Inequities in Care During Pregnancy Loss: Empirical Insights From Experiences With Canadian Perinatal Care

Abstract

Background: Individuals experiencing perinatal loss are entitled to respectful maternity care, but a paucity of research examines respectful care at the time of pregnancy loss. Method: We used data from an online cross-sectional survey (July 2020–February 2022), where 172 individuals reported on early (miscarriage) and late (late second trimester, stillbirth, neonatal death) losses since 2009. We aimed to explore inequities in respectful care experiences among individuals experiencing a late versus early perinatal loss in Canada. We assessed their experiences using the Mothers' Autonomy in Decision Making (MADM) scale and the Mothers on Respect Index (MORi). We created the Compassionate Disclosure of (perinatal) Loss (CDL) index to measure respectful care at the time of a loss. A single separate item, provider not listening to the individual's expression of concerns during pregnancy, was also analyzed. Results: The early and late loss groups differed in education levels. Individuals who self-identified as Indigenous/Black/People of Color (IBPOC) had lower odds of scoring in the top quartile on MADM and MORi scales (AOR = 0.31, 95% CI 0.13, 0.75; AOR = 0.34, 95% CI 0.13, 0.86); and higher odds of reporting that providers did not listen to their concerns prior to the loss (AOR = 2.61, 95% CI 1.24, 5.48). Psychometric analysis supported the CDL index. Participants experiencing late loss had higher odds of reporting top quartile CDL scores than those experiencing early loss (AOR = 3.08, CI 1.22, 7.77). Conclusion: Canadian individuals with perinatal loss report disproportionately poorer care when they are experiencing a miscarriage and when they identify as IBPOC.