The present study aimed to explore the objective and subjective experiences of “mistreatment” in maternity care in a diverse cohort of women who gave birth in New York City hospitals to identify the prevalence and risk factors of mistreatment and measure the relationship between mistreatment and mental health (Bohren et al., 2015). The study utilized a mixed-methods cross-sectional approach. To collect the quantitative data, 109 participants <1 year postpartum completed an anonymous online survey comprising a self-report measure of demographic, health and mental health information, several mental health questionnaires and two measures of mistreatment in maternity care. 8 of these participants were interviewed about their childbirth experience. The quantitative data was analyzed utilizing linear regression, moderation analysis and path analysis, and the qualitative data was thematically coded then analyzed using Reflexive Thematic (RT) analysis. These data were then triangulated using a mixed-methods model of mistreatment. In total, 10-15% of the sample experienced mistreatment in the form of Low to Very Low respect and/or autonomy in decision making in their maternity care. Forms of mistreatment included unwanted procedures, provider pressure to undergo procedures, dismissal of women’s concerns, racial discrimination, abandonment, and medical neglect. Approximately 25% of respondents received an unwanted intervention; this was the most significant predictor of mistreatment. This relationship was moderated by race, parity and birth plan. Black, Latinx and Hispanic women experienced the lowest levels of respect in maternity care. Mistreatment in maternity care was correlated with increased risk for postpartum mental illness: decreased respect and autonomy in childbirth was associated with increased postpartum depression and PTSD symptoms. Eight themes were identified in the qualitative analysis: Discrimination and Unfair Treatment, Confusion and Abandonment, Disregard for Patient Autonomy, Hospital-Level Drivers of Mistreatment, Women Treated as Passive, Normalization of Mistreatment, Self-Advocacy and Vulnerability and, Reclaiming Power through Knowledge. Together, the triangulated mixed- methods data were fit to render a comprehensive “model of mistreatment” to illustrate direct and indirect relationships between mistreatment, mental health, race, trauma history, and childbirth preparation. These findings demonstrate that mistreatment is a multi-determined phenomenon that is interdependent with mental health and requires systematic measurement in healthcare treatment, the integration of anti-racist and patient-centered care and improved childbirth education for patients.

Why do we defend the social conditions responsible for our injustice and exploitation? We are confused when disadvantaged women of color cite personal shortcomings rather than the social system as the source of their precarity. Yet, when social philosophers take up these questions by appealing to the concept of ideology, they turn to structural accounts and dismiss theories of false consciousness outright. Accounts of false consciousness, often understood as an epistemic failing to recognize some features of our inadequate social world, meet with a host of objections. Some argue that ascriptions of false consciousness involve authoritarianism, while others criticize the concept for commitments to an implausible correspondence picture of truth. Meanwhile, dismissal of false consciousness accounts of ideology have led to the neglect of an important feature of how ideology works: in and through our own agency. Without an account of false consciousness, critics fail to account for the fact that social structures are the result of our collective consent. They also fail to address how social structures are not analyzable without turning to the self-understandings of the participants in these very institutions. This dissertation addresses issues in ideology critique that account for our agency. By preserving what is still alive in a theory of false consciousness while addressing the long-standing concerns about authoritarianism and correspondence, this project reconstructs the notion of false consciousness. It closely engages with figures in critical social theory such as Marx, Lukacs, Habermas, Haslanger, Honneth, and Jaeggi, while widening the terms of the debate to consider the relevance, for instance, of object relations psychoanalysis for social philosophers. Beyond this, this dissertation shows that false consciousness is a damaged way of relating to ourselves, to each other, and to the social world. It is characterized, I propose, by affective investment. This move helps us clarify both the phenomenology of false consciousness and what a viable form of critique could look like. Psychoanalysis offers us a new way of understanding ideology critique by directing us beyond the model of critique as judgment as part of overcoming false consciousness.