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One in five U.S. women said they were mistreated during maternity care, according to a CDC study.

And the rate of mistreatment was even higher among Black (30%), Hispanic (29%), and multiracial (28%) women, reported researchers led by Yousra Mohamoud, PhD, of the CDC in Atlanta.

Women who had public insurance (26%) or no insurance (28%) reported higher rates of mistreatment compared with women with private insurance (16%), the group detailed in .

The most commonly reported experience of mistreatment was being ignored by a healthcare provider or having a request for help denied (10%). But other frequent examples included being shouted at (7%), violations of physical privacy (5%), and threats to withhold treatment or being made to accept unwanted care (5%).

During a call with reporters, co-author Wanda Barfield, MD, director of the CDC's Division of Reproductive Health, said that "as a mother, and as a Black woman, I was fortunate to have an obstetrician/gynecologist who saved my life, and the life of my son, because he respectfully listened to my concerns while I was pregnant. Yet this report provides evidence that many women are having experiences that are truly unacceptable."

"Every mom deserves respectful and fair and equal care during their pregnancy and delivery," she added.

The report also detailed high levels of discrimination, with 29% of women overall saying they were discriminated against during maternity care -- Black (40%), Hispanic (37%), and multiracial (39%) women flagged even higher levels of discrimination. Overall, age (10%), weight (10%), and income (7%) discrimination were most common, but differed by race and ethnicity, according to the researchers.

"As a healthcare community, we have to do better at providing unbiased and respectful maternity care equally to all mothers," said Debra Houry, MD, the CDC's chief medical officer, during the press call.

The researchers explained that from 2018 to 2021, maternal death rates jumped from 17.4 to 32.9 per 100,000 live births, with Native Hawaiian and other Pacific Islander, Black, and American Indian and Alaska Native persons having higher rates of pregnancy-related deaths than whites.

But approximately 80% of pregnancy-related deaths are preventable, the researchers stated, and have been linked with pregnancy complications.

The Porter Novelli View Moms Survey was conducted from April 24-30, 2023, and included 2,402 mothers who were asked about their maternity care experience during pregnancy or the delivery of their youngest child.

Overall, 70% of respondents identified as white, 11% as Black, 10% as Hispanic, 4% as Asian, 3% as multiracial, and 2% as American Indian, Alaska Native, Native Hawaiian, or Pacific Islander. About two-thirds of respondents reported that their youngest child was age 5 years or older. Just over half of respondents were privately insured, and about one-third were Medicaid enrollees when their youngest child was born.

The survey also drilled down into communication challenges among patients and providers.

Researchers found that 45% of respondents said they suppressed questions or stopped short of raising concerns during maternity care. The most common reasons for this included thinking that what they were feeling was normal (29%), or being told that it was by friends and family (21%); embarrassment or not wanting to make a big deal out of something (22%); worrying that their healthcare provider would think they were being difficult (21%); and observing that their provider seemed rushed (17%).

Mohamoud and co-authors noted that 90% of respondents said they were satisfied with the maternity care they received, but cautioned that "women might report satisfaction with the maternity care received overall and concurrently recall discrete instances of mistreatment."

By improving the quality of maternity care, healthcare systems can help prevent pregnancy-related deaths, according to the researchers, with strategies such as implicit bias training for providers, recruiting providers from diverse backgrounds, and integrating midwifery models and doulas into maternity care.

The CDC offers resources to help women and their support networks to communicate their concerns, and be aware of "life-threatening warning signs," so patients know when immediate care is needed.

Study limitations included the fact that the survey was conducted on an "opt-in" basis and did not leverage probability sampling or weighting, so results are not necessarily representative of the U.S. birthing population. Also, responses were subject to recall bias and the survey was only in English, so the data are not reflective of maternity care experiences of those not fluent in English.

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