By Sarah Johanek, MPH

On August 22nd, 2023, the CDC released a report titled Vital Signs: Maternity Care Experiences – United States, April 2023, outlining the mistreatment mothers face during maternity care and highlighting severe rates of racial discrimination among Black, Hispanic, and multiracial mothers. This report emphasizes the importance of implementing quality improvement initiatives and provider training to increase respectful maternity care.

In a report on maternal mortality from 2018 to 2021, the CDC found that maternal deaths increased from 17.4 to 32.9 per 100,000, with 80% of pregnancy-related deaths being preventable and Black and Brown mothers having the highest rates of pregnancy-related deaths. In order to understand this increase in maternal mortality and severe racial disparities, the CDC analyzed respectful maternity care, which is defined by the World Health Organization 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.”

The CDC analyzed data collected from Porter Novelli “PN View Moms” survey administered during April 24–30, 2023, to evaluate three contributing factors of respectful care:

Experiences of mistreatment, such as violations of physical privacy, ignoring requests for help, or verbal abuse
Discrimination because of race, ethnicity or skin color; age; or weight
Reasons for holding back from communicating questions or concerns during maternity care

The CDC found the following:

Among U.S. mothers with children under 18 years old, 20% reported mistreatment while receiving maternity care for their youngest child
30% of Black, Hispanic, and multiracial respondents reported mistreatment
30% of respondents with public insurance or no insurance reported mistreatment
29% of respondents experienced discrimination during the delivery of maternity care
40% of Black, Hispanic, and multiracial respondents reported discrimination
45% percent of all respondents reported holding back from asking questions or discussing concerns with their provider

Because one in five women reported mistreatment during maternity care, the CDC recommends:

Hospitals and Obstetric providers to implement quality improvement initiatives and training to recognize unconscious bias and stigma and promote shared-decision making
Providers to utilize the AIM patient safety bundles, which include the provision of safe, respectful, equitable, and supportive care
Perinatal quality collaboratives to improve the quality of care for mothers and babies and implement initiatives to address birth equity and establish routine measurement of patient experience to promote respectful maternity care
Hospitals to recruit and retain providers with diverse backgrounds, utilize midwifery models of care, and integrate doulas into maternity care

Read the full report here.