Dear users, if you are aware of relevant global research that is not included in our database and relates to obstetric violence, we invite you to write to us at cm@respectfulcare.eu. We accept open-source research from any country in the world. Your collaboration is essential to enrich our collection and support researchers worldwide. Likewise, if you find any errors, please do not hesitate to contact us. Thank you in advance for your cooperation.
AFRICA
2014, Defining disrespect and abuse of women in childbirth: a research, policy and rights agenda
Lynn P Freedman, Kate Ramsey, Timothy Abuya, Ben Bellows, Charity Ndwiga, Charlotte E Warren, Stephanie Kujawski, Wema Moyo, Margaret E Kruka & Godfrey Mbarukuc
The global movement to promote respectful maternal care is leveraging normative standards in law and policy. However, simply advocating for abstract standards is insufficient to address disrespect and abuse. These standards must be grounded in the lived experiences of women and the underlying power dynamics. Disrespect and abuse in childbirth are defined as interactions or conditions deemed humiliating or undignified by local consensus. This definition aims to align with national and human rights standards over time, providing a foundation to challenge poor health-system practices. Ongoing research seeks to measure prevalence and test interventions, but further understanding of the drivers and consequences is needed. Effective interventions require clear theories of change and strategies for assessing implementation to support the global movement for respectful maternal care.
Marge A Koblinsky; Cheryl A Moyer, PhD; Clara Calvert, PhD; James Campbell , MPH; Oona M Campbell, PhD; Andrea B Feigl, PhD; Wendy J Graham, PhD; Laurel Hatt, PhD; Steve Hodgins, MD/DrPH; Zoe Matthews, PhD; Lori McDougall , MSc; Allisyn C Moran, PhD; Allyala K Nandakumar, PhD; Ana Langer, MD
Millennium Development Goal (MDG) 5, with its target of reducing maternal mortality by 75%, was not achieved. High numbers of maternal deaths and morbidities persist despite considerable progress in the coverage of maternity services. This discrepancy between burden and coverage highlights a crucial gap in the quality of care. Additionally, millions of pregnant women and adolescent girls remain outside the health system, left behind from the progress in coverage. This vulnerable population faces multiple challenges arising from their circumstances of poverty, illiteracy, ethnicity, social and/or physical exclusion, and dislocation, including in fragile, remote settings or conflict zones. Poor quality and inaccessible care exist everywhere, affecting people in all countries, whether low, middle, or high-income.
ETHIOPIA
Wondwosen Molla , Aregahegn Wudneh and Ruth Tilahun
Obstetric violence is a specific form of violence against women that violates their human rights. It is perpetrated by obstetric care providers and involves dehumanized assistance, abusive interventions, excessive medicalization, and the pathologization of natural reproductive processes. Objective: To assess the magnitude of obstetric violence and associated factors among women during childbirth in Gedeo Zone, South Ethiopia.
Muhabaw Shumye Mihret
Obstetric violence is an often overlooked obstacle to the utilization of quality maternal health care services. In the study setting, there was limited evidence on obstetric violence. Therefore, this study aimed to assess the prevalence and associated factors of obstetric violence among women who gave birth at Gondar University Specialized Comprehensive Hospital in Northwest Ethiopia.
Dagmawit Shemelis, Abebaw Addis Gelagay, Moges Muluneh Boke
The results of this study revealed that three out of every four mothers were subjected to mistreatment during childbirth care at health facilities. Non-consented care and non-confidential care were the most prevalent forms of mistreatment. Factors significantly associated with mistreatment included the number of ANC visits, the type of health facility visited for childbirth care, and complications faced during labor and delivery. Therefore, it is essential to strengthen actions such as providing maternity education during antenatal care and appropriately managing complications to improve the quality of maternity care at health facilities. Additionally, healthcare providers working in childbirth care need training on the importance of informed consent and the provision of compassionate and respectful care. Health facilities should also promote positive birth experiences by ensuring respectful, dignified, supportive, and consented care.
