|Year : 2023 | Volume
| Issue : 1 | Page : 12-17
Mistreatment of women during child birth - A narrative review
Mamta Paliwal, Manisha Singh, Manju Khoja, Mansi Meghwal, Meena Jaitani, T Deviga, Himanshu Vyas
College of Nursing, AIIMS, Jodhpur, Rajasthan, India
|Date of Submission||09-Nov-2021|
|Date of Acceptance||07-Feb-2022|
|Date of Web Publication||15-Feb-2023|
Dr. Himanshu Vyas
College of Nursing, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
Source of Support: None, Conflict of Interest: None
Respectful maternity care is the universal right of every woman all around the world but recent evidences show that women receive disrespectful care and face abuse during facility-based childbirth. It creates a negative impression of the institutional delivery and indirectly contributes to increases in the maternal morbidity and mortality rate; hence, this narrative review was conducted to identify the various forms of mistreatment, determinants and prevalence of disrespectful maternity care in India. (i) To explore the status of mistreatment of women during childbirth. (ii) To assess the factors responsible for mistreatment experienced by women. Keywords searches of PubMed, Google scholar, manual searches of other relevant journals and references lists of primary articles. Quantitative studies and mixed-method studies on women's experiences of factors responsible for mistreatment during labor were explored, study result revealed that factors affecting respectful maternity care (RMC) include age, religion, income etc., Various types of mistreatments experienced by women during labur were physical abuse (9.3%), nondignified care (14.25%), nonconfidential care (33.95%), neglect/ignore (9.35%), verbal abuse (19.72%), discrimination (7.36%), threats to with hold treatment (8.15%), lack of information (26.2%), delivered alone (9.25%), choice of position denied (10.5%), requested payment of bribe (46.3%), unnecessary separation from baby (4.3%), nonconsented care (49.05%). Mistreatment during labor is common in India and is commonly found in the form of verbal abuse, physical abuse, discrimination, threats to with hold treatment, lack of information, ignored, delivered alone, choice of position denied, companion not allowed, requested payment or bribe, unnecessary separation from body etc., Health care personal plays a major role for providing RMC and in preventing mistreatment during childbirth. They must be aware about the mistreatment during childbirth and its consequences such as increasing maternal mortality rate and decrease no. of institutional delivery.
Keywords: Abuse, mistreatment during childbirth, respectful maternity care
|How to cite this article:|
Paliwal M, Singh M, Khoja M, Meghwal M, Jaitani M, Deviga T, Vyas H. Mistreatment of women during child birth - A narrative review. J Public Health Prim Care 2023;4:12-7
|How to cite this URL:|
Paliwal M, Singh M, Khoja M, Meghwal M, Jaitani M, Deviga T, Vyas H. Mistreatment of women during child birth - A narrative review. J Public Health Prim Care [serial online] 2023 [cited 2023 Jun 5];4:12-7. Available from: http://www.jphpc.org/text.asp?2023/4/1/12/369663
| Introduction|| |
Respectful maternity care is the universal right of every woman around the world. According to WHO, “Respectful maternity care refers to care for and provided to all women in a manner that maintains their privacy, dignity and confidentiality, ensures freedom from harm and mistreatment and enables informed choices and continuous support during labor and childbirth.”
It is a universal problem that occurs in underdeveloped, developed and developing countries. About 1/3rd of the maternal mortality occurs in South East Asia and more than 90% occurs in developing countries due to violations with fundamental rights. In India, the overall prevalence of Disrespectful maternity care was 71.31% and in community-based studies conducted in health care facilities was 65.38%4.
Disrespectful care and abuse during labor are defined as a violation of the fundamental rights of women which gives a negative impact on birth outcomes and discourages the women to seek for future hospital care. Disrespect and abuse gained acknowledgement not just in respect of maternity care but also in ignorance of fundamental rights of women during labor in the health facility., Problems such as disrespect, abuse, mistreatment, demand for informal payments, infrastructural issues (such as lack of water supply, sanitation, electricity and crowded rooms) are common globally. The key problems during labor and childbirth identified are lack of privacy and confidentiality, disrespect of choice to be in a comfortable position, lack of right to use basic health care facilities, medical care, and prompt care, poor intrapartum and postpartum care and assessment, neglect, care provided by inexperienced or unskilled staff, lack of communication, discrimination regarding race, ethnicity or physical abuse (beating or slapping) and verbal abuse (offensive and shouting), intimidating headed for treatment; proper information was not provided when the patient is in need as they are ignored or abandoned; delivering without companion; neither birth companion are allowed nor unnecessary separation from baby after birth.,
The common factors associated with labor room violence are: age, migrant, wealth (quartile), caste, education, place of residence, social group, religion, partners occupation, any mass media exposure, wealth index (socioeconomic status), parity, referral status, admission day, and sector (public or private)., The labor room violence is more prevalent in the urban area as comparative to the rural area and is high in government health facilities as relative to the private health facility.
