The Equity Experience, LLC, Tampa, FL, USA.
Department of Family Health Care Nursing, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA, USA.
Birth. 2022 Dec;49(4):749-762. doi: 10.1111/birt.12641. Epub 2022 Jun 23.
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.
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.
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.
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.
在美国，黑人和原住民以及有色人种（BIPOC）在妊娠和分娩护理期间经历更多不良健康结果和遭受虐待。身体自主和同意的权利是高质量医疗保健的核心组成部分。为了评估美国种族化服务使用者在围产期护理期间程序的强制和不同意的经历，我们分析了来自“赋予母亲声音（GVtM-US）”研究的数据。
在对 2700 名参与者的全样本的子样本分析中，我们检查了描述围产期护理期间经历压力或未经同意的程序或干预的参与者的调查答复。我们按种族和族裔身份进行了多变量逻辑回归分析，结果为：围产期程序的压力（例如，引产、硬膜外麻醉、会阴切开术、胎儿监测）、围产期护理期间未经同意的程序、剖宫产的压力和阴道分娩期间未经同意的程序。
在参与者中（n=2490），34%自我认同为 BIPOC，37%计划在医院分娩。总体而言，我们发现种族和族裔身份在压力和未经同意的围产期程序方面存在显著差异。即使在控制了出生地点、从业者类型和产前保健背景等背景因素后，这些不平等仍然存在。例如，具有黑人种族认同的参与者经历了更多的未经同意的围产期护理期间的程序（OR 1.89，95%CI 1.35-2.64）和阴道分娩（OR 1.87，95%CI 1.23-2.83）比那些自我认同为白人的参与者。此外，与白人相比，其他少数族裔身份认同的人报告说，他们更有可能接受围产期程序（OR 1.55，95%CI 1.08-2.20）的压力。
需要解决所有分娩者围产期护理中的侵犯人权问题，特别关注自我认同为 BIPOC 的人的需求。通过消除围产期护理中的虐待行为，例如接受服务和未经同意的程序的压力，我们可以帮助减轻长期存在的不平等。