GHANA
Sarah D Rominski, Jody Lori, Emmanuel Nakua, Veronica Dzomeku, and Cheryl A Moyer
Although midwifery students in Ghana’s public midwifery schools emphasize the importance of providing high-quality, patient-centered, respectful care, they also report experiencing and participating in various forms of disrespect and abuse during childbirth. While they understand the necessity of respectful care, they can also justify and explain the reasons behind disrespectful and abusive practices. This apparent contradiction underscores the complexity of discussing and addressing these issues. These young women are committed to ensuring a safe birthing experience for their patients and believe that yelling, shouting, and even hitting women to secure a positive outcome is justified, understood, and possibly appreciated by the women themselves. The healthcare and social contexts in which these midwives practice and live are multifaceted, as are the issues surrounding disrespectful and abusive care during childbirth (Warren et al., 2015). This study provides a crucial starting point for educators, researchers, and policymakers to reconsider how future healthcare providers should be prepared to offer high-quality, respectful care to women during labor and delivery in low-resource settings.
Meghan A. Bohre, Joshua P. Vogel, Bukola Fawole, Ernest T. Maya, Thae Maung Maung, Mamadou Diouldé Baldé, Agnes A. Oyeniran, Modupe Ogunlade, Kwame Adu-Bonsaffoh, Nwe Oo Mon, Boubacar Alpha Diallo, Abou Bangoura, Richard Adanu, Sihem Landoulsi , A. Metin Gülmezoglu1 and Özge Tunçalp
The transformative agenda of the SDGs provides a global framework to address health and gender inequalities and improve healthcare experiences. Eliminating all forms of mistreatment of women during childbirth in healthcare facilities is a crucial component of efforts to transform maternity services globally to be centered on the needs of women and their families. To achieve this, reliable measurement tools are required to understand the extent and burden of mistreatment across various contexts, measure progress, and identify areas where interventions and policies are needed. We employed a systematic, mixed-methods approach to develop two tools—a labor observation and a community survey—to measure the mistreatment of women during childbirth in four countries. These tools are now available in the public domain. We encourage other researchers and program implementers to use these tools in their contexts to measure the extent of mistreatment during childbirth. We anticipate that these tools will continue to evolve as further studies are conducted. By measuring the mistreatment of women during childbirth, we can design and implement programs and policies to transform maternity services on a global scale.
Patience A Afulani, Beth Phillips, Raymond A Aborigo, Cheryl A Moyer
This article demonstrates that in four different study settings across three countries in sub-Saharan Africa and South Asia, women are not receiving person-centered care during facility childbirth. Although overt disrespect and abuse are uncommon, fundamental aspects of patient-provider interaction, particularly communication and respect for women’s autonomy, are lacking. Therefore, increased efforts are needed in low- and middle-income countries (LMICs) to improve person-centered maternity care (PCMC). These efforts should include provider training on the importance of PCMC, patient and provider rights, and strategies to enhance interactions with patients and their families. Providers should also be trained on appropriately handling conditions that often lead to poor interactions with women; for example, they should learn coping mechanisms for stress and receive instruction on addressing biases that might affect their care for certain groups. Additionally, measurement and accountability mechanisms should be implemented to reinforce efforts to improve PCMC, all within the context of broader health systems strengthening.
Meghan A Bohren, Hedieh Mehrtash, Bukola Fawole, Thae Maung Maung, Mamadou Dioulde Balde, Ernest Maya, Soe Soe Thwin, Adeniyi K Aderoba, Joshua P Vogel, Theresa Azonima Irinyenikan, A Olusoji Adeyanju, Nwe Oo Mon, Kwame Adu-Bonsaffoh, Sihem Landoulsi, Chris Guure, Richard Adanu, Boubacar Alpha Diallo, A Metin Gülmezoglu, Anne-Marie Soumah, Alpha Oumar Sall, Özge Tunçalp
More than 40% of observed women and 35% of surveyed women experienced mistreatment during childbirth. Younger, less educated women were at the highest risk, highlighting the need for multilevel interventions. Addressing these inequalities and promoting respectful maternity care for all are essential to improving health equity and quality. Our findings can inform policies and programs to ensure all women have positive pregnancy and childbirth experiences and are supported by empowered healthcare providers within well-functioning health systems. Urgent action is needed to enhance the provision of respectful maternity care worldwide.
Mamadou Dioulde Balde, Khalidha Nasiri, Hedieh Mehrtash, Anne-Marie Soumah, Meghan A Bohren, Boubacar Alpha Diallo, Theresa Azonima Irinyenikan, Thae Maung Maung, Soe Soe Thwin, Adeniyi K Aderoba, Joshua P Vogel , Nwe Oo Mon, Kwame Adu-Bonsaffoh, Özge Tunçalp
More than half of postpartum women surveyed in Nigeria, Ghana, Guinea, and Myanmar reported having a labor companion. Depending on the country, the presence of a labor companion was associated with a lower risk of physical abuse, unconsented vaginal examinations, and poor communication with healthcare providers. Allowing women to have a companion of their choice can be a low-cost and effective intervention for reducing mistreatment during labor and childbirth in low-resource settings. Further research is needed to explore the best ways to implement labor companionship across different settings and ensure that women’s choices and autonomy are respected.
