Disrespect and abuse of women during the process of childbirth in the 2015 Pelotas birth cohort

Obstetric violence is a misnomer

The term "obstetric violence" has been used in the legislative language of several countries to protect mothers from abuse during pregnancy. Subsequently, it has been expanded to include a spectrum of obstetric procedures, such as induction of labor, episiotomy, and cesarean delivery, and has surfaced in the peer-reviewed literature. The term "obstetric violence" can be seen as quite strong and emotionally charged, which may lead to misunderstandings or misconceptions. It might be interpreted as implying a deliberate act of violence by healthcare providers when mistreatment can sometimes result from systemic issues, lack of training, or misunderstandings rather than intentional violence. "Obstetric mistreatment" is a more comprehensive term that can encompass a broader range of behaviors and actions. "Violence" generally refers to the intentional use of physical force to cause harm, injury, or damage to another person (eg, physical assault, domestic violence, street fights, or acts of terrorism), whereas "mistreatment" is a more general term and refers to the abuse, harm, or control exerted over another person (such as nonconsensual medical procedures, verbal abuse, disrespect, discrimination and stigmatization, or neglect, to name a few examples). There may be cases where unprofessional personnel may commit mistreatment and violence against pregnant patients, but as obstetrics is dedicated to the health and well-being of pregnant and fetal patients, mistreatment of obstetric patients should never be an intended component of professional obstetric care. It is necessary to move beyond the term "obstetric violence" in discourse and acknowledge and address the structural dimensions of abusive reproductive practices. Similarly, we do not use the term "psychiatric violence" for appropriately used professional procedures in psychiatry, such as electroshock therapy, or use the term "neurosurgical violence" when drilling a burr hole. There is an ongoing need to raise awareness about the potential mistreatment of obstetric patients within the context of abuse against women in general. Using the term "mistreatment in healthcare" instead of the more limited term "obstetric violence" is more appropriate and applies to all specialties when there is unprofessional abuse and mistreatment, such as biased care, neglect, emotional abuse (verbal), or physical abuse, including performing procedures that are unnecessary, unindicated, or without informed patient consent. Healthcare providers must promote unbiased, respectful, and patient-centered professional care; provide an ethical framework for all healthcare personnel; and work toward systemic change to prevent any mistreatment or abuse in our specialty.

"Normal in all the rush": A phenomenological study analyzing midwifery students' views on obstetric violence

INTRODUCTION

In recent years, obstetric violence, which undermines women's dignity and autonomy, has received increased attention worldwide. Considering the importance of midwives in combating violence in the obstetric field and the significance of the discussed issue, the following question arises: How do future midwives view obstetric violence?

OBJECTIVE

This study aimed to investigate midwifery students' thoughts about obstetric violence.

DESIGN AND METHOD

This study was conducted using a phenomenological qualitative research design. This study, which adopted a descriptive approach and used typical case sampling, was conducted in the midwifery department of the Kutahya Health Sciences University. Sixteen midwifery students studying fourth-year in the 2018-2019 academic year, who had participated in childbirth during their studies, and who agreed to participate in the study were included. All students had the experience of repeated monitoring and presence in labor. They had witnessed births in different institutions. Focus group interviews were conducted using an unstructured interview guide to obtain data for the study. Data were collected through four focus group interviews with groups of four students in the classroom environment. The data were evaluated separately by two researchers using the content analysis method in MAXQDA Analytics Pro 2020. The Consolidated Criteria for Reporting Qualitative Studies guidelines were used as a guide in reporting.

RESULTS

As a result of the analysis, four main themes emerged: defining violence, causes of violence, effects of witnessing violence, and whether can violence be prevented?

CONCLUSIONS

Midwifery students have an awareness of all visible forms of obstetric violence. However, they were less aware of the invisible structural and policy drivers of obstetric violence. It is invaluable to raise awareness of obstetric violence among midwifery students, who will be the most important defenders of women in childbirth. Studies focused on education and policy will contribute to women receiving quality care at birth.

Measuring disrespect and abuse during childbirth in a high-resource country: Development and validation of a German self-report tool

INTRODUCTION

Increasing evidence on disrespect and abuse during childbirth has led to growing concern about the quality of care childbearing women are experiencing. To provide quantitative evidence of disrespect and abuse during childbirth services in Germany a validated measurement tool is needed.

RESEARCH AIM

The aim of this research project was the development and psychometric validation of a survey tool in the German language that measures disrespect and abuse of women during childbirth.

METHODS

A survey tool was created including the following measures: German adaptations of the short and long form of the "Mothers on Respect" (MOR) index (MOR-7 and MOR-G); the "Mothers' Autonomy in Decision Making" (MADM) scale; a mistreatment-index (MIST-I) comprising indicators of mistreatment during childbirth; and a set of items that measure experiences of discrimination during maternity care. Internal consistency reliability and construct validity of the scales were assessed using Cronbach's alpha, unweighted least squares factor analysis and non-parametric correlation analysis with a scale that measures a related construct, the Posttraumatic Symptom Scale - Self Report (PSS-SR) scale. We distributed the survey online, recruiting through snowball sampling via social media. A selection bias towards women who had experienced disrespect and abuse during their birth was intended and expedient for tool validation. The final sample of participants (n = 2045) had given birth in Germany between 2009 and 2018.

FINDINGS

More than 77% of the study participants reported at least one form of mistreatment with non-consented care being the most commonly reported type of mistreatment, followed by physical violence, violation of physical privacy, verbal abuse and neglect. All included scales showed good psychometric properties with high Cronbach's alphas (0.95 for both MOR versions and 0.96 for MADM). Factor analysis generated one factor scales with high factor loadings (0.75 to 0.92 for MOR-7; 0.37 to 0.90 for MOR-G and 0.83 to 0.92 for MADM). MOR-7, MOR-G, MADM and MIST-I scores were significantly (p<0.001) correlated with PSS-SR scores (Spearman's rho -0.70, -0.61 and 0.68 for MOR-G, MADM and the MIST-I, respectively).

CONCLUSIONS

This study presents a valid and reliable instrument for the quantitative assessment of disrespect and abuse during childbirth in Germany. Childbearing women's experiences of disrespect and abuse are a relevant phenomenon in German hospital based maternity care. Disrespect and abuse during childbirth appear to contribute to post-traumatic symptoms and may be associated with severe mental health problems postpartum.

Provider-patient experiences and HIV care utilization among people living with HIV who inject drugs in St. Petersburg, Russia

Providers' disrespect and abuse of patients is a recognized but understudied issue affecting quality of care and likely affecting healthcare utilization. Little research has examined this issue among people living with HIV (PWH) who inject drugs, despite high stigmatization of this population. No research has examined this issue in the context of Russia. This study assesses patients' reports of disrespect and abuse from providers as a barrier to healthcare and examines the association between these reports and HIV care outcomes.We conducted a cross-sectional analysis of the associations between disrespect/abuse from health providers as a barrier to care and the following HIV care outcomes: (i) anti-retroviral treatment (ART) uptake ever, (ii) past 6-month visit to HIV provider, and (iii) CD4 count. Participants (N = 221) were people living with HIV who injected drugs and were not on ART at enrollment.Two in five participants (42%) reported a history disrespect/abuse from a healthcare provider that they cited as a barrier to care. Those reporting this concern had lower odds of ever use of ART (adjusted odds ratio 0.46 [95% CI 0.22, 0.95]); we found no significant associations for the other HIV outcomes. We additionally found higher representation of women among those reporting prevalence of disrespect/abuse from provider as a barrier to care compared to those not reporting this barrier (58.1% versus 27.3%).Almost half of this sample of PWH who inject drugs report disrespect/abuse from a provider as a barrier to healthcare, and this is associated with lower odds of receipt of ART but not with other HIV outcomes studied. There is need for improved focus on quality of respectful and dignified care from providers for PWH who inject drugs, and such focus may improve ART uptake in Russia.

