A new study involving School of Public Health researchers surveyed mothers nation-wide and found many who declined care for themselves or their newborn babies during hospital births were more likely to report experiencing discrimination and other forms of poor treatment as well.

“The connection between declining care and poor treatment suggests those women may be labeled as ‘problem patients’ and stigmatized,” says senior author and Assistant Professor Rachel Hardeman.

The study, which Hardeman co-authored with SPH graduate and Assistant Professor Laura Attanasio (PhD ‘16) at University of Massachusetts Amherst, was published in the journal Social Science & Medicine.

Attanasio and Hardeman examined the hospital birth experiences of women by reviewing responses from the Listening to Mothers III survey, a survey of 2,400 women age 18-45 who gave birth to a single baby. The survey asked various questions about their birth experience, including, “At any time during the hospital stay for your recent birth, did you refuse to accept any care that a nurse, doctor, or midwife offered to you or your baby? “Care” includes anything that might be done or given to either of you or that you were asked to do (take a test, treatment, medicine, etc.).”

The study found:

• Women who reported declining care for themselves or their infant during their childbirth hospital stay were more likely to report “poor treatment” corresponding to their race and ethnicity, insurance status or having a difference of opinion with a health care provider.
• Black women were more likely than White women to feel discriminated against when they had a difference of opinion with a health care provider.

“The popular press has shown us through stories, such as that of tennis player, Serena Williams, that Black women are not receiving the care they need and deserve during childbirth,” says Hardeman. “The results of our study illuminate this further. It seems that Black women pay a penalty for speaking up.”

Hardeman said the findings offer important insights and new questions related to the complex and multifactorial ways in which Black women receive lower quality care, experience implicit and explicit racial bias, and are disrespected within the health care system while pregnant. The alarming inequities in maternal and infant outcomes by race underscore the need for Black women to be vocal, and perhaps, at times decline certain procedures in order to protect their health and well-being. Likewise, providers need to improve their ability to respect the choices of patients while maintaining high-quality care.

Hardeman is continuing her work in addressing inequities in maternity care through the development of  strategies to bring respectful and culturally-centered maternity care practices to health care systems.