Theresa Azonima Irinyenikan, Adeniyi Kolade Aderoba, Olufunmilayo Fawole, Olusoji Adeyanju, Hedieh Mehrtash, Kwame Adu-Bonsaffoh, Thae Maung Maung ,10 Mamadou Dioulde Balde, Joshua P Vogel, Marina Plesons, Venkatraman Chandra-Mouli, Özge Tunçalp , Meghan A Bohren
Adolescent morbidity and mortality from pregnancy and childbirth complications remain significant global health issues. This study shows that adolescents and young women face high levels of mistreatment and low satisfaction with childbirth care in health facilities compared to older women. Common mistreatment includes verbal abuse, poor communication, lack of supportive care, and lack of privacy. Critical actions are needed to make maternity health services more responsive, adolescent-friendly, and non-judgmental. Interventions such as labor companionship can improve social and emotional support during labor. Efforts must focus on addressing these unique needs and reducing social stigma to ensure equitable and non-discriminatory care for adolescents and young women globally.
Meghan A. Bohren, Joshua P. Vogel, Bukola Fawole, Ernest T. Maya, Thae Maung Maung, Mamadou Diouldé Baldé, Agnes A. Oyeniran, Modupe Ogunlade, Kwame Adu-Bonsaffoh, Nwe Oo Mon, Boubacar Alpha Diallo, Abou Bangoura, Richard Adanu, Sihem Landoulsi, A. Metin Gülmezoglu1 and Özge Tunçalp
The transformative agenda of the SDGs provides a global framework to address health and gender inequalities and improve healthcare experiences. Eliminating mistreatment of women during childbirth in facilities is crucial for transforming maternity services to focus on the needs of women and their families. To achieve this, measurement tools are needed to understand the extent and burden of mistreatment across different contexts, reliably measure progress, and identify areas for interventions and policies. We developed two tools—a labor observation and a community survey—using a systematic, mixed-methods approach to measure mistreatment during childbirth in four countries. These tools are now available in the public domain, and we encourage other researchers and program implementers to use them in their contexts. We expect these tools to evolve with further studies. By measuring mistreatment during childbirth, we can design and implement programs and policies to globally transform maternity services.
Meghan A Bohren, Hedieh Mehrtash, Bukola Fawole*, Thae Maung Maung, Mamadou Dioulde Balde, Ernest Maya, Soe Soe Thwin, Adeniyi K Aderoba, Joshua P Vogel, Theresa Azonima Irinyenikan, A Olusoji Adeyanju, Nwe Oo Mon, Kwame Adu-Bonsaffoh, Sihem Landoulsi, Chris Guure, Richard Adanu, Boubacar Alpha Diallo, A Metin Gülmezoglu, Anne-Marie Soumah, Alpha Oumar Sall, Özge Tunçalp
More than 40% of observed women and 35% of surveyed women experienced mistreatment during childbirth, with younger, less educated women being at the highest risk. This underscores the need for multilevel interventions to address these inequalities and promote respectful maternity care for all, which is essential for improving health equity and quality. Our findings can inform policies and programs to ensure all women have positive pregnancy and childbirth experiences and are supported by empowered healthcare providers within well-functioning health systems. Urgent action is needed to enhance the provision of respectful maternity care worldwide.
Mamadou Dioulde Balde, Khalidha Nasiri, Hedieh Mehrtash, Anne-Marie Soumah, Meghan A Bohren, Boubacar Alpha Diallo, Theresa Azonima Irinyenikan, Thae Maung Maung , Soe Soe Thwin, Adeniyi K Aderoba, Joshua P Vogel, Nwe Oo Mon, Kwame Adu-Bonsaffoh,9 Özge Tunçalp
What is already known?
► Two Cochrane reviews have shown that the support provided by a labour companion during labour and childbirth improves maternal and perinatal outcomes, including enhancing the physiological process of labour and helping women have positive childbirth experiences.