The prevalence of obstetric violence experienced by women during childbirth care and its associated factors in Türkiye: A cross-sectional study

Objective This study determined the prevalence of obstetric violence experienced by women during childbirth and related factors in Türkiye. Design Cross-sectional study Setting This study was conducted in the mother-child health and gynecology outpatient clinics of the training and research hospital in Türkiye. Participants The study was completed with 513 women who gave birth in the last two years between January and May 2022. Methods Data were collected using a questionnaire prepared by the researchers. Bivariate and multivariate logistic regression analyzed the relationship between obstetric violence and socio-demographic and obstetric characteristics. Findings Obstetric violence was reported by 76.4% of the women: 44.4% physical abuse, 44.4% abandonment of care, 26.5% non-consented care, 25.1% non-dignified care, 3.3% non-confidential care, and 0.4% discrimination. Low income (OR=1.98), physician-attended birth (OR=2.91), vaginal birth (OR=6.04), and newborn admission to the neonatal care unit (OR=2.99) were associated with higher reporting of obstetric violence. Primiparous women (OR=0.51), whose pain was controlled by non-pharmacological methods (OR=0.34) and who received companion support (OR=0.24) were less likely to report experiencing obstetric violence (p < 0.05). Key conclusions Approximately three out of four Turkish women report that they have been exposed to obstetric violence during childbirth. In Türkiye, vaginal birth is the type of childbirth with the highest rate of obstetric violence reporting. Women who are low-income and multiparous, who are deprived of midwife, companion, and pain control support during childbirth, are more likely to experience obstetric violence. Implications for practice Supporting low-income women, protecting women from traumatic acts and unnecessary interventions in a vaginal birth, increasing births under the attendance of midwives, and providing pain control with non-pharmacological methods, and companion support during labor may be protective factors against obstetric violence.

Disrespect and abuse during childbirth and postpartum depression: a scoping review

This study aims to map, within the scientific literature, the relationship between disrespect and abuse during childbirth and the occurrence of postpartum depression. This is a scoping review designed in accordance with the recommendations of the Joanna Briggs Institute. The search was performed in Embase, LILACS, MEDLINE, PsycINFO, Web of Science, and in the CAPES Portal of Theses and Dissertations. We included studies that investigated the relationship between disrespect and abuse during childbirth with postpartum depression, considering cases diagnosed by physicians and by self-reports via validated scales, without restrictions regarding the year of publication and language. A total of 3,399 publications were identified and, after removing the duplicates and reading the title, abstracts, and the full-texts, seven articles were selected to integrate this review. Studies were published from 2017 onward, in four countries. Women who had experienced disrespect and abuse during childbirth were more likely to experience symptoms of postpartum depression. A standard terminology is necessary for disrespectful and abusive care during childbirth, as well as the elaboration of a measurement instrument that is universally accepted.

Disrespect and abuse of women during childbirth at health facilities in Eastern Africa: systematic review and meta-analysis

Background

Disrespectful and abusive maternity care is a sign of poor treatment that influences women's choice to deliver their babies in institutions. Such malpractices continue to go unreported and are rarely exposed in developing countries, despite their serious burden. Therefore, this meta-analysis study aimed to estimate disrespect and abuse of women during childbirth in East Africa.

Methods

PubMed, Google Scholar, Scopus, and Science Direct databases were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Publication bias was checked by forest plot, Begg's rank test, and Egger's regression test. To look for heterogeneity, I2 was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by study region, sample size, and publication. The pooled odds ratio for associated factors was also computed.

Results

Out of 654 articles assessed, 18 met the criteria and were included in this study. There were a total of 12,434 study participants. The pooled prevalence of disrespect and abuse of women during childbirth in East Africa was 46.85% (95% CI: 45.26.72-66.98), I2 = 81.9%. It was lower in studies with sample size greater than 5000 (33%). The disrespect and abuse rates between community-based studies (44.96%) and institutional-based studies (47.35%) did not differ significantly, though. Instrumental delivery (AOR = 2.70; 95%CI: 1.79-4.08), presence of complications (AOR = 6.41; 95% CI: 1.36-30.14), receiving care at government hospitals (AOR = 3.66; 95% CI: 1.09-12.23), and poor wealth index (AOR = 2.16; 95% CI: 1.26-3.70) were associated factors.

Conclusion

In East Africa, disrespect and abuse of women during childbirth was high. Instrumental delivery, presence of complications during childbirth, receiving care at government hospitals and poor wealth index were predictors of maternal disrespect and abuse. Safe delivery practice should be promoted. Training in compassionate and respectful maternity care, particularly in public hospitals, has also been recommended.

The effect of obstetric violence during childbirth on breastfeeding: findings from a perinatal cohort "Birth in Brazil"

Background

Recent literature has shown that many women worldwide are victims of obstetric violence during childbirth. Despite that, few studies are exploring the consequences of such violence on women's and newborn's health. Thus, the present study aimed to investigate the causal association between obstetric violence during childbirth and breastfeeding.

Methods

We used data from the study "Birth in Brazil", a national hospital-based cohort of puerperal women and their newborns in 2011/2012. The analysis involved 20,527 women. Obstetric violence was a latent variable composed of seven indicators (physical or psychological violence, disrespect, lack of information, privacy and communication with the healthcare team, inability to ask questions, and loss of autonomy). We worked with two outcomes: 1) breastfeeding at the maternity and 2) breastfeeding 43-180 days after birth. We applied multigroup structural equation modelling, based on the type of birth.

Findings

Obstetric violence during childbirth may decrease the probability for women to leave the maternity ward breastfeeding exclusively, having a stronger effect on women who have vaginal birth. Also, being exposed to obstetric violence during childbirth could indirectly affect those women's ability to breastfeed 43-180 days after birth.

Interpretation

This research concludes that obstetric violence during childbirth is a risk factor for breastfeeding discontinuation. Such knowledge is relevant so interventions and public policies can be proposed in order to mitigate obstetric violence and provide a better understanding of the context that may lead a woman into discontinuing breastfeeding.

Funding

This research was funded by CAPES, CNPQ, DeCiT, and INOVA-ENSP.

Experiences with obstetric violence among healthcare professionals and students in Spain: A constructivist grounded theory study

BACKGROUND

Obstetric violence appears to be a worldwide concern and is defined as a type of gender-based violence perpetrated by health professionals. This violence undermines and harms women's autonomy. In Spain, 38.3 % of women have identified themselves as victims of this type of violence.

AIM

To explore current information and knowledge about obstetric violence within the Spanish healthcare context, as well as to develop a theoretical model to explain the concept of obstetric violence, based on the experiences of healthcare professionals (midwives, registered nurses, gynaecologists and paediatricians) and nursing students.

METHODS

A constructivist grounded theory study was conducted at Jaume I University in Spain between May and July 2021, including concurrent data collection and interpretation through constant comparison analysis. An inductive analysis was carried out using the ATLAS.ti 9.0 software to organise and analyse the data.

