More than one-third of women in four lower-income countries experienced mistreatment during childbirth in health facilities, according to a new study published in the Lancet medical journal.
The study — carried out in Ghana, Guinea, Myanmar, and Nigeria — found that younger women and those who were less educated were more likely to be mistreated.
The mistreatment includes facing stigma, discrimination, and verbal and physical abuse. It also includes medical produces being conducted without their consent (such as cesarean sections, being induced, or vaginal examinations), the use of force during procedures, and neglect by health care workers.
“Poor experiences of maternity care can negatively affect both the woman herself and future [choices to seek health care],” the study stated. It is also likely to worsen women's anxiety, distress, and disempowerment.
The study found that 42% of women experienced verbal or physical abuse, stigma, or discrimination. Of these, 14% experienced physical abuse such as being slapped, hit, or punched, experiencing forceful downward abdominal pressure, and being forcefully held down to the bed.
Among the births observed by researchers, 75% of episiotomies (surgical cuts made at the opening of the vagina during childbirth) were conducted without the woman’s consent, 59% of cases involved vaginal examinations without consent, and 13% of cesarean births were non-consensual.
The verbal abuse included being shouted at, scolded, and mocked and some women experienced stigma or discrimination regarding their age, economic circumstances, race or ethnicity.
In addition, 5% of women or their babies were detained in the health facility because they were unable to pay the bill. In the study, 94% of women did not have a companion with them (nearly half were not allowed). Privacy measures such as curtains or partitions were not used for 37% of births, and many women reported that private health details were discussed publicly.
This mistreatment and abuse is in direct conflict with WHO guidelines which promote respectful maternity care “that maintains dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth.”
A statement by WHO said: “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.”
Racial biases in maternal health have a widespread impact, including in the US, where African American, Native American, and Alaska Native women are three times more likely to die from pregnancy-related causes than white women. While maternal mortality rates were nearly cut in half between 1990 and 2015, the rate has been on the rise in the US.
According to the study, “midwives and doctors described women as ‘uncooperative’ during this period and some justified using physical and verbal abuse as ‘punishment’ for non-cooperation and to ensure ‘good outcomes’ for the baby.”
To tackle this mistreatment, WHO provided recommendations on how to support women during childbirth, which include: redesigning labor wards to allow for privacy, improving processes around informed consent, and giving women the option of having a companion during labor and childbirth.