Coercion and non‐consent during birth and newborn care in the United States

Abstract

In the United States, Black, Indigenous, and People of Color (BIPOC) experience more adverse health outcomes and report mistreatment during pregnancy and birth care. The rights to bodily autonomy and consent are core components of high‐quality health care. To assess experiences of coercion and nonconsent for procedures during perinatal care among racialized service users in the United States, we analyzed data from the Giving Voice to Mothers (GVtM‐US) study. Methods In a subset analysis of the full sample of 2700, we examined survey responses for participants who described the experience of pressure or nonconsented procedures or intervention during perinatal care. We conducted multivariable logistic regression analyses by racial and ethnic identity for the outcomes: pressure to have perinatal procedures (eg, induction, epidurals, episiotomy, fetal monitoring), nonconsented procedures performed during perinatal care, pressure to have a cesarean birth, and nonconsented procedures during vaginal births. Results Among participants (n = 2490), 34% self‐identified as BIPOC, and 37% had a planned hospital birth. Overall, we found significant differences in pressure and nonconsented perinatal procedures by racial and ethnic identity. These inequities persisted even after controlling for contextual factors, such as birthplace, practitioner type, and prenatal care context. For example, more participants with Black racial identity experienced nonconsented procedures during perinatal care (AOR 1.89, 95% CI 1.35–2.64) and vaginal births (AOR 1.87, 95% CI 1.23–2.83) than those identifying as white. In addition, people who identified as other minoritized racial and ethnic identities reported experiencing more pressure to accept perinatal procedures (AOR 1.55, 95% CI 1.08–2.20) than those who were white. Discussion There is a need to address human rights violations in perinatal care for all birthing people with particular attention to the needs of those identifying as BIPOC. By eliminating mistreatment in perinatal care, such as pressure to accept services and nonconsented procedures, we can help mitigate long‐standing inequities.

Addressing inequalities in the identification and management of perinatal mental health difficulties: The perspectives of minoritised women, healthcare practitioners and the voluntary sector

“…Further, a recent systematic review of ethnic minority women's experiences of PMH conditions and services in Europe identified the need for cultural competency training, noting the variation in provision ( 3 ). The urgent relevance of cultural competency for perinatal services is indicated by various findings, including evidence of institutional/systemic racism and discrimination ( 43 – 45 ) and ethnic/racial disparities in the mortality and morbidity rates of mothers and their babies ( 46 ) together with evidence of aspects such as different rates of coercion and non-consensual procedures by racial and ethnic identity ( 47 ). We propose here an additional need for training specifically about cultural competence in PMH given the specific challenges that may present.…”

“…Darwin et al 10.3389/fgwh.2022.1028192procedures by racial and ethnic identity(47). We propose here an additional need for training specifically about cultural competence in PMH given the specific challenges that may present.…”

Verletzte Geburtsintegrität während der COVID-19-Pandemie in Deutschland: Erfahrungen von Gebärenden mit der geburtshilflichen Versorgung

“…d („kristellern“) Ja 72/107 (67,3) Nein 35/107 (32,7) Einwilligung bei Verwendung von Geburtszange/Saugglocke d Ja 40/107 (37,4) Nein 67/107 (62,6) Einwilligung vor vaginalen Untersuchungen Ja, immer 898 (70,6) Manchmal 193 (15,2) Nein, niemals 110 (8,6) Ich hatte nie vaginale Untersuchungen 70 (5,6) Haut-zu-Haut-Kontakt mit Kind Ja 1152 (90,6) Nein 36 (2,8) Diese Möglichkeit hatte ich aufgrund meiner Gesundheit oder der Gesundheit meines Babys nicht 83 (6,5) Stillversuch nach Geburt Ja 1085 (85,4) Nein 86 (6,8) Diese Möglichkeit hatte ich aufgrund meiner Gesundheit oder der Gesundheit meines Babys nicht 100 (7,9) a Frauen mit Wehen und/oder Blasensprung. Die Unterscheidung zwischen den Geburtsmodi basiert auf den Leitlinien des National Institute for Health and Care Excellence (NICE; [ 46 ]) b Frauen mit Kaiserschnitt c Frauen mit spontan-vaginaler Geburt d Frauen mit operativ-vaginaler Geburt …”

“… a Frauen mit Wehen und/oder Blasensprung. Die Unterscheidung zwischen den Geburtsmodi basiert auf den Leitlinien des National Institute for Health and Care Excellence (NICE; [ 46 ]) b Frauen mit Kaiserschnitt c Frauen mit spontan-vaginaler Geburt d Frauen mit operativ-vaginaler Geburt …”

“…a Frauen mit Wehen und/oder Blasensprung. Die Unterscheidung zwischen den Geburtsmodi basiert auf den Leitlinien des National Institute for Health and Care Excellence (NICE; [ 46 ])…”