RESULTS

Twenty in-depth interviews were conducted, which revealed that healthcare professionals and students considered obstetric violence a violation of human rights and a serious public health issue. The interviews allowed them to describe certain characteristics and propose preventive strategies. Three main categories were identified from the data analysis: (i) characteristics of obstetric violence in the daily routine, (ii) defining the problem of obstetric violence and (iii) strategies for addressing obstetric violence. Participants identified obstetric violence as structural gender-based violence and emphasised the importance of understanding its characteristics. Our results indicate how participants' experiences influence their process of connecting new information to prior knowledge, and they provide a connection to specific micro- and macro-level strategic plans.

DISCUSSION

Despite the lack of consensus, this study resonates with the established principles of women and childbirth care, but also generates a new theoretical model for healthcare students and professionals to identify and manage obstetric violence based on contextual factors. The term 'obstetric violence' offers a distinct contribution to the growing awareness of violence against women, helps to regulate it through national policy and legislation, and involves both structural and interpersonal gender-based abuse, rather than assigning blame only to care providers.

CONCLUSIONS

Obstetric violence is the most accurate term to describe disrespect and mistreatment as forms of interpersonal and structural violence that contribute to gender and social inequality, and the definition of this term contributes to the ongoing awareness of violence against women, which may help to regulate it through national policy and legislation.

Obstetric Violence among Pregnant Jordanian Women: An Observational Study between the Private and Public Hospitals in Jordan

BACKGROUND

Obstetric Violence (OV) is a public health matter that affects women and their children with an incidence rate between 18.3-75.1% globally. The delivery institution of public and private sectors represents a potential factor contributing to OV. This study aimed to assess OV existence among sample of pregnant Jordanian women and its risk factors domains between public and private hospitals.

METHODOLOGY

This is a case-control study including 259 recently delivered mothers from Al-Karak Public and Educational Hospital and The Islamic Private Hospital. A designated questionnaire including demographic variables and OV domains was used for data collection.

RESULTS

A significant difference was seen between patients delivering in the public sector compared to patients delivering the private sector in education level, occupation, monthly income, delivery supervision and overall satisfaction. Patients delivering in the private sector showed a significantly less physical abuse by the medical staff compared to patients delivering in the public sector, and patients delivering in a private room also showed a significantly less OV and risk of physical abuse compared to patients delivering in shared room. In public settings, medications information was lesser versus the private ones, additionally, there is significant association between performing episiotomy, physical abuse by staff and the delivery in shared rooms in private settings.

CONCLUSION

This study showed that OV was less susceptible during childbirth in private settings compared to public settings. Educational status, low monthly income, occupation are risk factors for OV; also, features of disrespect and abuse like obtaining consent for episiotomy performance, delivery provision updates, care perception based on payment ability and medication information were reported.

The prevalence of respectful maternity care during childbirth and its determinants in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Respectful maternity care is the provision of woman-centered health care during childbirth that is friendly, abuse-free, timely, and discrimination-free. Although several epidemiological studies on the magnitude and determinants of Respectful maternity care in Ethiopia have been conducted, the results have been inconsistent and varied. This makes drawing equivocal conclusions and evidence at the national level harder. Hence, this systematic review and meta-analysis aimed at estimating the pooled prevalence of respectful maternity care and its determinants in Ethiopia.

METHODS

Studies conducted from 2013 to June 30, 2022, were searched by using PubMed, Google Scholar, Science Direct, Scopus, ProQuest, Web of Science, Cochrane Library, and Direct of Open Access Journals. Searching was carried out from May 15- June 30, 2022. In total, sixteen studies were considered in the final analysis. The data were extracted using Microsoft Excel and analyzed using STATA 16 software. The methodological quality of included studies was assessed by using Joanna Briggs Institute's critical appraisal checklist for prevalence studies. To estimate the pooled national prevalence of respectful maternity care, a random effect model with a DerSimonian Laird method was used. To assess the heterogeneity of the included studies, the Cochrane Q test statistics and I2 tests were used. To detect the presence of publication bias, a funnel plot and Begg's and Egger's tests were used.

RESULTS

Sixteen studies were eligible for this systematic review and meta-analysis with a total of 6354 study participants. The overall pooled prevalence of respectful maternity care in Ethiopia was 48.44% (95% CI: 39.02-57.87). Receiving service by CRC-trained health care providers [AOR: 4.09, 95% CI: 1.73, 6.44], having ANC visits [AOR: 2.34, 95% CI: 1.62, 3.06], planning status of the pregnancy [AOR = 4.43, 95% CI: 2.74, 6.12], giving birth during the daytime [AOR: 2.61, 95% CI: 1.92, 3.31], and experiencing an obstetric complication[AOR: 0.46, 95% CI: 0.30, 0.61] were identified as determinants of RMC.

CONCLUSION

As per this meta-analysis, the prevalence of respectful maternity care in Ethiopia was low. Managers in the health sector should give due emphasis to the provision of Compassionate, Respectful, and Care(CRC) training for healthcare providers, who work at maternity service delivery points. Stakeholders need to work to increase the uptake of prenatal care to improve client-provider relationships across a continuum of care. Human resource managers should assign an adequate number of health care providers to the night-shift duties to reduce the workload on obstetric providers.

Mistreatment of Women during Childbirth and Associated Factors in Northern West Bank, Palestine

Mistreatment of women during childbirth is a clear breach of women's rights during childbirth. This study aimed to determine the prevalence and associated factors of mistreatment of women during childbirth in the north of West Bank, Palestine. A cross-sectional study was conducted among 269 women within the first 16 weeks of their last vaginal childbirth to understand the childbirth events by using proportionate stratified random sampling. An Arabic valid questionnaire was used as a study instrument. Simple and multiple logistic regression analyses were conducted to determine the factors associated with each type of mistreatment. The mean age of the women was 26.5 (SD 4.77) years. The overall prevalence of mistreatment was 97.8%. There were six types of mistreatment. Nine factors were significantly associated with the occurrence of one or more types of mistreatment. Delivery at a public childbirth facility was associated with all of the six types (aAdjOR: 2.17-16.77; p-values < 0.001-0.013). Women who lived in villages (aAdjOR 2.33; p-value = 0.047), had low education (aAdjOR 5.09; p-value = 0.004), underwent induction of labour (aAdjOR 3.03; p-value = 0.001), had a long duration of labour (aAdjOR 1.10; p-value = 0.011), did not receive pain killers (aAdjOR: 2.18-3.63; p-values = 0.010-0.020), or had an episiotomy or tear (aAdjOR 5.98; p-value < 0.001) were more likely to experience one or more types of mistreatment. With every one-hour increase in the duration of labor, women were 1.099 times more likely to experience a failure to meet the professional standard of care. Women were less likely to experience mistreatment with increasing age. Women with increasing age (aAdjOR: 0.91-0.92; p-values = 0.003-0.014) and parity (aAdjOR 0.72; p-value = 0.010) were less likely to experience mistreatment. Awareness of women's fundamental rights during childbirth, making the childbirth process as normal as possible, and improving the childbirth facilities' conditions, policies, practices and working environment may decrease mistreatment occurrence.