► These available reviews have also demonstrated that women greatly value and benefit from the presence of a support person of choice during labour and childbirth who can provide emotional, psychological and practical support and advice to women during labour and childbirth. ► There is limited and varied evidence using empirical data to examine the association between labour companionship and mistreatment of women during childbirth.
What are the new findings?
► We provide evidence that women without labour companions experienced some, but not all, forms of mistreatment more often than women with labour companions, and that this association varied depending on the country.
► Using a standardised tool to examine women’s mistreatment during childbirth in four low/middleincome countries facilitates comparability of the results across settings and contexts.
More than half of postpartum women surveyed in Nigeria, Ghana, Guinea, and Myanmar reported having a labor companion. The presence of a labor companion was associated with a lower risk of physical abuse, unconsented vaginal examinations, and poor communication with healthcare providers, varying by country. Allowing women to have a companion of their choice can be a low-cost and effective intervention for reducing mistreatment during labor and childbirth in low-resource settings. Further research is needed to determine the best ways to implement labor companionship across different settings and ensure that women’s choices and autonomy are respected.
Theresa Azonima Irinyenikan, Adeniyi Kolade Aderoba, Olufunmilayo Fawole, Olusoji Adeyanju, Hedieh Mehrtash , Kwame Adu-Bonsaffoh Thae Maung Maung, Mamadou Dioulde Balde, Joshua P Vogel, Marina Plesons, Venkatraman Chandra-Mouli, Özge Tunçalp, Meghan A Bohren
What is already known?
► Despite considerable progress in preventing adolescent pregnancy over the past 25 years, an estimated 12million girls aged 15–19 years give birth each year.
► Adolescents and young women are less likely than adult women to get the maternal healthcare and support they need in health facilities.
► Adult women who experience mistreatment during childbirth are more likely to report low satisfaction with care, but the extent and type of adolescent experiences of mistreatment have not been explored.
What are the new findings?
► This study explored the experiences of mistreatment during childbirth among adolescents (15–19 years) and young women (20–24 years), and their satisfaction with care, using community-based crosssectional surveys in Ghana, Guinea, Myanmar and Nigeria.
► We found that adolescent experiences of mistreatment were common, particularly verbal abuse, poor communication, lack of supportive care and lack of privacy.
► Adolescents and young women who reported experiences of mistreatment—especially the better educated young women—were more likely to report lower satisfaction with the care they received.
Adolescent morbidity and mortality from pregnancy and childbirth complications remain significant global health issues. This study shows that adolescents and young women face high levels of mistreatment and low satisfaction with childbirth care in health facilities compared to older women. Common mistreatment includes verbal abuse, poor communication, lack of supportive care, and lack of privacy. Critical actions are needed to make maternity health services more responsive, adolescent-friendly, and non-judgmental. Interventions such as labor companionship can improve social and emotional support during labor. Efforts must focus on addressing these unique needs and reducing social stigma to ensure equitable and non-discriminatory care for adolescents and young women globally.
KENYA
Timothy Abuya, Charlotte E. Warren, Nora Miller, Rebecca Njuki, Charity Ndwiga, Alice Maranga, Faith Mbehero, Anne Njeru, Ben Bellows
One out of five women reported feeling humiliated during labor and delivery. Six categories of disrespect and abuse (D&A) during childbirth in Kenya were identified. Women with higher parity were three times more likely to be detained for lack of payment and five times more likely to be asked for a bribe compared to first-time mothers. Understanding the prevalence of D&A is critical for developing interventions at national, health facility, and community levels to address the drivers of D&A and encourage future facility utilization by clients. Further research is needed to understand the extent of D&A in other regions.
Patience A. Afulani, Nadia Diamond-Smith, Ginger Golub and May Sudhinaraset
This paper introduces a tool for measuring Person-Centered Maternity Care (PCMC) in developing settings, suitable for validation or direct use if validation is not feasible. It can be administered to women up to 9 weeks postpartum through exit or community interviews, ideally by non-health providers to reduce bias. The tool enables quantitative measurement of childbirth experiences, allowing for comparisons, statistical analysis, and evaluation of interventions. Periodic administration by facility heads can help identify areas for quality improvement. Developing similar scales for other reproductive health services will support the improvement of person-centered reproductive health care and outcomes.
