Equity in Maternal Care during Pregnancy, Birth and Postpartum

Racism and discrimination can affect different domains of the everyday, but some of them are studied much more than others. Here we examine healthcare provision with a particular focus on pregnancy, birth, and postpartum. Using a mixed-methods design in the Swiss healthcare system, we examine a case with high-quality maternal care, yet consistently higher mortality and morbidity for minorities. We document systematic differences in the treatment of women in vulnerable positions, notably people read as immigrants or socioeconomically disadvantaged. Empirically, we draw on 30 expert interviews in maternal care, migration, and health, as well as 30 semi-structured interviews with obstetric-gynaecological specialists and midwives. These interviews are used to design an experimental vignette study, in which a large-N population of healthcare professionals assess different situations that the qualitative part identified as sites of discrimination and exclusion. Preliminary results identify widespread stereotypes related to pain, good motherhood, health literacy, language and communication skills, as well as being ‘problematic’ in the sense of complicated and expensive consultations. These images are associated with the reading of patients as immigrants, ethnic minorities, and low socio-economic status. Considerations of deservingness and ‘social worth’ seem to influence how healthcare professionals assess patients. Health equity is undermined by a normalization of differential treatments of people read as immigrants and ethnic minorities. While we can identify efforts to counter this situation, these vary greatly between institutions, are often depend on individual initiatives and informal exchanges between healthcare professionals rather than being formalized and institutionalized.