Pregnant women of color more likely to have procedures they didn’t consent to, study finds

Black, Indigenous and people of color giving birth were more likely than white people to be coerced by health care providers into doing procedures they didn’t want or having their lack of health according to a new study, according to a new study. explicit consent totally ignored.

The new research, published Thursday in the journal Birth, provides insight into how birthing experiences differ significantly for pregnant women of color compared to pregnant white women.

For example, the study reported that 51% of BIPOC people surveyed said they had received non-consensual procedures – such as an epidural or medications to speed up their labor – during perinatal care or during a vaginal birth they never wanted. had not consented. The corresponding figure for whites was 36%.

Researchers from the Birth Place Lab at the University of British Columbia and UC San Francisco have shown that if BIPOC and white people refuse care at the same rate, healthcare providers are more likely to respect the wishes of the people. Whites.

Black patients were most likely to have their wishes ignored even after refusing a procedure. Compared to white patients, they were 89% more likely to have non-consensual procedures during perinatal care and 87% more likely to have them during vaginal deliveries. People who identified as Asian, Latina, Indigenous, or multiracial reported being pressured to agree to perinatal procedures 55% more often than white people.

Of all people who gave birth vaginally, 40% reported having undergone non-consensual procedures.

The study authors analyzed data from the Giving Voice to Mothers study, which recorded the pregnancy and childbirth experiences of 2,700 people in the United States between 2010 and 2016. They used responses to the survey of a subset of over 2,400 participants who underwent non-consensual procedures or felt they were coerced into taking medications to start or hasten labor, using an epidural, or taking medications to relieve pain, begin continuous fetal monitoring, or undergo an episiotomy.

Overall, participants who had C-sections were 30 times more likely to report pressure from providers than those who eventually delivered vaginally. The researchers noted that they did not find a racial or ethnic difference in the experience of pressure to have a C-section.

The study’s goal was “to collect data from populations that had not previously been included in studies of the childbirth experience,” the researchers wrote, and they partnered with organizations to “intentionally oversample communities of color and those who have chosen to give birth in the community.

“We often need these quantitative data … to explain what the community understands and knows,” said study leader Rachel G. Logan, a postdoctoral fellow in the department of family and community medicine at UC San Francisco.

She said that too often, the onus is on the people giving birth rather than the healthcare providers to change their behaviors in order to receive better service. In her research on people’s experiences of sexual and reproductive health care using a reproductive justice framework, she found that black and brown people who try to defend themselves “can be misinterpreted as being aggressive.

Part of the problem is that healthcare systems provide little or no avenues for accountability when patients of color experience racism in healthcare settings, Logan said. While she isn’t opposed to advice on how patients can defend themselves, “this idea that patients can overcome structural racism really misses the mark of talking about the root cause of the problem in the first place.”

“What I constantly hear when we talk about health services research, especially because I work with black women, is, ‘What should they be doing to be better patients? ‘” Logan added. “I think it might sometimes fall into the politics of respectability – ‘Do your research beforehand’, ‘Dress a certain way’, ‘Speak a certain way’. … In the together it won’t save us.”

The new study comes amid a push by medical schools, healthcare providers and public health experts to address racism and racial health disparities across the system, from doctors’ offices to hospital emergency rooms. While some researchers and medical providers have sounded the alarm in previous decades, the COVID-19 pandemic, the death of George Floyd and the Centers for Disease Control and Prevention calling racism a “serious threat to public health” have heightened attention on how to combat bias, prejudice and racism in health.

In the birth study, Logan and colleagues found that participants who had a midwife or a birth planned outside of a hospital, more antenatal care visits, or the same provider all throughout their pregnancy were less likely to experience pressure or non-consensual procedures. . But even then, they discovered that people of color were still under constant pressure.

Overall, 31% of all respondents were pressured to agree to perinatal procedures, 41% were pressured into non-consensual procedures, and 10% were pressured into having a caesarean section.

Saraswathi Vedam, professor of midwifery at UBC and one of the study’s authors, said the team’s previous research found that 17% of pregnant women had experienced abuse, including screaming , scolding, denial or ignoring of their requests for help, and being threatened that something bad will happen to them or their baby.

Vedam said the new findings were “discouraging” because they show “the health care system is failing to protect people’s human rights”.

“This particular article is probably the most shocking because you’re talking about people having things done to their bodies, or their babies without their involvement or consent or being pressured and… being pressured because of their identity,” she said. said.

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