Charlotte E. Warren, Rebecca Njue, Charity Ndwiga and Timothy Abuya
The results presented here contribute to the growing body of literature on the mistreatment of women during labor and childbirth, highlighting drivers at individual, family, community, facility, and policy levels. Emerging frameworks that categorize these manifestations into themes or components help focus on specific interventions to promote respectful maternity care. The findings from Kenya align with emerging literature, demonstrating that this is a global issue requiring a global solution.
Abuse, violence, and control during childbirth, as well as women's vulnerability, remain under-theorized legally. This collection provides a promising start but leaves many themes unexplored. The legally focused chapters address visible violence and abuse during childbirth, neglecting structural violence. This is crucial as individual violence stems from structural inequalities. The role of courts in addressing structural violence is unclear. The Kenyan case of Majani, ruled in her favor, highlights this, but the court failed to mandate necessary structural changes. The question of whether medical negligence constitutes obstetric violence remains open. Some research and laws in Mexican states recognize medical negligence as obstetric violence, but it's unclear if contemporary theories include negligence and how the law should respond. This book seeks to start a discussion on the boundaries of obstetric violence. Until its multifaceted nature is understood, effective legal responses cannot be developed. The hope is that this volume will inspire better legal responses and more respectful treatment of women in labor.
MALAWI
Reena Sethi, Shivam Gupta, Lolade Oseni, Angella Mtimuni, Tambudzai Rashidi and Fannie Kachale
Cada vez hay más evidencia a nivel mundial de que el trato negativo a las mujeres embarazadas durante el trabajo de parto y el parto puede ser un obstáculo para buscar atención materna calificada. Hasta el momento, se ha publicado poca evidencia cuantitativa sobre el irrespeto y el abuso (D&A) en Malawi. El objetivo de esta investigación es describir la prevalencia de irrespeto y abuso durante el trabajo de parto y el parto a través del análisis secundario de observaciones clínicas directas, y explorar la asociación entre la observación de elementos de D&A con el lugar de parto y las características de fondo de las pacientes.
NIGERIA
Foluso Ishola1,2*, Onikepe Owolabi3,4, Veronique Filippi3 | 1 Atlas Service Corps, Washington, District of Columbia, United States of America, 2 International Centre for Evaluation and Development, Nairobi, Kenya, 3 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom, 4 Guttmacher Institute, New York, United States of America
This systematic review documented a broad range of disrespectful and abusive behaviors experienced by women during childbirth in Nigeria, along with their contributing factors and consequences. The factors influencing these behaviors suggest the need for educating women on their rights, strengthening health systems to address specific needs during childbirth, improving providers' training to include interpersonal care, and implementing and enforcing policies on respectful maternity care. Additionally, this review highlights the need for more robust research to further explore the disrespect and abuse of women during childbirth in Nigeria and to propose effective interventions.
Meghan A. Bohren, Joshua P. Vogel, Bukola Fawole, Ernest T. Maya, Thae Maung Maung, Mamadou Diouldé Baldé, Agnes A. Oyeniran, Modupe Ogunlade, Kwame Adu-Bonsaffoh, Nwe Oo Mon, Boubacar Alpha Diallo, Abou Bangoura, Richard Adanu, Sihem Landoulsi, A. Metin Gülmezoglu1 and Özge Tunçalp
The transformative agenda of the SDGs offers a global framework to address health and gender inequalities and improve healthcare experiences. Eliminating all forms of mistreatment of women during childbirth in facilities is crucial for transforming maternity services to focus on the needs of women and their families. To achieve this, reliable measurement tools are needed to understand the extent and burden of mistreatment across different contexts, measure progress, and identify areas for intervention and policy development. We used a systematic, mixed-methods approach to develop two tools—a labor observation and a community survey—to measure mistreatment during childbirth in four countries. These tools are now publicly available, and we encourage other researchers and program implementers to use them in their contexts. We anticipate that these tools will evolve with further studies. By measuring mistreatment during childbirth, we can design and implement programs and policies to globally transform maternity services.
Meghan A Bohren, Hedieh Mehrtash, Bukola Fawole, Thae Maung Maung, Mamadou Dioulde Balde, Ernest Maya, Soe Soe Thwin, Adeniyi K Aderoba, Joshua P Vogel, Theresa Azonima Irinyenikan, A Olusoji Adeyanju, Nwe Oo Mon, Kwame Adu-Bonsaffoh, Sihem Landoulsi, Chris Guure, Richard Adanu, Boubacar Alpha Diallo, A Metin Gülmezoglu, Anne-Marie Soumah, Alpha Oumar Sall, Özge Tunçalp
More than 40% of observed women and 35% of surveyed women experienced mistreatment during childbirth. Younger, less educated women were at the highest risk, underscoring the need for multilevel interventions. Addressing these inequalities and promoting respectful maternity care for all are essential to improving health equity and quality. Our findings can inform policies and programs to ensure all women have positive pregnancy and childbirth experiences, supported by empowered healthcare providers within well-functioning health systems. Urgent action is needed to enhance the provision of respectful maternity care worldwide.
