Carolyn Smith Hughes

UC San Francisco

“Agency and autonomy in maternity care among women of color during the COVID-19 pandemic: A qualitative analysis”

Carolyn’s research interests include using mixed methods to explore experiences of prenatal, intrapartum, and postpartum care around the world. This qualitative study specifically focuses on experiences of maternity care among women of color who delivered in the US during the COVID-19 pandemic. We found that factors at many levels (system/facility, provider, and individual) affected individuals’ ability to have their delivery desires fulfilled and clinical needs addressed.


The COVID-19 pandemic deeply affected maternity care for birthing persons in the US, especially women of color. However, individual experiences have not been extensively studied. In our study, we use qualitative methods and thematic analysis to assess experiences of maternity care among women of color who gave birth in the US during the COVID-19 pandemic. We focus on issues of autonomy and agency in our analysis. We found that individuals’ experiences with autonomy and agency were affected by factors at many levels: system/facility, interpersonal (provider-individual), and internal/individual. Respondents reported: poor responsiveness to needs and requests, having concerns dismissed, inadequate pain management, and fear. Importantly, we found that many reported experiences were due to underlying issues (pre-COVID-19) in the provision of maternity care in the US. System and facility-level stressors influence interpersonal interactions, which also influence individuals’ perspectives of their own agency and autonomy. Our study provides important insights to improve experiences at the system/facility and provider levels.

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