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Respectful Maternity Care in the United States—Characterizing Inequities Experienced by Birthing People

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Abstract

Objective

 The purpose of this study is to understand experiences of respectful maternity care (RMC) from the perspective of birthing people in the United States from 2013 to 2018.

Methods

 We conducted an online cross-sectional survey of United States birthing people ages 18–50 in April 2018 using SurveyMonkey Audience. Quantitative survey data consisted of demographics and responses to RMC indicators. Qualitative data consisted of comments from individuals regarding their birth experiences.

Results

 1036 birthing people participated in the survey. Most births (95%) occurred in hospitals. 16.3% of Black or African American participants reported discrimination compared to 5.5% of participants who did not identify as Black or African American (p < 0.001). Participants who speak a language other than English were also more likely to report discrimination. 19.5% of all respondents felt neglected during their birth experience. Most prevalent experiences of disrespect and mistreatment were related to neglect (most commonly in postpartum phase of care), poor interpersonal communication, lack of respect for patient wishes, negative experience with breastfeeding services, peripartum complications, and discrimination.

Conclusion for Practice

Birthing people in the United States experience many forms of mistreatment, particularly those who identify as Black or African American or speak a language other than English. Patients described experiencing neglect most commonly after birth—an opportunity to improve the provision of RMC postpartum. Strategies to improve quality of maternal health care in the United States should include the provision of RMC as part of a larger effort to reduce inequities in maternal health experiences and outcomes.

Significance

Respectful Maternity Care (RMC) is a growing focus of maternal health programs and research globally. While disrespect and mistreatment during childbirth has been studied globally, this is one of few cross-sectional studies that measures patient experiences of respectful maternity care in the United Sates. Our results demonstrates that birthing people of color or with language barriers disproportionately experience significant birth inequities, particularly in the postpartum period. Strategies to improve quality of maternal health care in the United States should include the provision of RMC as part of a larger effort to reduce inequities in maternal health experiences and outcomes.

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Data Availability

For participant privacy and confidentiality, data will not be placed in data repository.

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References

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Funding

This study was funded by an Expanding the Boundaries research grant from Brigham and Women’s Hospital.

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Authors and Affiliations

Authors

Contributions

All authors participated in planning the study. Patel and Schantz-Dunn conducted the study. Patel, DeAndrade, Jacober and Medina conducted the data analysis. All authors participated in the manuscript writing.

Corresponding author

Correspondence to Samantha Truong.

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Competing Interests

The authors do not have any conflicts of interest to declare.

Ethics Approval

This study was approved by the Institutional Review Board of Brigham and Women’s Hospital.

Consent to Participate

All participants provided informed consent to participate in this study.

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Cite this article

Patel, S.J., Truong, S., DeAndrade, S. et al. Respectful Maternity Care in the United States—Characterizing Inequities Experienced by Birthing People. Matern Child Health J 28, 1133–1147 (2024). https://doi.org/10.1007/s10995-023-03893-0

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  • DOI: https://doi.org/10.1007/s10995-023-03893-0

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