The Giving Voice to Mothers Study: Measuring Respectful Maternity Care in the United States [18Q

Abstract

INTRODUCTION: Adverse perinatal outcomes among immigrants, refugees, and women of colors in the US are well-documented and persist even when socio-economic background is considered. METHODS: Community members and researchers designed a survey to capture patient-oriented data on maternity care experiences among communities of color. Items included previously validated instruments including the Mothers Autonomy in Decision Making (MADM) scale, the Mothers on Respect index (MORi); and the Perceptions of Racism (PR) scale. The final instrument was content validated, piloted, and distributed across the US. Descriptive statistics describe access, experience, and outcomes; and regression analyses link MADM and MORi scale scores to respectful care and autonomy (adjusting for differences in sociodemographics, risk profile, type of provider, and place of birth). RESULTS: Of the total sample (N=2260), 37.3% were women of color (Black, Hispanic, Native, other), and 18% Medicaid recipients. Women of color had significantly lower MADM scores, and 20.5% were not satisfied with their role in decision making. Women with low MORi scores reported pressure by health professionals to accept interventions [(6.8%) epidurals, (15.8%) inductions, (11.1%) cesarean]. Reported discrimination due to a difference in opinion with providers was more common (17%) among women of color. MADM, MORi, and PR scores varied significantly by place of birth and type of provider. CONCLUSION: Persons of color in the US report receiving less respectful maternity care, and reduced access to options for physiologic birth care. Data suggest that type of provider or place of birth modulates outcomes, and institutional racism may be a contributing factor.