Mamadou Dioulde Balde, Khalidha Nasiri, Hedieh Mehrtash, Anne-Marie Soumah, Meghan A Bohren, Boubacar Alpha Diallo, Theresa Azonima Irinyenikan, Thae Maung Maung , Soe Soe Thwin, Adeniyi K Aderoba, Joshua P Vogel, Nwe Oo Mon, Kwame Adu-Bonsaffoh,9 Özge Tunçalp
More than half of postpartum women surveyed in Nigeria, Ghana, Guinea, and Myanmar reported having a labor companion. The presence of a labor companion was associated with a lower risk of physical abuse, unconsented vaginal examinations, and poor communication with healthcare providers, varying by country. Allowing women to have a companion of their choice can be a low-cost and effective intervention for reducing mistreatment during labor and childbirth in low-resource settings. Further research is needed to determine the best ways to implement labor companionship across different settings and ensure that women’s choices and autonomy are respected.
Theresa Azonima Irinyenikan, Adeniyi Kolade Aderoba, Olufunmilayo Fawole, Olusoji Adeyanju, Hedieh Mehrtash, Kwame Adu-Bonsaffoh, Thae Maung Maung ,10 Mamadou Dioulde Balde, Joshua P Vogel, Marina Plesons, Venkatraman Chandra-Mouli, Özge Tunçalp , Meghan A Bohren
Adolescent morbidity and mortality from pregnancy and childbirth complications remain significant global health issues. This study shows that adolescents and young women face high levels of mistreatment and low satisfaction with childbirth care in health facilities compared to older women. Common mistreatment includes verbal abuse, poor communication, lack of supportive care, and lack of privacy. Critical actions are needed to make maternity health services more responsive, adolescent-friendly, and non-judgmental. Interventions such as labor companionship can improve social and emotional support during labor. Efforts must focus on addressing these unique needs and reducing social stigma to ensure equitable and non-discriminatory care for adolescents and young women globally.
SENEGAL
Émilie Gélinas, Oumar Mallé Samb
Cette étude examine l'impact des interventions d'humanisation des naissances sur l'expérience des soins des femmes au moment de l'accouchement. Les résultats montrent que l'accouchement humanisé est apprécié pour l'amélioration des attitudes et comportements des professionnels de santé. Cependant, peu de femmes ont bénéficié pleinement de l'intervention en raison de difficultés de mise en œuvre. Pour améliorer l'efficacité, il est nécessaire de revoir l'allocation des ressources et de mieux communiquer sur l'intervention. La préparation à l'accouchement, incluant la reconnaissance des droits et options de soins, est cruciale. Les femmes ont souligné l'importance de l'accompagnement par un proche, de l'autorisation de boire et manger, et du choix de la position d'accouchement. Les résultats suggèrent que pour améliorer la qualité des soins maternels, il faut intervenir sur ces aspects et former les professionnels de santé aux soins maternels respectueux et à la communication.
TANZANIA
Margaret E Kruk, Stephanie Kujawski, Godfrey Mbaruku, Kate Ramsey, Wema Moyo and Lynn P Freedman
KEY MESSAGES
- Despite a large body of anecdotal evidence, there are no reliable estimates of the prevalence of disrespectful and abusive treatment during labour and delivery in health facilities.
- We measured the frequency of abusive and disrespectful treatment during delivery in eight Northeastern Tanzanian health facilities using a structured survey. We interviewed women on discharge from facility, and re-interviewed a subset in the community 5–10 weeks later.
- Reporting of any disrespectful treatment ranged from 19% on discharge to 28% on community follow-up, with ignoring, shouting and negative comments among the most frequently reported events.
