Pregnant women of color are more likely to have procedures they did not consent to, study finds

Blacks, indigenous people and people of color who give birth were more likely than whites to experience healthcare providers coercing them into procedures they didn’t want or having their lack of explicit consent completely disregarded, according to a new study. .

The new research, published Thursday in the journal Birth, provides a comprehensive look at how birthing experiences differ dramatically for pregnant black women compared to white pregnant women.

For example, the study reported that 51% of BIPOC people surveyed said they received non-consenting procedures — such as an epidural or medication to speed up labor — during perinatal care or during vaginal delivery that they did not consent to. The corresponding number for whites was 36%.

Researchers at the University of British Columbia’s Birthplace Laboratory and UC San Francisco showed that while BIPOC and whites refused care at the same rate, healthcare providers were more likely to respect whites’ wishes.

Black patients were the most likely to have their wishes ignored even after refusing a procedure. Compared with white patients, they were 89% more likely to perform non-consenting procedures during perinatal care and 87% more likely to have them during vaginal delivery. People who identified as Asian, Latina, Indigenous or multiracial reported experiencing pressure to accept perinatal procedures 55% more often than white people.

Among all people who had vaginal births, 40% reported having performed 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 US between 2010 and 2016. They used survey responses from a subset of more than 2,400 participants who had non-consensual procedures. or felt pressured to take medication to initiate or speed up labor, use an epidural or take pain-relieving medication, initiate continuous fetal monitoring, or have an episiotomy.

Overall, participants who had cesareans were 30 times more likely to report pressure from providers than those who had vaginal deliveries. The researchers noted that they found no racial or ethnic differences in the experience of pressure to have a cesarean section.

The aim of the study was to “collect data from populations that had not previously been included in studies of the birth experience,” the researchers wrote, and they partnered with organizations to “intentionally examine communities of color and those who chose to give birth in community”.

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

She said the onus is often placed on people who give birth, rather than on healthcare providers, to change their behaviors to receive better service. In her research, analyzing people’s experiences of sexual and reproductive health 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 offer few avenues of accountability when patients of color experience racism in healthcare, Logan said. While she is not opposed to tips on how patients can defend themselves, “this idea that patients can overcome structural racism really misses the point of talking about the root cause of the problem in the first place.”

“One thing I always hear when we talk about health care research is, especially as I work with women of color, ‘What should they do to be better patients?’” added Logan. “I think it can sometimes fall into the politics of respectability – ‘Do your research first’, ‘Dress a certain way’, ‘Speak a certain way’. … By and large, this will not save us.”

The new study comes amid an effort by medical schools, healthcare professionals 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 public health threat” have reinforced the attention on how to deal with prejudices and prejudices. and racism in health.

In the Birth study, Logan and colleagues found that participants who had a midwife, or planned to deliver outside a hospital, a greater number of antenatal visits, or the same health care provider throughout their pregnancy were less likely to experience pressure. or non-consented procedures. But even so, they found that people of color were still constantly under pressure.

Overall, 31% of all respondents were pressured to accept perinatal procedures, 41% received non-consensual procedures and 10% were pressured to have a cesarean section.

Saraswathi Vedam, a professor of obstetrics at UBC and one of the study’s authors, said the team’s previous research found that 17% of pregnant women experienced abuse, including yelling, scolding, having their requests for help denied or ignored, and being threatened with abuse. that something bad is going to happen to them or their baby.

Vedam said the new findings are “distressing” because they show that “the healthcare system is not protecting people’s human rights.”

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

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