With the US maternal death rate already the highest among affluent countries and still rising, a new study by the Centers for Disease Control and Prevention suggests pregnant people experience high levels of mistreatment and discrimination during maternity care.

The survey of 2,402 mothers from around the country found that 1 in 5 experienced some type of mistreatment by health care providers during their maternity care. The most common forms included having health concerns ignored or dismissed (10 percent), being shouted at or scolded (7 percent), having their physical privacy violated (5 percent), and having a provider threaten to withhold treatment or force them to accept unwanted treatment (5 percent). Additionally, nearly 30 percent of survey takers reported experiencing discrimination during their maternity care, including their race, age, weight, and income.

Black, Hispanic, and multi-racial mothers reported the highest rates of mistreatment and discrimination. These racial disparities mirror disparities seen in pregnancy outcomes; mothers in these groups face the highest maternal mortality rates in the country. Black mothers, for instance, are three times more likely to die from pregnancy-related causes than white mothers.

Overall, 45 percent of the survey respondents said they held back from discussing health concerns during pregnancy and delivery with their care provider. They often did this because they thought what they felt was normal; they didn't want to make a big deal about a problem; they didn't want to seem "difficult;" and they felt their health care provider was rushed.

The survey study has many limitations—including that it's not nationally representative, it was taken years after some respondents' pregnancies, and responses are subject to recall bias. But, it offers a glimpse into the lived experiences of pregnant people in the US, who continue to die and suffer severe health problems at remarkably high rates. Between 2018 and 2021, the US maternal mortality rate rose from 17.4 deaths per 100,000 live births to 32.9 deaths. Those numbers easily surpass the rates of other high-income countries, which have generally seen maternal mortality decline in recent years. In 2020, when the US rate was 23.8, the country with the next highest rate was New Zealand, with a rate of 13.6 deaths per 100,000 live births, according to a report by the Commonwealth Fund. Across the northern border in Canada, the rate was 8.4, and in the UK, it was 6.5.

Tragic outcomes

The current survey study does not draw a direct line from mistreatment and discrimination to deaths and morbidity. But, CDC officials suggest it clearly plays a role, noting that higher scores for the quality of maternity care are associated with lower risks of pregnancy complications.

In a media briefing Tuesday, Debra Houry, CDC’s chief medical officer, called the study's findings "unacceptable" and said that it's clear that mistreatment and discrimination lead to bad outcomes.

"We have heard too many heartbreaking stories of women, particularly Black women, who knew something wasn't right with their pregnancy and voiced it, but were not heard and died as a result," Houry said. "CDC's own Dr. Shalon Irving was one of these women."

Irving was a lieutenant commander in the US Public Health Service and an epidemiologist at the CDC who focused on racial disparities in health. Despite her work, her PhD, her two master's degrees, her excellent health insurance plan, and a care team at the highly regarded health system at Emory University, Dr. Irving died in 2017 several weeks after giving birth due to high blood pressure.

Irving, who was Black, died "despite continuously visiting her providers where she kept insisting something was wrong and was being dismissed," Houry said. "As a health care community, we have to do better at providing unbiased and respectful maternity care, equally, to all mothers."

The CDC has laid out strategies for health care providers and patients to avoid such tragic outcomes via a campaign called "Hear her." For providers, the CDC recommends hiring and retaining a diverse workforce, providing training on unconscious bias and stigma, and supporting doulas and midwifery models of care. For patients, the CDC offers tips on how to talk with health care providers about concerns, what questions to ask, and what urgent warning signs to know.