ObGyn Intelligence
Evidence Matters
Prepare
Evidence LibraryUnderstanding pregnancy, risk, and consentHow it goes wrong
Evidence Library · How it goes wrong

What happens when you do speak up

About one in five women in the same CDC survey reported at least one kind of mistreatment. The commonest kind was being ignored.

The previous topic showed what stops women speaking. This one shows what some of them met when they did.

CDC: Approximately one in five (20.4%) respondents reported experiencing at least one type of mistreatment.

Type of mistreatment, in CDC's own wordingShare
being ignored by health care providers, having requests for help refused, or not responded to9.7%
being shouted at or scolded by health care providers6.7%
having their physical privacy violated5.1%
being threatened with withholding of treatment or being forced to accept treatment they did not want4.6%

The rates were not the same for everyone. Reported mistreatment was 30.0% among Black respondents, 29.3% among Hispanic respondents and 27.3% among multiracial respondents. Separately, Overall, 28.9% of respondents reported experiencing at least one form of discrimination, rising to 40.1% among Black respondents. The leading stated reasons overall were age (10.1%), weight (9.7%) and income (6.5%).

A second, independent US survey found something of similar size using questions designed with the help of women who had given birth. In the Giving Voice to Mothers study, 369 of 2,138 women (17.3%) reported one or more types of mistreatment. That survey was an online, self-selected sample that deliberately over-represented community birth, so its percentage is not a national rate, and it was published four years earlier, on pregnancies from 2010 to 2016, using different questions. The two surveys should not be lined up as a trend. What they can honestly be said to show is two separate efforts landing in the same neighbourhood.

Mistreatment is not only shoutingThe global review that produced these categories examined 65 studies from 34 countries and sorted what women described into seven domains: (1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. That review could not pool a single prevalence figure, and its authors say so; the categories are its contribution.

Look at number five. Failure to meet professional standards of care is mistreatment. That is exactly what a lowered expectation produces, and it is why this belongs in a chapter about expectations rather than a chapter about rudeness.
Say this out loud"I asked about this an hour ago and nobody has come back to me."

"I would like this concern noted in my chart with the time."

"Who else can I speak to about this?"
Where this comes from:
253. Mohamoud YA, Cassidy E, Fuchs E, Womack LS, Romero L, Kipling L, et al. Vital signs: maternity care experiences, United States, April 2023. MMWR Morb Mortal Wkly Rep. 2023;72(35):961-967.
254. Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, et al. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health. 2019;16(1):77.
454. Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS Med. 2015;12(6):e1001847.

Covered in the essential classes

Continue

More from Two kinds of expectation

This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.