“ By slapping their laps, the patient will know that you truly care for her ”: A qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria

Abstract

BackgroundMany women experience mistreatment during childbirth in health facilities across the world. However, limited evidence exists on how social norms and attitudes of both women and providers influence mistreatment during childbirth. Contextually-specific evidence is needed to understand how normative factors affect how women are treated. This paper explores the acceptability of four scenarios of mistreatment during childbirth.MethodsTwo facilities were identified in Abuja, Nigeria. Qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) were used with a purposive sample of women, midwives, doctors and administrators. Participants were presented with four scenarios of mistreatment during childbirth: slapping, verbal abuse, refusing to help the woman and physical restraint. Thematic analysis was used to synthesize findings, which were interpreted within the study context and an existing typology of mistreatment during childbirth.ResultsEighty-four IDIs and 4 FGDs are included in this analysis. Participants reported witnessing and experiencing mistreatment during childbirth, including slapping, physical restraint to a delivery bed, shouting, intimidation, and threats of physical abuse or poor health outcomes. Some women and providers considered each of the four scenarios as mistreatment. Others viewed these scenarios as appropriate and acceptable measures to gain compliance from the woman and ensure a good outcome for the baby. Women and providers blamed a woman's “disobedience” and “uncooperativeness” during labor for her experience of mistreatment.ConclusionsBlaming women for mistreatment parallels the intimate partner violence literature, demonstrating how traditional practices and low status of women potentiate gender inequality. These findings can be used to facilitate dialogue in Nigeria by engaging stakeholders to discuss how to challenge these norms and hold providers accountable for their actions. Until women and their families are able to freely condemn poor quality care in facilities and providers are held accountable for their actions, there will be little incentive to foster change.

Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers

“…This explanation parallels other literature in the field [27, 28, 49]; however mistreatment cannot be blamed solely on the health system. Another publication resulting from this study explored social norms and acceptability of mistreatment during childbirth in Nigeria, and found that both women and healthcare providers considered physical and verbal abuse as acceptable and appropriate measures to gain compliance from the woman and ensure a good outcome for the baby [50]. Furthermore, in Nigeria, women and their families are unable to express their satisfaction or dissatisfaction with services rendered, thus hindering the ability to engage with users and improve the quality of care.…”

Defining quality of care during childbirth from the perspectives of Nigerian and Ugandan women: A qualitative study

“…This manifested through the treatment of birth as a medical event only, thus disregarding critical psychosocial elements of care . Bohren et al . and Jewkes and Penn‐Kekana echo this sentiment and draw parallels between structural gender inequalities, social pressures to denounce abusive acts toward women, and justifications for mistreatment during childbirth and violence against women more broadly.…”

A qualitative study of women’s and health providers’ attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea

“…For example this may include slapping, pinching, verbal abuse, lack of privacy and discrimination [3]. In recent years, evidence from several sub-Saharan African countries, including Tanzania [4, 5], Kenya [6, 7], Nigeria [8] and Ghana [9–11], suggests that mistreatment during childbirth may be a common occurrence, and may be exacerbated by certain characteristics of the woman, including age and HIV status. This work has been groundbreaking to better understand women’s experiences of mistreatment during childbirth, as well as efforts to measure mistreatment that does occur, through observations of labor and childbirth, and follow-up surveys with women.…”