New UCSF Analysis Quantifies Widespread Inequities in Everyday Maternity Care for Black Birthing People in California

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Infographic stating that too few California Black women experience person-centered maternity care at birth, showing 63.2% statewide vs. 54.6% for Black women, with images of a Black mother holding her baby and healthcare providers, branded by UCSF Center for Health Equity.

 

Previous research, widespread reporting and personal accounts have brought to light the disrespectful treatment that Black women often experience during maternity care. New statewide data from UCSF shows how common these experiences are in California — and why they matter for health. 

A new analysis from the UCSF Center for Health Equity draws on representative data from the 2023 California Maternal and Infant Health Assessment (MIHA) to better understand how Black birthing people experience care during childbirth. 

Researchers found that only about half of Black birthing people in California (54.6%) received person-centered maternity care — care where patients feel listened to, respected, clearly informed, and included in decisions — compared to 63.2% statewide. 

"These findings help paint a picture of what’s happening inside maternity care settings across California. They show that everyday interactions — how providers communicate, listen, and respond — play a major role in people’s well-being and contribute to unfair differences in Black women’s maternal health outcomes."
Kristen Marchi, MPH
Executive Director of UCSF’s Center for Health Equity and a co-author of the report
Where Care Breaks Down – Shouting and Scolding During Childbirth 

The analysis shows that substandard care most often occurs in health care provider communication and patient autonomy. The most common issue Black women reported was not feeling listened to by their providers when communicating their needs.  

More than one in five Black birthing people reported being pressured into medical decisions, ignored or neglected, treated unfairly, or spoken to rudely by providers — including being shouted at or scolded during childbirth.  

“Being shouted at or spoken to harshly while giving birth undermines trust and a sense of safety at a critical moment. These experiences are not rare, and they are linked to health after birth.”  
Dr. Patience Afulani
Co-author, UCSF 
Respectful Care Is Linked to Better Health 

The analysis also shows that respectful, person-centered care is linked to better outcomes. Black birthing people who felt listened to and supported were less likely to experience anxiety or depression and more likely to attend postpartum visits and breastfeed. 

Clear Ways to Improve Care 

The report also points to practical steps California can take to improve maternity care, including clearer communication between patients and providers, shared decision-making, expanded access to doulas and midwives, culturally centered care models, workforce diversity, and payment policies that support respectful care. Many of these approaches align with ongoing Medi-Cal and maternal health reforms. 

“Black families have been describing these experiences for years. These data provide the numbers to support what we hear from families about their maternity care. The new data will help advocates and policymakers measure progress to improve care and outcomes as well as demand accountability from health systems.” 
Mashariki Kudumu
 
About the Data 

MIHA is an annual, statewide survey run by the California Department of Public Health in partnership with UCSF. The findings represent the entire population of Black birthing people across California who gave birth in 2023 –over 21,000 individuals. 

About the UCSF Center for Health Equity 

The UCSF Center for Health Equity works with researchers, clinicians, community organizations, and policymakers to improve health and health care for communities facing inequities. Through research and partnerships, the Center helps turn lived experience into evidence that can inform policy and practice across California and beyond. For general inquiries, contact [email protected].