons varied by race and ethnicity. For example, among Black respondents, the most common reasons were weight (13.2%), race, ethnicity, or skin color (12.9%), and age (12.8%). Among multiracial respondents, the most common reasons were age (16.7%), difference in opinion with caregivers about the right care for oneself or one’s baby (12.1%), race, ethnicity, or skin color (10.6%), income (10.6%), and substance use (10.6%). Among Hispanic respondents, the most common reported reasons for discrimination were age (11.4%), weight (10.2%), and income (8.9%).
Approximately one half (44.7%) of all respondents reported holding back from asking questions or discussing concerns with their provider during maternity care. The most common reasons included thinking that what they were feeling 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 maternity care provider might think they were being difficult (20.7%).
Summary
Approximately one in five surveyed women reported mistreatment and approximately 30% reported discrimination during maternity care. These experiences were more common among Black, Hispanic, and multiracial mothers. Approximately one half of respondents reported holding back from discussing questions and concerns during maternity care. These findings highlight the gaps in delivering respectful maternity care and underscore the need for improvement. Respectful maternity care is a component of quality care and can be integrated into broader strategies to reduce pregnancy-related deaths.
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