Various features of disrespect and abuse during labor have effects on maternal mortality in both ways, indirect and direct causes. The direct causes are by use of inappropriate and excessive invasive procedures in vaginal birth, ignorance and care not provided on time, especially in women with different socioeconomic status, marital status, and HIV status. The indirect cause is by becoming a challenge in seeking care of delivery. Women who are experiencing disrespect and abuse during labor will not choose the hospital facilities and also not recommend another woman to get hospital care.
The White Ribbon Alliance charter which includes the seven articles associated with the seven domains of disrespect and abuse. The seven universal rights of every pregnant woman from the Respectful Maternity Care Charter are as follows: Right to stay safe from harm and mistreatment, Right to get an option and preference for companionship and also to get informed consent, refusal and information during natal care, Right to secrecy and privacy, Right to get dignified care, Right to stay free from discrimination, and get fair care, Right to get best level of healthcare and to approach on time, Right to independence, sovereignty, autonomy, and free from coercion. The Indian government recommends the prerequisite of services regarding maternity care appropriately by professional and experienced health care workers in facilities. Government must take care that inexperienced and nonprofessional personnel should not get involved in these services and also pay attention to protect those women's rights.
Further, respectful maternity care (RMC) gives the positive experience by reducing maternal morbidity and it promotes positive child birth experience.
UNICEF support the different interventions implemented by the Indian government which includes the approach to every individual women, continuum of care, natal care and PradhanMantriSurakshitMatritvaAbhiyan gives positive impact on RMC.,
As per the WHO, the following actions should be taken worldwide to eliminate mistreatment during labor in hospital care facilities. WHO support the government and participants for research purpose and take actions on mistreatment during labor and also initiate and maintain the programs which were designed to promote the quality of RMC; Emphasizing fundamental rights of every woman throughout the pregnancy and labor to get RMC; it facilitates the data regarding the clinical practices during maternity care and are also accountable to give professional support from the systems to meet the crucial component of quality of care. To promote the RMC and eliminate mistreatment practices with women involves all team members.
The objective of this study was to explore the factors and also to assess the types of mistreatment during childbirth. Most studies focused on only one or another aspect of mistreatment during labor. This emphasized the need for further and detailed exploration of types of mistreatment during labor and factors affecting it.
| Methods|| |
This narrative review summarizes the types of mistreatment during labor and factors affecting it. Database PubMed, Google Scholar were searched using keywords used in database searches were mistreatment, labor, RMC, violence, disrespect, abuse, childbirth. Reference list of selected articles was also explored.
The inclusion criteria are limited to the English language, published between 2010 and 2020, from India, searched from PubMed, and Google scholar, the quantitative and mixed type of studies including full-text articles. Total 12 articles were found in PubMed and 30 articles from Google Scholar. According to inclusion criteria, 6 articles were selected from PubMed and 2 articles from Google Scholar. All the articles were thoroughly read and evaluated [Figure 1].