Association between mistreatment of women during childbirth and symptoms suggestive of postpartum depression

Background

Postpartum depression is a common condition in the pregnancy and postpartum cycle. The development of this condition is multifactorial and can be influenced by previous traumas. This study sought to verify whether there is an association between having been exposed to mistreatment during childbirth and presenting symptoms suggestive of postpartum depression.

Methods

This is a cross-sectional study, with the inclusion of 287 women without complications in childbirth, randomly selected from two maternity hospitals of Porto Alegre, southern Brazil, in 2016. Four weeks after delivery, the postpartum women answered a face-to-face interview about socioeconomic aspects, obstetric history, health history, and childbirth experience (practices and interventions applied) and completed the Edinburgh Postnatal Depression Scale (EPDS). From the perception of women regarding the practices performed in the context of childbirth care, a composite variable was created, using item response theory, to measure the level of mistreatment during childbirth. The items that made up this variable were: absence of a companion during delivery, feeling insecure and not welcome, lack of privacy, lack of skin-to-skin contact after delivery, not having understood the information shared with them, and not having felt comfortable to ask questions and make decisions about their care. To define symptoms suggestive of postpartum depression, reflecting on increased probability of this condition, the EPDS score was set at ≥ 8. Poisson Regression with robust variance estimation was used for modeling.

Results

Women who experienced mistreatment during childbirth had a higher prevalence of symptoms suggestive of postpartum depression (PR 1.55 95% CI 1.07–2.25), as well as those with a history of mental health problems (PR 1.69 95% CI 1.16–2.47), while higher socioeconomic status (A and B) had an inverse association (PR 0.53 95% CI 0.33–0.83).

Conclusions

Symptoms suggestive of postpartum depression seem to be more prevalent in women who have suffered mistreatment during childbirth, of low socioeconomic status, and with a history of mental health problems. Thus, qualifying care for women during pregnancy, childbirth and postpartum and reducing social inequalities are challenges to be faced in order to eliminate mistreatment during childbirth and reduce the occurrence of postpartum depression.

Development of an instrument to measure mistreatment of women during childbirth through item response theory

The objective of this study was to structure a proposal for an instrument to measure the mistreatment level of women during childbirth, through item response theory, based on the birth experience of postpartum women. A cross-sectional study was conducted, with the inclusion of 287 women who did not suffer complications during childbirth, randomly selected from two maternity hospitals in the capital of Rio Grande do Sul—Brazil, in 2016. Approximately 30 days after delivery, the women answered questions in a face-to-face interview about their birth experience (practices and interventions applied) and were inquired about their perception of having suffered disrespect, mistreatment or humiliation by health professionals. The set of practices was included in the item response theory model to design the instrument. Of the 36 items included in the model, 21 dealt with practices applied exclusively to women who went into labor, therefore two instruments were developed. The instrument including all women, containing 09 items, identified 23.7% prevalence of mistreatment to women during childbirth, while the instrument for women going into labor included 11 items and identified 22% prevalence. The items with the highest discrimination were: not having had a companion during labor (2.05; and 1.26), not feeling welcome (1.81; and 1.58), and not feeling safe (1.59; and 1.70), for all women and for those who went into labor, respectively. For those who went into labor, the items, did not have a companion during labor (1.22; PE 0.88) and did not feel comfortable asking questions and participating in decisions (1.20; PE 0.43) also showed greater discrimination. In contrast, when directly questioned, only 12.5% of women said they had experienced disrespect or mistreatment, suggesting that harmful practices are often not recognized as violent. Standardizing the measurement of mistreatment of women during childbirth can create more accurate estimates of its prevalence and contribute to the proposal of strategies to eliminate obstetric violence.

Disrespect and abuse during childbirth in maternity hospitals in Piauí, Brazil: a cross-sectional study

OBJECTIVES

To assess the prevalence and associated factors of disrespect and abuse during childbirth in Piauí, Brazil.

METHODS

A cross-sectional study with 698 postpartum women in 21 maternity hospitals in 14 municipalities between August 2018 and September 2019. Face-to-face interviews were carried out at least 6 hours after birth, with an assessment of disrespect and abuse during childbirth (D&A). Robust Poisson regression was used, with calculation of the adjusted prevalence ratio (aPR) and 95% confidence intervals (95%CI).

RESULTS

There was evidence that 19.8% of women experienced at least one type of D&A, with verbal abuse (12.6%), non-compliance with professional standards (11.6%) and health service restrictions being more common (8.3%). There was an association of D&A with women aged 10-19 years (aPR=1.97; 95%CI 1.58-2.44), absence of companions (aPR=2.43; 95%CI 1.85-2.89), cesarean sections after labor (aPR=2.19; 95%CI 1.64-3.59), public hospitals (aPR=1.87; 95%CI1.42-2.85) and in the countryside (aPR=2.29; 95%CI 1.81-3.98).

CONCLUSIONS

There was a high prevalence of D&A in Piauí, associated with structural conditions of the services, care practices and characteristics of women.

Women's experiences throughout the birthing process in health facilities in Arab countries: a systematic review

BACKGROUND

Mistreatment of women during facility-based childbirth has become a significant public health issue globally and is gaining worldwide attention. This systematic review of quantitative studies aimed to estimate the prevalence of mistreatment women may experience throughout the birthing process in health facilities in Arab countries. The review also aimed to identify the types of mistreatment, terminology, tools, and methods used to address this topic.

METHODOLOGY

The search was conducted using three electronic databases: "PubMed," "Embase," and "CINAHL" in May 2020. Studies meeting the inclusion criteria were included and assessed for risk of bias. The analysis was conducted based on the evidence-based typology developed by Bohren et al. as a guide to try to estimate the prevalence of mistreatment.

RESULTS

Eleven studies out of 174 were included. The included studies belonged to only seven Arab countries out of 22 Arab countries. The mistreatment of women during childbirth is still new in the region. Searching within the included studies yielded diverse and indirect terms that were a proxy for the word mistreatment. These terms were not comprehensive to cover different aspects of the topic. The tools that were used to measure the terms widely varied.. Moreover, it was not possible to estimate the prevalence of mistreatment of women due to high heterogeneity among the 11 studies.

CONCLUSION

The topic of mistreatment of women in Arab countries was not adequately addressed in the studies included in this review. More research on this topic is recommended due to its importance in improving maternal health in the region. However, a standardized and comprehensive terminology for mistreatment of women, a standardized tool, and a standardized methodology are recommended to enable comparability between results and allow pooling to estimate the prevalence.

Desrespeitos e abusos, maus tratos e violência obstétrica: um desafio para a epidemiologia e a saúde pública no Brasil

Resumo Estudos sobre desrespeitos e abusos/maus tratos/violência obstétrica durante gestação, parto e puerpério têm aumentado nas últimas décadas. Entretanto, os pesquisadores interessados na temática se deparam com muitas dificuldades teóricas e metodológicas. Nesse sentido, o objetivo do presente estudo consiste em discutir e refletir sobre como questões relacionadas a definição e terminologia, mensuração e políticas públicas no Brasil têm dificultado a pesquisa da temática, assim como a mitigação desses atos. O primeiro problema abordado foi a falta de consenso em relação a terminologia e definição desse construto. Essa situação provoca um efeito em cascata, com a utilização de instrumentos de aferição não validados que implicam falta de precisão e comparabilidade entre os estudos. Outra questão mencionada é a falta de estudos explorando as consequências desses atos na saúde da mulher e do recém-nascido, configurando uma das principais lacunas sobre o tema atualmente. A ausência de estudos causais impacta a tomada de decisão em saúde, prejudicando a elaboração de políticas públicas específicas.

