“If I did not slap you, you would not have given birth to your baby”: The mistreatment of women during childbirth
Bohren, Meghan A
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Background Evidence suggests that women experience mistreatment during childbirth in facilities across the world, including physical and verbal abuse, discrimination and neglect. However, there is no agreed-upon definition of mistreatment, hampering measurement and preventative measures. This study aims to address this by systematically reviewing existing evidence and conducting a qualitative study in Abuja, Nigeria. Methods A mixed-methods systematic review was conducted to contribute to the development of a global evidence-informed definition of mistreatment during childbirth. PubMed, CINAHL, Embase and grey literature were searched. Thematic synthesis was used for qualitative evidence and the CERQual approach was used to assess confidence in qualitative review findings. Due to heterogeneity of quantitative data, only descriptions of study characteristics, outcome measures, and results are presented. A qualitative study using focus group discussions and in-depth interviews was conducted in Abuja, Nigeria, among women, midwives, doctors and administrators. Thematic synthesis was used to identify key themes and patterns. Results In the systematic review, 65 studies were included from 34 countries. Qualitative findings were organized under seven domains: physical abuse, sexual abuse, verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers, and health system conditions and constraints. The first qualitative analysis showed that women experience and providers acknowledge mistreatment during childbirth, including physical and verbal abuse, being tied to a delivery bed, and detainment in the hospital. The second qualitative analysis showed that women and providers are accepting of mistreatment, including slapping, shouting, neglect and physical restraint, when used to gain compliance or ensure a good outcome. Conclusion Mistreatment of women during childbirth occurs on labor wards across the world, and has serious public health and human rights implications. This dissertation provides three contributions: (1) evidence-informed typology of mistreatment; (2) contextual analysis of experiences and perceptions of mistreatment during childbirth in Abuja; and (3) analysis of the parallels between acceptability of mistreatment during childbirth and violence against women more broadly. These results can be used to develop measurement tools to quantify the burden of mistreatment, and to inform future research and interventions to prevent mistreatment and promote respectful care.