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“They Threatened and Bullied Me”: Examining Disparities in Autonomy, Respect, and Mistreatment Across Childbearing Communities

by Saraswathi Vedam, Professor and Principal, Birth Place Lab at UBC
  • Duration: 60 Mins
  • Credits: 1 CERP, 1 R-CERP, 0.1 Midwifery CEU
  • Learning Format: Online Webinar
  • Handout: No
  • Origin: GOLD Midwifery 2019

New global standards highlight the critical impact of patient-provider communication, emotional support, and respectful care (RMC) on quality and safety for mothers and newborns. Yet, very little is known about how people experience maternity care in high and middle resource countries; and validated indicators of RMC are scarce.

Researchers have proposed that institutional racism and lack of access to autonomy and respect, and physiologic birth options, contribute to adverse outcomes. Community members in Canada and the US worked with clinicians, NGO leaders, and researchers to design a study on quality of maternity care as experienced by pregnant persons from communities that experience higher rates of adverse outcomes due to race (African American, Indigenous, and Latina), immigrant or refugee status, or social barriers (homelessness, incarceration, substance use). Together they developed and administered a cross-sectional online survey and convened focus groups to explore novel topics including: women’s experiences of agency in decision-making, non-consented care, access to supportive services, and systemic respect or discrimination over the course of care.

Through these large community-based participatory research projects, we validated three new quality measures, the Mother’s Autonomy in Decision Making (MADM) scale and the Mothers on Respect (MORi) index, and the Pregnant Persons Experience of Mistreatment by Providers (PPEMP) Index, and adapted a fourth, the Perceptions of Racism scale. Using these as indicators, and adjusting for differences in socio-demographics, risk profile, type of provider, and place of birth, our multi-stakeholder team has completed descriptive, psychometric, regression, and mixed-effects analysis of data from over 5000 women in the US and Canada.

In this session we will explore how these reports of the lived experience of care can help us to understand how to address equitable access to the highest quality of care across all communities.

Learning Objectives:

Objective 1: Describe the Giving Voice to Mothers Study and development of the MADM, MORi, and PPEMP scales in the context of Patient Oriented Outcomes research.

Objective 2: Describe research on maternity care experience that address person-centred outcomes in high, middle and low resource countries.

Objective 3: List discrepancies in experiences of high quality care and respectful treatment by care providers, based on race, ethnicity, place of birth and socio-economic status globally.

Objective 4: Name two evidence based resources that can implement recommendations based on the findings of emerging participatory research on respectful maternity care.

Objective 5: Discuss the results of the GVtM studies within the global context for improving access to high quality care in institutions.

Presentations: 13  |  Hours / CE Credits: 10.5  |  Viewing Time: 8 Weeks