Disrespect and abuse during focused antenatal care and associated factors among pregnant women who visited public health facilities in Awsi Rasu of Afar Region Northeast Ethiopia

Objectives:

Maternal disrespect and abuse are the top significant barriers to the use of maternal health services. However, poor attention has been given to the hospitality and suitability of care provided to women in the facilities where they have been moved to utilize health services. This study is aimed to assess the prevalence of maternal disrespect and abuse during focused antenatal care and its associated factors among pregnant women who visit public health facilities in Awsi Rasu of Afar Region Northeast Ethiopia.

Methods:

Institution-based cross-sectional study design was employed from March 1 to 30, 2022 in selected health facilities of the Awsi Rasu of Afar Region, Northeast Ethiopia. A total of 1278 mothers were included using consecutive sampling techniques. The data were entered into Epi-data version 3.1 and exported to SPSS version 23.0 for statistical analysis. Statistical significance is declared using adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI).

Results:

The overall prevalence of disrespect and the abusive experience was 56.7% (95% CI: 54–59.3%). A low average monthly income of less than or equal to 3000 Ethiopian birrs (AOR = 0.72; 95% CI: 0.55–0.94), Age (20–25) years (AOR = 2.33; 95% CI 1.72–3.2), having no formal education (AOR = 2.01; 95% CI: 1.35–3.15), and having unplanned pregnancy (AOR = 1.6; 95% CI: 1.21–2.01) were significantly associated with disrespect and abuse during focused antenatal care.

Conclusion:

The prevalence of disrespect and abusive experience during antenatal care in the study area was high relative to other studies. In the multivariable logistic regression model age of the mother (20–25 years), no formal education, low family income, and unplanned pregnancy are the predictors of disrespect and abusive care. Providing respectful health care during antenatal care with a suitable approach for all mothers irrespective of their age, unplanned pregnancies, and educational status is the most substantial to encourage maternal service use.

Childbirth violence-based negative health consequences: a qualitative study in Iranian women

BACKGROUND

Violation of mothers' rights during childbirth is a global problem that often silently torments women in many parts of the world. The aim of this study was to explore negative health consequences due to childbirth violence based on mothers' perceptions and experiences.

METHODS

To achieve rich data, an exploratory qualitative study was carried out in 2019 on 26 women with childbirth violence experience who had given birth in hospitals of Ilam, Iran. Data were collected using semi‑structure in‑depth interviews (IDIs) and a purposive sampling. Participants were asked about their experiences and perceptions of negative health consequences due to childbirth violence. Data were analyzed by conventional content analysis based on Graneheim and Lundman approach. MAXQDA (v.18) software was used for better data management.

RESULTS

Final codes were classified into 9 sub-categories and 3 main categories including maternal and newborn injuries, weakening of family ties, sense of distrust and hatred. These findings emerged the theme: negative health consequences.

CONCLUSIONS

This study broke the silence of abused mothers during childbirth and expressed the perspective of mothers who suffered childbirth violence as a routine phenomenon in maternal care, and a serious threat to the health of mothers, newborns and families. Findings of this study can be a warning for maternity health system, monitoring and support structures as well as health policy-makers to seriously plan to prevent and eliminate this problem.

Development and validation of a new questionnaire to measure mistreatment of women during childbirth, satisfaction of care, and perceived quality of care

OBJECTIVE

This study aims to develop and validate a new questionnaire to measure mistreatment of women during childbirth and its association with satisfaction and perceived quality of care among women in West Bank, Palestine.

RESEARCH DESIGN /SETTING

A cross-sectional validation study was conducted in middle and south of West Bank from February 2019 to June 2020. Two-hundred postpartum women were given self-administered and online questionnaire. Content and face validity were assessed. The "satisfaction of care" and "perceived quality of care" domains were analyzed using exploratory factor analysis, while items in "experience of mistreatment" domain were evaluated descriptively. Cronbach's alpha was used to assess the reliability of the questionnaire items.

FINDINGS

The new questionnaire consisted of three domains: "satisfaction of care", "perceived quality of care", and "experience of mistreatment" during childbirth. Five new items were added and two items were removed during content validation. Another two items were deleted through face validation. Exploratory factor analysis was conducted for the "satisfaction of care" and "perceived quality of care" domains. Two factors were identified for each domain, with a factor loading of more than 0.5. Twelve items were deleted from "satisfaction of care" domain and two items from "perceived quality of care" domain. The Cronbach's alpha values for the two factors in both domains were more than 0.87. The items in the "experience of mistreatment during childbirth" domain were evaluated descriptively.

KEY CONCLUSIONS

The new questionnaire is valid and reliable. The final questionnaire consists of 11 items for "satisfaction of care", 16 items for "perceived quality of care" and 43 items for "experience of mistreatment of women during childbirth".

A comparative study of epidural labor analgesia and natural delivery without analgesia

OBJECTIVE

To investigate the effects of epidural labor analgesia and natural delivery without analgesia on labor duration, pain, uterine continuous contraction time, abnormal labor process and complications.

METHODS

A total of 220 primiparas in our hospital were selected and divided into two groups according to whether they accepted epidural labor analgesia, including 146 cases in the study group and 74 cases in the blank group. Primiparas in the study group received epidural block analgesia, and those in the blank group received routine labor without analgesia. Duration of the first, second and third stages of labor was observed and recorded. The NRS pain score and uterine continuous contraction time were detected before and after the analgesia. The abnormal situation and complications of primiparas in the two groups were recorded.

RESULTS

Compared with those in the blank group, the duration of the first stage of labor and the amount of postpartum hemorrhage in the study group were decreased (all P<0.001). The primiparas' NRS score in the study group was lower than that in the blank group at 10 min, 15 min, 30 min, 60 min and 120 min after analgesia (all P<0.001). The duration of uterine contractions in the study group was lower than that in the blank group at 15 min, 30 min and 60 min after analgesia (all P<0.01). Compared with those in the blank group, primiparas in the study group had a higher probability of active phase arrest in the process of labor (P<0.05). Compared with the blank group, the probability of urinary retention in the study group increased (P<0.05).

CONCLUSION

The effect of epidural labor analgesia is better, which is conducive to shorten the time of the first stage of labor, good analgesic effect, shorter duration of the uterine contraction and higher safety.

Obstetric Violence in Spain (Part III): Healthcare Professionals, Times, and Areas

BACKGROUND

Obstetric violence is a worldwide public health problem, which seems greater in Spain. As no studies were found that identify the most representative healthcare professionals, times, and areas involved in obstetric violence, the objective of this work was to study at what time of maternity, with which professionals, and in what areas women identified obstetric violence.

METHODS

This descriptive, retrospective, and cross-sectional study was performed from January 2018 to June 2019. The main variables were the area (hospital, primary care, both), the time (pregnancy, birth, puerperium), and the professionals attending to women.

RESULTS

Our sample comprised 17,541 participants. The area identified with the most obstetric violence for the different studied variables was hospitals. Women identified more obstetric violence at time of birth. Findings such as lack of information and informed consent (74.2%), and criticism of infantile behavior and treatment (87.6%), stood out. The main identified healthcare professionals were midwives and gynecologists, and "other" professionals repeatedly appeared.

