One-fifth of U.S. mothers say they have experienced mistreatment by their health care provider during their pregnancy and delivery care and 29% say they have faced discrimination, according to new research from the Centers for Disease Control and Prevention, with higher rates of such incidents reported among women of color.

Approximately 20% of more than 2,400 women surveyed in a CDC Vital Signs report released Tuesday said they experienced some form of physical neglect or verbal abuse during their maternal care. The report’s findings were based on a survey conducted from April 24 through April 30 by public relations firm Porter Novelli.

Higher rates of mistreatment were reported by mothers who identify with a racial and ethnic minority group, including 30% of Black women, 29% of Hispanic women and 27% of multiracial women during their pregnancy care, compared to 19% of white women and 15% of Asian mothers.

Nearly 30% of women who were uninsured and 26% of those covered by Medicaid reported mistreatment during their maternity care compared to 16% of women with private insurance, according to the analysis.

The most common forms of mistreatment reported by survey respondents included receiving no response to requests for help, being shouted at or scolded, having a lack of physical privacy, and being threatened with the withholding of treatment or being coerced into accepting unwanted treatment.

“This report provides evidence that many women are having experiences that are truly unacceptable,” said Dr. Wanda Barfield, director of the CDC’s Division of Reproductive Health in a call with reporters held Tuesday.

In addition, 29% of women surveyed said they experienced at least one form of discrimination during their pregnancy care, with 40% of Black women, 39% of multiracial women, and 37% of Hispanic women reporting such incidents, compared to 26% of white women and 23% of Asian women. The most common reasons for discrimination reported included issues concerning age, weight and income.

“We know mistreatment and discrimination can have a negative impact on the quality of maternity care,” said CDC Chief Medical Office Dr. Debra Houry during a call with reporters.

Houry told the story of Dr. Shalon Irving, an officer within the CDC’s Epidemic Intelligence Service who died in 2017 as a result of high blood pressure three weeks after giving birth.

“As a health care community, we have to do better in providing unbiased and respectful maternity care equally to all mothers,” Houry said.

The report’s findings come at the same time as rising rates of death associated with giving birth in the U.S. The maternal mortality rate increased 89% from 17.4 deaths per 100,000 live birth in 2018 to 32.9 per 100,000 in 2021, according to a March CDC report, with the total number of annual deaths nearly doubling from 658 to 1,205 during that period. And women of color are even worse off than the general population. The maternal mortality rate among Black women increased from 37.3 deaths per 100,000 live births in 2018 to 69.9 per 100,000 in 2021, while the rate among Hispanic women increased by more than two-fold during that same period to 28 deaths per 100,000 live births in 2021, surpassing the rate among white women for the first time.

Houry said health care providers can do more to improve maternity care quality by promoting greater cultural competency and diversity within their clinical workforce, as well as focusing on developing practices that result in all maternity patients receiving an equitable standard of care.

“We know that most pregnancy-related deaths are preventable – more than 80%,” Houry said. “Respectful maternity care can be defined as preventing harm and mistreatment, communicating effectively, and providing equitable and unbiased care.”