The Consequences of Being Mistreated by the Healthcare System

This article originally appeared  here.

What are the consequences of being mistreated by the healthcare system? That is the question we asked after reading a new study published last month in the journal  JAMA Network Open. The study involved 4,458 postpartum individuals and found that “more than 1 in 8 individuals…reported experiencing mistreatment during childbirth.” The most common form of mistreatment was being ignored or refused a request for help.  Other types of mistreatment included “being shouted at or scolded” by healthcare clinicians and having healthcare clinicians threaten “to withhold treatment or force you to accept treatment that you did not want.” Factors that increased the chance of being mistreated during childbirth were being LGBTQ, Medicaid insured, unmarried, obese before pregnancy, having an unplanned cesarean birth, a history of substance use disorder, experienced intimate partner or family violence, mood disorder, or giving birth during the pandemic. In 2019  The Giving Voice to Mothers study found that indigenous, Hispanic, and Black women were more likely to report mistreatment during childbirth than white women.

Maternal Mortality is Higher Among Black than White Women

These findings are of course disturbing and beg the question of what psychological and physical consequences attend being mistreated by healthcare providers during pregnancy. Right now, there is a  debate about whether maternal morbidity and mortality are increasing significantly in the U.S. The Centers for Disease Control and Prevention (U.S.) reported a tripling of the U.S. maternal mortality rate over the past two decades, but a recent paper in the  American Journal of Obstetrics and Gynecology (ACOG) called the CDC data into question, finding that, using an alternative method of analysis, rates of maternal mortality in the U.S. have not been rising. CDC officials stood by their data, however, and the controversy raged on very publicly.

But one thing that both the CDC and the ACOG paper authors agree on is that the rates of maternal morbidity are much higher among Black than white women. (NB: Critica is aware that not all pregnant people identify as women, but we use this terminology to be consistent with what is used in the papers under discussion). CDC issued a report showing that in 2021 maternal pregnancy-related deaths were  2.6 times higher among non-Hispanic Black women than among non-Hispanic white women. There are likely many reasons for this disparity including the stress attendant to experiencing racism and discrimination. We hypothesize that one significant factor in the increased risk of pregnancy-related deaths among Black people is that mistreatment by healthcare professionals, which as noted is also reported to be higher among Black than white women,  dissuades Black individuals from taking advantage of all the recommended steps to protect pregnancy health. Perhaps this is one reason that the rate of home births among Black women is rising so sharply.

Does the Experience of Mistreatment Drive People Away from the Healthcare System?

Mistreatment during pregnancy affects pregnant people of all races and ethnic groups and may be a factor in driving them away from the traditional healthcare system. When an individual is mistreated by a healthcare professional it may cause a variety of psychological reactions, including anger, fear, and anxiety. People in such a state are vulnerable to believing misinformation, something that is rampant in the area of reproductive health. This in turn may lead the mistreated person to distrust the healthcare system and favor other, “alternative” approaches to reproductive healthcare.

More and more pregnant people seem to be listening to the purveyors of “wellness” approaches to pregnancy, labor, and delivery. This can, in turn, lead to unsafe situations in which the pregnant person’s life is threatened. We suggest that the consequences of mistreatment of pregnant people by healthcare providers may be the induction of serious psychological harm, making pregnant individuals shun recommended preventative care and refuse medically necessary interventions. The results can be fatal.