| Discussion|| |
The first objective of this narrative review was to explore the factors responsible for the mistreatment of women during labor. Eight studies included in this review indicated that the women who had experienced mistreatment during labor, most of them were in the age group of 20–35 years (46%) and were Hindu (52.5%). More than half (52.5%) were multipara. Most of them belonged to the middle wealth index (33.7%) and had delivered in a government health facility (60.3%). The large number of mothers under this review had not attended school (39.3%) and belonged to either scheduled caste or scheduled tribe. A study reported higher form of ill-treatment has found in the age group of 35 years or more (60.9%). However, another three studies reported that women of the age group of 20–30 years experienced more ill-treatment, i. e., more than 50%, and some studies reported it to be <50%.,, Many of the studies reported that the ill-treatment is more common in multipara (i.e. >50%) but one study reported in another way this is more common in primipara. As reported by some studies, more than 50% of mistreatment was found in Hindu females.,, However according to some other studies, disrespect and abuse were almost the same in Hindus and Muslims., Women who have not attended school (>50%) and belonged to either scheduled caste or scheduled tribe have experienced more ill-treatment as shown in two studies., Other studies also found the same association between caste and mistreatment. According to two studies, women belonging to the lower wealth index experienced more ill-treatment., Whereas, another three studies reported that women belonging to higher wealth index reported more ill-treatment.,, Women in the government facilities have experienced more disrespect and abuse reported as 63.6%, 71%, 76.7% and 30.1%, respectively.,,,
Our second objective for this narrative review was to assess the frequency of disrespect and abuse experienced by women. Many of the studies revealed verbal abuse to be the mot common type of mistreatment faced by women during childbirth.,,, [12,] According to some studies, approximately 9.3% of women reported physical abuse in the form of slapping, pinching, beating, tying the women, invasive procedures done without any pain relief (episiotomies and caesarean sections), repetitive use of excessive force during vaginal examinations, labor, or delivery.,,,, Two studies suggested that confidentiality was not maintained while providing care in 33.95% of cases., 9.35% of women under two studies faced ignorance and negligence by the health care providers.,, 13.25% of women under two studies reported provision of nondignified care in health-care settings., 7.36% of women under three studies faced discrimination based on their caste, socioeconomic status, educational level, etc.,, 46.3% of women under three studies reported that there were requests made for informal payments or bribes for delivery [Table 1].,, Approximately half of the women (49.05%) under two studies reported that consent was not taken before doing procedures such as episiotomy, cesarean sections etc., 26.2% of women under two studies reported that there were no information were given regarding the procedure, postprocedure care, etc.,, Moreover, according to two studies, 8.15% of women reported threats to withhold treatment and 9.25% of women reported that no companion was allowed at the time of delivery and they delivered alone., One study said that 10.5% of women's choice for the position was denied and 4.3% of women reported unnecessary separation from baby [Table 1].
An important question that emerges from this review is whether it is ethical to allow women to deliver in conditions where basic standards of care are not met like cleanliness [Figure 1], hygiene, dignity, and equity. Mistreatment occurs everywhere at least in part. Hence, the government should ensure that women's experiences and perceptions of care are addressed and that RMC standards are followed.
Strengths and limitations
This narrative review from northern India to report the barriers of RMC. Being a narrative review, it helps in collecting data from all sections including public, private and communities. The strength of this review is that it includes all factors or barriers which are affecting the RMC. Limitation of this study includes that this is a narrative review so it does not consider the original work and rigorous methodological approaches; it only includes the theoretical and contextual points of view which are discussed in this study. This is also important that the studies included in this review are focusing on the mistreatment faced by the women and also suggest that there are some programs and schemes are going on to promote the RMC and to overcome their barriers. Furthermore, to improve RMC, it is essential to understand the perception of the various stakeholders involved and the health system issues to develop measures for improvement. Developing women cantered targeted interventions; appropriate tools to measure RMC based on determinants and finally help in policy and program implementation.
| Conclusion|| |
This narrative review identified that mistreatment during childbirth is high in Northern India. These eight studies included in this review indicate that the women who had experienced mistreatment during labor were mostly in the age group of 20–35 years, multipara and they were middle-class families. The labor room violence is more prevalent in urban area as relative to the rural area and the prevalence of abuse is high in government health facilities as relative to the private health facility. Highest reported forms of mistreatment are nonconsented care on minor procedures and verbal abuse. Finally, this review suggests the need for improvement in quality of care and the importance to get women aware about their rights. This can be achieved by the implementation of various policies and training programs of health-care workers to ensure good quality of care, especially during childbirth. Further large scale mixed-method studies are required to explore factors of mistreatment and labor room violence to understand the complexity of disrespect and abuse which may provide ways of reducing and eliminating the same. The review also suggested the need to promote the quality of maternal care and to get women aware about their rights. This can be achieved by the implementation of policies and programs that will help to eliminate the barriers and ensure good quality of care in all settings and situations.
We express our gratitude to all the authors of the manuscripts which are included in this review.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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