A team that includes B.C. researchers has found that Black, Indigenous and people of colour are more likely to feel pressured into procedures by health providers during pregnancy and birth care.
The study, published in the journal Birth on Thursday, suggests that Black people in the U.S. are twice as likely as white people to be coerced into procedures during childbirth and postpartum.
The findings resonate across the border as research underway in Canada raises similar concerns about how racism influences pregnant people's experiences of coercion and consent, says Saraswathi Vedam, lead investigator at University of British Columbia's Birth Place Lab.
"As a baseline, there is not always a culture that we involve the service user as a lead decision maker," said Vedam, a professor of midwifery at UBC's medical school.
"It's difficult to explain these differences that we see for racialized people without talking about racism."
Researchers at UBC and University of California San Francisco examined data from a study of 2,700 people in the U.S. who were surveyed about their pregnancy and birth experiences between 2010 and 2016.
Of the 2,490 respondents included in the team's analysis, 34 per cent identified as Black, Indigenous or people of colour (BIPOC).
Overall, nearly a third of participants reported feeling pressured into procedures, such as episiotomy, which involves making an incision to widen the opening of the vagina, using drugs to speed up labour or receiving an epidural.
Thirty-one per cent of BIPOC respondents said they felt pressured to undergo continuous fetal monitoring, which involves listening to the baby's heart by wearing a belt or wire, compared to 20 per cent of white participants.
Evidence suggests that continuous fetal monitoring is linked to higher rates of cesarean deliveries and other intervention, said Vedam. For low-risk pregnancies, intermittent monitoring is considered safe and more comfortable, she said.
Vedam and the research team found that white and Black participants declined care at similar rates, but practitioners were more likely to proceed with procedures that Black people had refused and respect the wishes of white respondents.
Vedam said this discrepancy could be a product of "unconscious bias" among providers about what a patient understands and their capacity to make their own health decisions.
"I don't think that service providers are performing these things specifically as a racist act," said Vedam. "It's more about not listening, or not taking the time or not including someone in a conversation or decision-making moment."
Early findings from a parallel survey of 6,000 people across Canada suggest these problems exist in this country as well, said Vedam.
Alixandra Bacon, president of the Canadian Association of Midwives, said Thursday's paper adds to the growing body of research about how racism affects reproductive health.
"These findings are difficult to swallow, but they're a clear call to action," said Bacon.
Vedam called for more education in the health community about addressing racism and providing care based on "informed decision making."
"We understand that people feel like they either weren't asked, it wasn't explained to them or they didn't really understand why. They didn't think it was necessary," she said.
"They didn't feel like they were getting the information that was fulsome and truthful. And so I think having us address that and be reflective about power imbalances ... requiring things like anti-racism training, is where we need to start."
This report by The Canadian Press was first published June 23, 2022.
Adina Bresge, The Canadian Press
Note to readers: This is a corrected story. An earlier version of this story misstated Saraswathi Vedam's title. In fact, Vedam is a professor of midwifery at UBC's medical school.