Obstetric mistreatment in the United States: A narrative review

Abbas, Miral

Background: The widening maternal health disparities in the United States (U.S.) require a close introspection of possible clinical and social causes. Regarding the latter, the interwoven elements of racism and social marginalization in the U.S.’ healthcare system may perpetuate experiences of discrimination that contribute to adverse maternal health outcomes. These experiences qualify as ‘obstetric mistreatment,’ or dehumanizing treatment by medical personnel during and after birthing experiences.1 Given that mistreatment is difficult to identify without standardized measurements and that it has proven adverse impacts on birthing individuals, a review of existing studies that quantify mistreatment and offer patient-centered solutions is necessary to begin understanding and thus addressing it.

Methods: This narrative review included published peer-reviewed studies that reported quantitative findings on the rates and predictors of obstetric mistreatment and/or qualitative descriptions of experiences of mistreatment. Keywords for searching were pre-selected and used in online databases (PubMed, Columbia University Library, and Google Scholar). Only peer-reviewed articles published from 2000 to 2023 that studied mistreatment in a U.S. setting were included. 42 articles were initially identified, and ultimately 12 peer reviewed studies with a mix of study methodologies were selected. A systematic review was not possible given limited literature available and varied types of studies (mixed-methods, quantitative, and qualitative studies).

Results: Published research indicates that mistreatment occurs in approximately 1 of 6 birthing individuals in the U.S., with birthing individuals of color being 2 times as likely to report a healthcare provider had ignored them, refused requests for help, or failed to respond to requests for help.2 Three themes emerged from the literature review that all attributed causes and trends in obstetric mistreatment to individual predictors and systemic faults. Obstetric mistreatment was common amongst birthing individuals of color; based on qualitative reports, those experiencing mistreatment felt this was largely due to institutional bias that affects care delivery especially for birthing individuals of color, and medicalization of the birthing process that disregards birthing individuals’ autonomy.

Conclusions: By reviewing existing literature on the prevalence and underlying causes of mistreatment, the review uncovered patterns in mistreatment that may explain maternal health disparities and could be targets for interventions. The literature indicated that obstetric mistreatment occurs because of fundamental shortcomings and systemic bias in the U.S. healthcare system that are rooted in racial disparities and social determinants of health. These instances of mistreatment may culminate into adverse birthing experiences that occur disproportionately among birthing individuals of color.

Keywords: obstetric mistreatment, maternal health, disparities, adverse maternal health outcomes, bias, respectful care, birth justice, intersectionality


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More About This Work

Academic Units
Health Policy and Management
Published Here
May 19, 2023


Independent study project with advisor Jamie Daw, Health Policy and Management