- This work confirms that disrespectful treatment is relatively common in this low-income setting and signals a crisis in a health system that is attempting to encourage women to deliver in health facilities to reduce maternal mortality
This study measured the frequency of reported abusive experiences during childbirth in eight health facilities in rural northeastern Tanzania and examined associated factors. Using a structured questionnaire, women were interviewed upon discharge and a subset was re-interviewed 5–10 weeks later. A total of 1779 women participated in the exit survey, and 593 were re-interviewed. The frequency of any abusive or disrespectful treatment was 19.48% in the exit sample and 28.21% in the follow-up sample, with the difference possibly due to courtesy bias. Common abuses reported included being ignored (14.24%), shouted at (13.18%), and receiving negative or threatening comments (11.54%). Additionally, 5.1% of women were slapped or pinched, and 5.31% delivered alone. Abusive treatment was more likely reported by women with secondary education, poor women, and those with self-reported depression. Between 19% and 28% of women experienced disrespectful or abusive treatment, highlighting a health system crisis that requires urgent solutions to ensure women's dignity in healthcare and improve the utilization of childbirth facilities to reduce maternal mortality.
Sando, David, Hannah Ratcliffe, Kathleen McDonald, Donna Spiegelman, Goodluck Lyatuu, Mary Mwanyika-Sando, Faida Emil, Mary Nell Wegner, Guerino Chalamilla, and Ana Langer. 2016. “The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania.” BMC Pregnancy and Childbirth 16 (1): 236. doi:10.1186/s12884-016-1019-4. http:// dx.doi.org/10.1186/s12884-016-1019-4.
This study is one of the first to quantify the prevalence of disrespect and abuse during facility-based childbirth in a large public hospital in an urban setting. The difference in respondent reports between the two time periods is striking, and more research is needed to determine the most appropriate methodologies for measuring this phenomenon. The levels and types of disrespect and abuse reported here represent fundamental violations of women's human rights and are symptomatic of failing health systems. Action is urgently needed to ensure acceptable, quality, and dignified care for all women.
SOUTH AFRICA
RACHEL JEWKES, NAEEMAH ABRAHAMS and ZODUMO MVO CERSA, Women's Health, Medical Research Council, Private Bag X385, Pretoria 0001, South Africa
This study reveals that nurse-patient relationships in parts of South Africa's public health services can be marked by conflict, neglect, and abuse, contradicting the caring image of the nursing profession. The legacy of apartheid impacts black nurses and the profession, but poor working conditions alone don't explain staff attitudes. Abuse persists even in well-resourced areas, targeting disempowered black women seeking obstetric care. Nurses may use violence to create social distance and maintain power. The problem's roots are complex, involving poor workplace conditions and professional identity issues. Violence is common due to lack of accountability and competing patient care ideologies. These factors are potentially changeable.
Camilla Pickles is a doctoral candidate at the Centre for Child Law, Department of Private Law, University of Pretoria.
This article examines the disrespectful, abusive and violent maternity care that many South African people face. It identifies this conduct as a human rights violation and argues that intentional abusive maternity care should be labelled as obstetric violence, a specific form of gender-based violence, and that it should be criminalised. This approach reflects a nascent global trend to act against obstetric violence, and draws inspiration from statutory crimes introduced in Venezuela and Mexico. Building on the Latin American experience, the article proposes how the current legal conception of obstetric violence should be further developed to suit the unique position of pregnant people in South Africa.
Rachelle Joy Chadwick Gender Studies Section, School of African and Gender Studies, Anthropology and Linguistics, Faculty of Humanities, University of Cape Town, South Africa
Regardless of the roots of abusive treatment, it is important to strive for accountability on all levels—in respect of the state, medical institutions, training programs, and individual practitioners. The use of violence in the form of coercive practices, physical and emotional abuse, lack of consent, intentional humiliation, the withholding of medical attention and care during labor and childbirth as a form of punishment, and the unnecessary use of medical interventions are unacceptable and reflect entrenched systems of gender and class marginalization in South Africa. The medical establishment needs to recognize forms of abuse during labor and childbirth as more than the actions of a few misinformed individuals and address wider systemic sexism and classism in medical training, established protocols, and attitudes towards childbearing women and girls.
Rachelle Chadwick. University of Cape Town, South Africa
Obstetric violence is increasingly recognized as a global issue across various geopolitical contexts. Despite growing public health attention, feminist psychologists have not sufficiently engaged with this phenomenon. This paper addresses this gap by analyzing narratives from 35 black, low-income women in Cape Town, South Africa, focusing on obstetric violence as a relational, disciplinary, and productive process affecting women's subjectivities and agency during childbirth. The findings reveal that obstetric violence should be seen as more than isolated acts, functioning instead as a mode of discipline embedded in class, gender, race, and medical power dynamics, framed within a Foucauldian approach and the concept of assemblage.
