BACKGROUND:
Historically oppressed and marginalized populations are more likely to experience barriers and mistreatment during health care interactions. Qualitative studies find that Indigenous and racialized individuals, people with disabilities, sexual and gender minorities, and those with lower socioeconomic status, are at risk for adverse perinatal outcomes. While studies in other countries have examined these issues, there is limited research on the lived experience of perinatal services and drivers of disparities in Canada.

OBJECTIVES:
We used a community participatory action research approach to explore factors associated with mistreatment and disrespect during pregnancy in Canada and examined the characteristics of these experiences across different sociodemographic groups.

METHODS:
We analyzed data from the Research Examining Stories of Pregnancy and Childbirth in Canada Today (RESPCCT) study, a national cross-sectional survey. We used validated person-centred measures to examine human rights violations such as verbal abuse, discrimination, denial of autonomy, coercion, and being dismissed by healthcare providers. Respondents used the the Mistreatment and Disrespect Index (MIST-15), and Day-to-Day Discrimination Index to detail their experiences. Chi-square tests and multivariable logistic regression models were used to explore associations between mistreatment and demographic, socioeconomic, and clinical factors.

RESULTS:
Of all participants who completed the items (n 3853/6096) nearly half (47.5%) reported high levels of some type of mistreatment. Sociodemographic factors, including racial/ethnic identity, disability status, minority sexual identity, and socioeconomic background, were significantly associated with increased reports of mistreatment. Individuals who underwent cesarean or assisted vaginal births were also more likely to report negative experiences. However, midwife-led care and shared identity with a healthcare provider were associated with lower odds of mistreatment.

CONCLUSIONS:
These findings contribute to the growing understanding of drivers of disparities and opportunities for quality improvement and accountability.

KEY MESSAGE:
People with lived experiences of care are the "experts" who are best positioned to inform patient-oriented, community-responsive perinatal services Respectful maternity care 2