SIGNIFICANT Mistreatment of Women during Childbirth

October 15, 2019

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Can you imagine, even for one moment, being physically abused and tormented by your healthcare provider while you are in labour?

A pregnant woman in a medical facility, with no privacy, is about to give birth while doctors, nurses and patients are witness to her being punched and yelled at - and no one does anything about it…as if to say, these actions are somehow normal or acceptable.

I have no words - nothing that could elucidate the cruelty of this most abysmal and barbaric violation that thousands upon thousands of young women continue to endure.

Giving birth is portrayed as miraculous - the single most beautiful gift of life and significant moment when a woman becomes a mother. Giving birth can also be a very intimidating and stressful experience, especially for young women. Receiving professional, medical care is unquestionably fundamental in ensuring the health and well-being of mother and child.

The World Health Organization (WHO) concluded a study that found one third of young women in low and middle-income countries experienced verbal and physical abuse, stigmatization and discrimination from midwives, obstetricians and other maternity providers during and after childbirth in health facilities and hospitals located in Ghana, Guinea, Myanmar and Nigeria.

The cross-sectional study observed 2,016 women during labour and childbirth and 2,672 women after childbirth. (Labour observations were not completed in Myanmar). Evidence shows:

838 women (or 41.6%) experienced high levels of verbal abuse, i.e. shouted at, scolded and mocked. Verbal abuse peaked 30 minutes before birth until 15 minutes after birth.
282 women (or 7.15%) were hit, slapped and punched.

434 women (or 16.4%) reported feeling ignored, neglected and that their presence was a nuisance for health workers and staff.
190 out of 253 women (or 75.1%) underwent non-consensual episiotomies.
35 women underwent non-consensual caesarean sections.
63 women (or 3.1%) experienced forceful downward abdominal pressure
38 women (or 1.9%) were forcefully held down to the bed
11 women experienced stigma and discrimination regarding their race or ethnicity
Out of 4,393 vaginal examinations, 2,611 were non-consensual and with no privacy
48 women of 142 (or 33.8%) who requested pain relief did not receive any
427 women (or 19.5%) did not receive water and 708 were not allowed any food
1,890 women (or 93.8%) did not have a companion present.
1,202 women (or 45.0%) did not have privacy (curtains or partitions).
16 women out of 113 women (or 14.2%) with second degree or higher perineal tears did not receive local anaesthetic during repair and suture.
725 women (or 27.1%) during labour were bribed for informal payment by healthcare providers.

183 women (or 6.9%) during labour were threatened with poor outcomes for their baby
118 women (or 4.4%) were asked to clean up their own blood, urine, faeces and amniotic fluid after birth
133 women (or 5%) were detained because they were unable to pay their bills

Young women from 15 to 19 years of age who had very little education were the primary determinants of mistreatment.

“Poor experiences of maternal care can negatively impact women and their future health seeking behaviours,” states the Lancet in an article entitled, ‘How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys’.

The WHO concludes that, "...health systems must be held accountable and sufficient resources must be in place to provide quality, accessible maternal health care and clear policies on women’s rights. Health care providers also require support and training to ensure that women are treated with compassion and dignity.”

United Nations quote regarding pregnant women

In 2014, WHO issued a statement on the prevention and elimination of disrespect and abuse during facility-based childbirth, citing mistreatment as a violation of rights and trust between women and their healthcare providers.

In 2018, WHO recommended woman-centred care should optimize women’s experiences of labour and childbirth through a holistic, human rights-based approach including the provision of respectful maternity care that maintains women’s dignity, privacy and confidentiality; enables informed choice and continuous support throughout labour and childbirth; and ensures freedom from mistreatment.

Acknowledgement

A great big and resounding “thank you” goes out to Dr. Meghan Bohren, Gender and Women’s Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health at the University of Melbourne and her colleagues for having the integrity and fortitude to bring this very important study to the forefront.

Bohren and colleagues have completed other birth observation studies in Ethiopia, Kenya, Madagascar, Rwanda and Tanzania.

“…the top demand from more than one million women from 114 countries was respectful and dignified health care,” said Patience A. Afulani, Assistant Professor, Epidemiology & Biostatistics at the University of California and Cheryl A. Moyer, Associate Professor of Learning Health Sciences and Associate Professor of Obstetrics and Gynecology at the University of Michigan.

“Although measurement remains important, we need to move beyond assessing prevalence of mistreatment and begin using the validated tools that have been developed to drive efforts at increasing accountability and tracking change,” add Afulani and Moyer.

Research for this study was made possible by the support of the American People through the United States Agency for International Development (USAID) and the UNDP/ UNFPA/ UNICEF/ WHO/ World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research and WHO.