CONCLUSIONS

Having identified the professionals, times, and areas of most obstetric violence in Spain, it seems necessary to reflect on not only the Spanish National Health System's structure and management but also on healthcare professionals' training.

The association between mistreatment of women during childbirth and postnatal maternal and child health care: Findings from "Birth in Brazil"

BACKGROUND

The mistreatment of women during pregnancy, childbirth, and the puerperium is a global public health problem besides being a violation of human rights. However, research exploring the consequences of mistreatment of women and newborns is scarce.

QUESTION

To shed light on this issue, we investigated the association between the mistreatment of women during childbirth and the subsequent use of postnatal health services by women and their newborns.

METHODS

We used data from the study "Birth in Brazil", a national hospital-based survey of puerperal women and their newborns, carried out in 2011/2012. This analysis involved 19,644 women. Mistreatment was a latent variable composed of seven indicators. We assessed the attendance of women and newborns to a review consultation following birth, and the timing of this appointment. We applied multigroup structural equation modeling (based on childbirth payment source) and considered separate analysis for women (vaginal births and0 caesarean-sections) and newborns.

FINDINGS

We found a causal association between mistreatment during childbirth and decreased and/or delayed use of postnatal health services, for both women and their newborns. These results also revealed that women who use the public sector are affected more than those who pay for private healthcare.

CONCLUSION

Mistreatment during childbirth has broader implications than "maternal mental health", and it would be useful to understand that experience of care has vast implications for families. In Brazil, the mistreatment must be mitigated via the implementation of public policy. This is part of the path to dignified and respectful childbirth care for all women.

Multi-stakeholder Perspectives on the Maternal, Provider, Institutional, Community, and Policy Drivers of Disrespectful Maternity Care in South-East Nigeria

Purpose

Understanding the contextualized perspectives of stakeholders involved in maternal health care is critical to promoting respectful maternity care. This study explored maternal, provider, institutional, community, and policy level drivers of disrespectful maternity care in Southeast Nigeria. This study also identified multi-stakeholder perspectives on solutions to implementing respectful maternity care in health facilities.

Materials and Methods

This was a mixed-methods cross-sectional study conducted in two urban cities of Ebonyi State, South-eastern Nigeria. Data were collected using semi-structured questionnaires, focus group discussions, and key informant interviews with mothers, providers, senior facility obstetric decision-makers, ministry of health policymaker, and community members. Quantitative data and qualitative data were analysed using SPSS version 20 and manual thematic analysis, respectively.

Results

Maternal level drivers were poor antenatal clinic attendance, uncooperative clients, non-provision of birthing materials, and low awareness of rights. Provider factors included work overload/stress, training gaps, desire for good obstetric outcome, under-remuneration and under-appreciation. Institutional drivers were poor work environments including poorly designed wards for privacy, stressful hospital protocols, and non-provision of work equipment. Community-level drivers were poor female autonomy, empowerment, and normalization of disrespect and abuse during childbirth. The absence of targeted policies and the high cost of maternal health services were identified as policy-related drivers.

Conclusion

A variety of multi-level drivers of disrespectful maternity care were identified. A diverse and inclusive multi-stakeholder approach should underline efforts to mitigate disrespectful maternity care and promote respectful, equitable, and quality maternal health care.

Respectful maternity care during childbirth in India: A systematic review and meta-analysis

Background

Respectful maternity care is a rightful expectation of women. However, disrespectful maternity care is prevalent in various settings. Therefore, a systematic review and meta-analysis were conducted to identify various forms of ill-treatment, determinants, and pooled prevalence of disrespectful maternity care in India.

Methods

A systematic review was performed in various databases. After quality assessment, seven studies were included. Pooled prevalence was estimated using the inverse variance method and the random-effects model using Review Manager Software.

Results

Individual study prevalence ranged from 20.9% to 100%. The overall pooled prevalence of disrespectful maternity care was 71.31% (95% CI 39.84-102.78). Pooled prevalence in community-based studies was 77.32% (95% CI 56.71-97.93), which was higher as compared to studies conducted in health facilities, this being 65.38% (95% CI 15.76-115.01). The highest reported form of ill-treatment was non-consent (49.84%), verbal abuse (25.75%) followed by threats (23.25%), physical abuse (16.96%), and discrimination (14.79%). Besides, other factors identified included lack of dignity, delivery by unqualified personnel, lack of privacy, demand for informal payments, and lack of basic infrastructure, hygiene, and sanitation. The determinants identified for disrespect and abuse were sociocultural factors including age, socioeconomic status, caste, parity, women autonomy, empowerment, comorbidities, and environmental factors including infrastructural issues, overcrowding, ill-equipped health facilities, supply constraints, and healthcare access.

Conclusion

The high prevalence of disrespectful maternity care indicates an urgent need to improve maternity care in India by making it more respectful, dignified, and women-centered. Interventions, policies, and programs should be implemented that will protect the fundamental rights of women.

Obstetric Violence in Spain (Part I): Women's Perception and Interterritorial Differences

The decentralization of health systems can have direct repercussions on maternity care. Some inequalities can be noted in outcomes, like neonatal and child mortality in Spain. This study aimed to make the presence of obstetric violence in Spain visible as an interterritorial equity criterion. A descriptive, restrospective and cross-sectional study was conducted between January 2018 and June 2019. The sample comprised 17,541 questionnaires, which represented all Spanish Autonomous Communities. Of our sample, 38.3% perceived having suffered obstetric violence; 44.4% perceived that they had undergone unnecessary and/or painful procedures, of whom 83.4% were not requested to provide informed consent. The mean satisfaction with the attention women received obtained 6.94 points in the general sample and 4.85 points for those women who viewed themselves as victims of obstetric violence. Spain seems to have a serious problem with public health and respecting human rights in obstetric violence. Offering information to women and requesting their informed consent are barely practiced in the healthcare system, so it is necessary to profoundly reflect on obstetric practices with, and request informed consent from, women in Spain.

Abuse and disrespectful care on women during access to antenatal care services and its implications in Ndola and Kitwe health facilities

BACKGROUND

Antenatal care utilization is fundamental in preventing adverse pregnancy and birth outcomes. This paper assessed abuse and disrespectful care on women during access to antenatal care services and its implications in Ndola and Kitwe districts of Zambia.

METHODS

The assessment used a cross-sectional study design with a sample size of 505 women of child bearing age (15-49). Eighteen (18) high volume health facilities were identified as benchmarks for catchment areas (study sites) and using cluster sampling, households within catchment areas of health facilities were sampled. Chi-square and poison regression analysis was performed to ascertain associations between abuse and disrespect and antenatal care utilization.

RESULTS

One third (33%) of the participants attended less than half of the recommended antenatal visits. Results reveal a statistical significant association between; physical abuse (p value = 0.039); not being allowed to assume position of choice during examination (p value = 0.021); not having privacy during examination (p value = 0.006) and antenatal care service utilization. The difference in the logs of expected count on the number of antenatal care visits is expected to be; 0.066 (CI: -0.115,-0.018) unit lower for women who experienced lack of privacy during examinations; 0.067 (CI: -0.131,-0.004) unit lower for women who were discriminated based on specific attributes and 0.067 (CI: -0.120,-0.014) unit lower for women who were left unattended.

CONCLUSION

Abuse and disrespect during antenatal care service impedes demand for health care and service utilization thereby barricading the element of the package of services aimed at improving maternal and newborn health.

Disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa: a systematic review and meta-analysis

Background

Disrespectful and abusive treatment of women by health care providers during the process of childbirth at health facility is an international problem. There is a lack of data on disrespect and abuse of women during the process of childbirth at health facilities in Sub-Saharan Africa. The purpose of this study was to determine the prevalence of disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa.

Methods

The PRISMA guideline protocol was followed to write the systematic review and meta-analysis. Published studies were searched from Medline, PubMed, CINAHL, EMBASE, Maternal and infant care, science direct, and PsycINFO. Articles were accessed by three reviewers (ZY, BT and AA) using the following key terms, “attitude of health personnel” AND “delivery obstetrics*/nursing” OR “maternity care” AND “disrespect” OR “abuse” OR “professional misconduct” AND “parturition” AND “prevalence” AND “professional-patient relations” AND “Sub-Saharan Africa”. Additional articles were retrieved by cross referencing of reference. The heterogeneity of studies were weighed using Cochran’s Q test and I² test statistics. Publication bias was assessed by Egger’s test.

Results

Thirty three studies met the inclusion and included in this systematic review and meta–analysis of disrespect and abuse of women during the process of childbirth at health facilities. The pooled prevalence of disrespect and abuse women during the process of childbirth at health facilities in Sub-Saharan Africa was 44.09% (95% CI: 29.94–58.24).Particularly physical abuse was 15.77% (95% CI: 13.38–18.15), non-confidential care was 16.87% (95% CI: 14.49–19.24), abandonment was 16.86% (95% CI: 13.88–19.84) and detention was 4.81% (95% CI: 3.96–5.67).

Conclusion

In this study disrespect and abuse of women during the process of childbirth at health facilities are high compared with other studies, particularly non-confidential care and abandonment his high compared with other studies. This study points out that the ministry of health, health care providers, maternal health experts shall due attention to women’s right during the process of childbirth at health facilities.

Counteracting Abuse in Health Care: Evaluating a One-Year Drama Intervention with Staff in Sweden

In Northern European countries 13–28% of female patients seeking gynecological health care have reported abuse by health care staff (AHC). We conducted workshops with health care staff using the improvised role-play method Forum Play (FP), based on techniques developed by Boal. The study explores to what extent the intervention increased the staff’s awareness of AHC and their ability to take action against it. A total of 16 half-day FP workshops were conducted with staff from a Swedish women’s clinic over one year. Self-reported questionnaires were distributed to all staff before, during, and after the intervention. Primary outcome measures were the number of reported occasions of AHC and FP participants’ ability to act in AHC-situations. We found an increase in the participants’ self-reported ability to act in AHC-related situations. However, no change could be observed in the number of reported occasions of AHC between baseline and one year after the intervention. Health care staff’s participation in workshops using improvised role-play can increase staff’s perceived ability to take action in AHC situations. The voluntary nature of the intervention may have attracted those who were already aware of the topic, and likely explains the unchanged awareness of AHC.

Disrespect and abuse towards women during childbirth and postpartum depression: findings from Birth in Brazil Study

BACKGROUND

Many women are victims of disrespect and abuse during childbirth period. In Brazil, the prevalence of these acts has varied between 11.3% and 18.3%. Despite the high prevalence and grave consequences of mistreatment of women during birth care, women's mental health during this period, and its determining factors, are still poorly understood. The main objective is to investigate the association between mistreatment of women during childbirth and postpartum depression.

METHODS

national survey in childbirth care carried out between 2011 and 2012. The sample was composed of 23,378 puerperal women. Disrespect and abuse was composed by seven indicator.We assessed postpartum depression using Edinburgh Postnatal Depression Scale screening questions. We applied multigroup structural equation modelling (childbirth payment source), considering different theoretical models for vaginal births and C-sections.

RESULTS

Disrespect and abuse towards women during childbirth were associated with postpartum depression both in the public and private sectors, for both vaginal births and C-sections. In the public healthcare sector, disrespect and abuse were associated with maternal hospitalization. Presence of fundal pressure manoeuvre, not be white, and not receiving the desired mode of birth (only for C-sections). In the private sector, for both vaginal births and C-sections, not having the desired mode of birth was the only characteristic associated with disrespect and abuse.

CONCLUSION

Disrespect and abuse towards women during childbirth may contribute to the development of postpartum depression. Identifying its causes may help prevent the problem and strengthen public policies that favor the good quality of childbirth care.

Correction to: Toda mujer en el mundo debe tener un cuidado respetuoso durante el parto: una reflexión

An amendment to this paper has been published and can be accessed via the original article.

How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys

BACKGROUND

Women across the world are mistreated during childbirth. We aimed to develop and implement evidence-informed, validated tools to measure mistreatment during childbirth, and report results from a cross-sectional study in four low-income and middle-income countries.

METHODS

We prospectively recruited women aged at least 15 years in twelve health facilities (three per country) in Ghana, Guinea, Myanmar, and Nigeria between Sept 19, 2016, and Jan 18, 2018. Continuous observations of labour and childbirth were done from admission up to 2 h post partum. Surveys were administered by interviewers in the community to women up to 8 weeks post partum. Labour observations were not done in Myanmar. Data were collected on sociodemographics, obstetric history, and experiences of mistreatment.

FINDINGS

2016 labour observations and 2672 surveys were done. 838 (41·6%) of 2016 observed women and 945 (35·4%) of 2672 surveyed women experienced physical or verbal abuse, or stigma or discrimination. Physical and verbal abuse peaked 30 min before birth until 15 min after birth (observation). Many women did not consent for episiotomy (observation: 190 [75·1%] of 253; survey: 295 [56·1%] of 526) or caesarean section (observation: 35 [13·4%] of 261; survey: 52 [10·8%] of 483), despite receiving these procedures. 133 (5·0%) of 2672 women or their babies were detained in the facility because they were unable to pay the bill (survey). Younger age (15-19 years) and lack of education were the primary determinants of mistreatment (survey). For example, younger women with no education (odds ratio [OR] 3·6, 95% CI 1·6-8·0) and younger women with some education (OR 1·6, 1·1-2·3) were more likely to experience verbal abuse, compared with older women (≥30 years), adjusting for marital status and parity.

INTERPRETATION

More than a third of women experienced mistreatment and were particularly vulnerable around the time of birth. Women who were younger and less educated were most at risk, suggesting inequalities in how women are treated during childbirth. Understanding drivers and structural dimensions of mistreatment, including gender and social inequalities, is essential to ensure that interventions adequately account for the broader context.

FUNDING

United States Agency for International Development and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO.

Obstetric violence and its associated factors among postnatal women in a Specialized Comprehensive Hospital, Amhara Region, Northwest Ethiopia

Objective

Obstetric violence is an often overlooked obstacle to quality maternal health care service utilization. In the study setting, there was limited evidence on obstetric violence. Hence, this study aimed at assessing the prevalence and associated factors of obstetric violence among women who gave birth in Gondar University Specialized Comprehensive Hospital, Northwest Ethiopia.

