Structural inequities and provider burnout in maternal health in the United States

Abstract

The United States is experiencing a maternal health crisis with one of the highest maternal mortality rates among high income countries and with major access to care issues, including growing maternity care deserts and workforce shortages. These systemic issues have led to a robust social scientific research agenda identifying individual and structural drivers of maternal health inequity, though focus has largely been on the impact these inequities have had on patients. Less attention has been given to the effect of structural inequities on maternal health providers in the US. Drawing from 48 interviews with individuals working in maternal health, conducted from November 2021 through May 2024, we reveal their experiences navigating structural inequities in maternal healthcare systems and the consequences of these experiences for their well-being, specifically through the emergence of burnout. The data reveal that maternal health providers are vulnerable to burnout because they experience triple marginalization. First, maternal health is a marginalized sub-field within medicine, so providers feel unequal access to resources. Second, marginalization occurs among maternal health providers as interprofessional hierarchies stratify clinical and non-clinical individuals working in the field. And third, individuals who hold marginalized identities are at greater risk of enduring difficult working conditions. These experiences of marginalization precipitate burnout, with non-clinical birthworkers and providers of color at greatest risk of experiencing burnout.