Pickles C "Sounding the Alarm: Government of the Republic of Namibia v LM and Women's Rights during Childbirth in South Africa" PER / PELJ 2018(21) - DOI http://dx.doi.org/10.17159/1727-3781/2018/v21i0a4303
Government of the Republic of Namibia v LM [2014] NASC 19 (hereafter the LM case) concerns the involuntary sterilisation of women during childbirth. The Supreme Court of Namibia found that obtaining consent during the height of labour is inappropriate because labouring women lack the capacity to consent because of the intensity of their labour pains. This article recognises that the LM case may make its way into current litigation strategies against involuntary sterilisations in South Africa and for this reason I evaluate the soundness of the court's reasoning in the LM case. I argue that the court relied on the harmful gender stereotype that labouring women lack the capacity to make decisions, I expose this stereotype as baseless and demonstrate the harmful consequences of its perpetuation. Finally, I demonstrate why the reasoning in the LM case is particularly problematic in the South African context, and I conclude that the adoption of this sort of reasoning will result in many women facing serious injustices, because it strikes at the core of a woman's agency during childbirth.
Submission was compiled by researchers: Dr. Jessica Rucell, Dr. Rachelle Chadwick, Lieketseng Mohlakoana-motopi, and Kerigo E. Odada.
This submission offers a comprehensive overview of the various forms of violence that girls and women face when seeking reproductive healthcare, particularly during maternity and childbirth. It also provides a detailed analysis of the underlying causes and drivers of this specific violence against women. Additionally, the submission summarizes and analyzes the national, regional, and international legal frameworks that govern the provision of reproductive healthcare in South Africa, with a particular focus on protecting women's rights, especially their sexual and reproductive health rights.
Rodante van der Waal, Veronica Mitchell, Inge van Nistelrooij & Vivienne Bozalek (2021) Obstetric violence within students’ rite of passage: The reproduction of the obstetric subject and its racialised (m)other, Agenda, 35:3, 36-53, DOI: 10.1080/10130950.2021.1958553
Building on the works of Mbembe and Silva, this text theorizes that the obstetric institution remains fundamentally modern, intertwined with colonialism, slavery, bio- and necropolitics, and patriarchy. It argues that modern obstetric practitioners (doctors or midwives) other and racialize the (m)other to assert their own self-determination and universal reason. While Davis-Floyd described obstetric training as a technocratic rite of passage, the text contends that this training involves significant violence and racism, revealing a deeper issue of students maturing through the violent appropriation of the (m)other. By examining student experiences in South Africa and the Netherlands, the text highlights global systemic tendencies that push students to violate ethical, social, and political boundaries. This violence embedded in their training perpetuates the modern obstetric subject, the racialized (m)other, and institutionalized violence globally.
Camilla Pickles
Evidence-based guidelines play a crucial role in maternity care, aiming to benefit women and mitigate disrespect and abuse during pregnancy and childbirth. However, this chapter highlights how these guidelines can lead to women being silenced, excluded from care, and experiencing psychological violations. It reveals that the law provides little leverage against medical decisions that negatively impact women. The argument is made that these negative experiences are not mere accidents or acceptable outcomes of 'good medical practice' but constitute obstetric violence. Evidence-based guidelines can facilitate this violence by allowing harmful applications of medical knowledge and justifying violence against women. The failure to fully recognize these flaws may stem from a narrow understanding of abuse and violence by those promoting the guidelines. Recognizing these circumstances as violence against women imposes significant state obligations to prevent and protect women from such violence. This can be achieved by supporting evidence-based guidelines that promote informed decision-making and by developing creative legal solutions to address the diverse needs of women, particularly when healthcare providers attempt to override and silence them using these guidelines as justification.
SOUTH SUDAN
Sumit Kane, Matilda Rial, Maryse Kok, Anthony Matere, Marjolein Dieleman, and Jacqueline E. W. Broerse
Barriers related to geographical accessibility, affordability, and perceptions of maternal health services in South Sudan persist and must be addressed. Equally important is addressing social accessibility barriers by identifying and mitigating the social fears and concerns about dignity violations that may deter women from using these services. Health services should aim to transform facilities into social spaces where the dignity of all women and citizens is protected and upheld.