Results

A total of 409 women had been participated in the study with a response rate of 100%. Three in four (75.1%) women reported that they had been subjected to at least one form of obstetric violence during labor and delivery with 95% CI (70.9–79.0). The reported forms of obstetric violence include non-consented care—260 (63.6%), non-dignified care—226 (55.3%), physical abuse—192 (46.9%), non-confidential care—132 (32.3%, neglected care—52 (12.7%) and discriminated care—38 (9.3%). On the contrary, none of the respondent had reported detention for failure to pay in the hospital. The multivariable logistic regression analysis demonstrated that urban residents (AOR = 1.89; 95% CI 1.11, 3.22) and primary school attendants (AOR = 0.49; 95% CI 0.27, 0.91) were significantly associated with experiencing obstetric violence. This study indicated the high prevalence of obstetric violence. Thus, interventions need to be undertaken by taking the reported forms of obstetric violence and participants’ sociodemographic status in to account.

The association between disrespect and abuse of women during childbirth and postpartum depression: Findings from the 2015 Pelotas birth cohort study

BACKGROUND

This study examined the association between disrespect and abuse of women during facility-based childbirth and postpartum depression (PD) occurrence.

METHODS

We used data from the 2015 Pelotas (Brazil) Birth Cohort, a population-based cohort of all live births in the city. We assessed 3065 mothers at pregnancy and 3-months after birth. Self-reported disrespect and abuse experiences included physical abuse, verbal abuse, denial of care, and undesired procedures. We estimate the occurrence of each disrespect and abuse type, one or more types and disrespect and abuse score. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PD. EPDS scores ≥13 and ≥15 indicated at least moderate PD and marked/severe. Odds ratios (OR) were calculated by logistic regression.

RESULTS

The prevalence of at least moderate PD and marked/severe PD was 9.4% and 5.7%, respectively. 18% of the women experienced at least one type of disrespect and abuse. Verbal abuse increased the odds of having at least moderate PD (OR = 1.58; 95%CI 1.06-2.33) and marked/severe PD (OR = 1.69; 95%CI 1.06-2.70) and the effect among women who did not experience antenatal depressive symptoms was greater in comparison to those who did (OR = 2.51; 95%CI 1.26-5.04 and OR = 4.27; 95%CI 1.80-10.12). Physical abuse increased the odds of having marked/severe PD (OR = 2.28; 95%CI 1.26-4.12). Having experienced three or more mistreatment types increased the odds of at least moderate PD (OR = 2.90; 95%CI 1.30 - 35.74) and marked/severe PD (OR=3.86; 95%CI 1.58-9.42).

LIMITATIONS

Disrespect and abuse experiences during childbirth were self-reported.

CONCLUSIONS

Disrespect and abuse during childbirth increased the odds of PD three months after birth. Strategies to promote high quality and respectful maternal health care are needed to prevent mother-child adverse outcomes.

Disrespectful and abusive behavior during childbirth and maternity care in Ethiopia: a systematic review and meta-analysis

Objective

Disrespectful and abusive behavior during childbirth and maternity care is violation of fundamental right of women and unborn child. There is scarce of data on disrespectful and abusive behavior during childbirth and maternity care in Ethiopia. The aim of this study was to determine disrespectful and abusive behavior during childbirth and maternity care in Ethiopia.

Results

Seven studies were included in this meta-analysis of disrespectful and abusive behavior during childbirth and maternity care. The pooled prevalence of disrespect and abuse care during childbirth and maternity care was 49.4% (95% CI 30.9–68.1). Whereas physical abuse was 13.6% (95% CI 5.2–31.2), non-confidential care was 14.1% (95% CI 7.3–25.4), abandonment care was 16.4% (95% CI 14.7–18.2), and detention was 3.2% (95% CI 0.9–11.5). This study showed that disrespectful and abusive behavior during child birth and maternity care is high. Whereas, abandonment care is high. This study indicates that health care providers shall not leave women during childbirth and maternity care and listen women, federal minister of health and regional health bureau also identifying root of cause disrespect and abuse and to alleviate mistreatment during childbirth and maternity care.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4118-2) contains supplementary material, which is available to authorized users.

Disrespect and abuse during facility-based childbirth and its sociodemographic determinants - A barrier to healthcare utilization in rural population

CONTEXT

The provider-driven disrespect and abuse (DA) of women during childbirth is a marker for quality of maternal care and violation of basic human rights.

AIMS

This study was done to assess prevalence and sociodemographic determinants of DA experienced during facility-based childbirth.

SETTINGS AND DESIGN

This is a cross-sectional, community-based study done in six villages in the district of Aligarh, north India.

SUBJECTS AND METHODS

In all, 305 women who underwent facility-based childbirth were interviewed by pretested and structured questionnaire at home between 4 and 6 weeks postpartum period.

STATISTICAL ANALYSIS USED

Descriptive statistics, Chi-square test, and bivariate regression analysis using SPSS 20.0 were used.

RESULTS

A total of 257 (84.3%) of 305 women reported any form of DA. Nonconsented services (71.1%) and nonconfidential care (62.3%) were the most common types. Abandonment/neglect during childbirth was reported by 10.2% women, nondignified care by 9.2%, physical abuse by 5.9%, detention in the health facility by 3.3%, and discrimination by 3.9%. Women who had undergone vaginal birth [odds ratio (OR) 3.36; confidence interval (CI) 1.7-6.5], at public health facility (OR 2.65; CI 1.4-5.0), given care by providers other than doctors (OR 2.89; CI 1.5-5.5), who belonged to low socioeconomic status (OR 3.68; CI 1.4-9.7), and who did not decide place of delivery themselves (OR 4.49; CI 2.0-12.1) were more at risk of DA. Out of all females unwilling to attend facility in future, 93.8% reported experiencing DA. The association between any DA and decision to attend the facility in future was statistically significant.

CONCLUSION

More than 8 of 10 women experienced any DA during facility-based childbirth. It can be a barrier to utilization of facility for childbirth. Preventing DA is important to improve quality of maternal care and institutional deliveries.

Mothers' experience of disrespect and abuse during maternity care in northern Ethiopia

BACKGROUND

The provision of respectful and satisfactory maternity care is essential for promoting timely care-seeking behaviour, and ultimately ensuring the health and well-being of mothers and their babies. Disrespectful and abusive care has been recognized as one of the barriers to seeking timely maternity health services. However, the issue has not been adequately researched in community settings in low- and middle-income countries using validated measurement tools.

OBJECTIVE

This study was conducted to assess the extent of, and factors associated with, disrespectful and abusive maternity care reported by women who utilized facility-based delivery services in northern Ethiopia.

METHODS

We conducted a community-based cross-sectional study in Tigray, northern Ethiopia. Women who gave birth in the preceding year and visited health institutions for these deliveries were selected using a multistage cluster sampling procedure. Data were collected using a pretested questionnaire. Six domains of disrespect and abuse (D and A) were included in the questionnaire. Socio-demographic and obstetric related factors associated with D and A were tested using a negative binomial regression model.

RESULTS

Of the 1125 women in the sample, 248 (22%; 95% CI: 19.8%, 24.4%) reported at least one incident of D and A during delivery at a public health facility in northern Ethiopia. Higher incidents of D and A were reported by women who were older than 19 years at the time of delivery (aIRR = 2.649 (95% CI: 1.455, 4.825) compared to younger women. Incidents of D and A were reported more by women residing in urban areas, by women educated to the ninth grade and above, by women who experienced longer labour duration, and also by women who were not permitted to have support persons attend labour and delivery.

CONCLUSIONS

A fifth of the women reported D and A while receiving care during labour and delivery. Policies and practices aimed at ensuring universal coverage for institutional deliveries need to promote respectful maternity care for women in all facilities.