This article is based on an interview with Patience Afulani. Dr. Afulani is the Principal Investigator of PTBi's Patient-Centered Maternity Care study. Learn more here.
I had my first child in Ghana, and my second child in the US. My experience in both places was not bad. In Ghana, I gave birth in a health facility I worked in as a doctor, so my experience was not like everybody else’s experience. I noticed the difference between how I was treated as a doctor giving birth there, and how I would say the ordinary woman coming in was giving birth.
Once in the US, I started talking to people about US birth experience and I realized I overestimated other women's experiences. Although I wasn't a doctor in the US Health facility, I was still in a privileged position. That made me want to learn more. Thinking through my privilege and how my privilege changed how I was treated and how other women who do not have that privilege are treated in health facilities has influenced me a lot.
Dr. Afulani after her second birth in a U.S. healthcare facility.
Measuring care and addressing unconscious bias
So, my work looks at how to measure and improve the quality of care for women during pregnancy and childbirth. There's a saying that what doesn't get measured, doesn't get done. And so, if we're not measuring particular issues, it means we're not doing anything about it. We haven't had validated tools that capture the experiences of women of color, who are more likely to have poor experiences in healthcare settings. So, I am focused on developing a validated tool that reflects their experiences during pregnancy, during childbirth. When we measure it, then we know what the issues actually are, and that can inform interventions to see if we're making progress or not.
For my California work, we're still collecting that data. But one of the main factors influencing women’s experiences of care is the issue of unconscious biases held by providers against women of color and particularly Brown and Black women. Most of the time these attitudes are based on societal perceptions of those women, and that plays out in the healthcare encounter. For example, assumptions that Black women have higher pain thresholds might lead providers to be less likely to provide pain medication to Black women in labor.
Qualitative research shows that sometimes providers just do not value women's experiences. There are judgment calls on whose knowledge is valued. Certain groups of people are more likely to be listened to in healthcare settings than others, and Black women, in particular, do not feel they are being listened to.
One of the things we want to do is to highlight these disparities in a more quantitative manner and then to use that as a way of advocating for change in terms of what healthcare providers need to be doing to ensure that these disparities do not exist. Having some solid data behind it would help move that conversation forward.
Working with healthcare providers for change
The group I particularly like to present this work is to healthcare providers because there are a lot of things that providers do that are very unconscious. Presenting the data to them is usually an eye-opener and a reminder that these are basic aspects of care. People are more committed to change after you share the data with them.
One of my favorite quotes is by Maya Angelou who says, "People may not remember what you say or do, but they'll always remember how you make them feel." And I think that is very important for healthcare providers to remember. A lot of the time, when they're having those clinical encounters, it's not the technical things they do, but how they make women feel in that healthcare encounter that is very important, so being consciously aware of that.
We're hoping that once we have this scale, anybody can pick up this set of questions and use it for their work. Then we will have the data to be able to say, "This is what women report on their experiences" and be able to advocate for change based on that. Seeing people motivated to want to do better, to want to treat women better, is very gratifying.
Read Dr. Afulani's paper on person-centered maternity care
Development of the Person-Centered Prenatal Care scale for People of Color
