Mistreatment of women during childbirth and its influencing factors in public maternity hospitals in Tehran, Iran: a multi-stakeholder qualitative study

Abstract

Background Mistreatment during labour and childbirth is a common experience for many women around the world. This study aimed to explore the manifestations of mistreatment and its influencing factors in public maternity hospitals in Tehran. Methods A formative qualitative study was conducted using a phenomenological approach in five public hospitals between October 2021 and May 2022. Sixty in-depth face-to-face interviews were conducted with a purposive sample of women, maternity healthcare providers, and managers. Data were analyzed with content analysis using MAXQDA 18. Results Mistreatment of women during labour and childbirth was manifested in four form: (1) physical abuse (fundal pressure); (2) verbal abuse (judgmental comments, harsh and rude language, and threats of poor outcomes); (3) failure to meet professional standards of care (painful vaginal exams, neglect and abandonment, and refusal to provide pain relief); and (4) poor rapport between women and providers (lack of supportive care and denial of mobility). Four themes were also identified as influencing factors: (1) individual-level factors (e.g., providers’ perception about women’s limited knowledge on childbirth process), (2) healthcare provider-level factors (e.g., provider stress and stressful working conditions); (3) hospital-level factors (e.g., staff shortages); and (4) national health system-level factors (e.g., lack of access to pain management during labour and childbirth). Conclusions Our study showed that women experienced various forms of mistreatment during labour and childbirth. There were also multiple level drivers for mistreatment at individual, healthcare provider, hospital and health system levels. Addressing these factors requires urgent multifaceted interventions.

An investigation into the acceptability, adoption, appropriateness, feasibility, and fidelity of implementation strategies for birth companionship in Tehran: a qualitative inquiry on mitigating mistreatment of women during childbirth

“…This project, initiated in October 2021, consists of five phases: (1) needs assessment, (2) identifying the interventions to reduce mistreatment of women during childbirth, (3) identifying the implementation challenges of interventions, (4) designing implementation strategies for the intervention, and (5) testing implementation strategies in a real-life setting. The results of phases 1 and 3 of the project are presented in detail elsewhere [ 5 , 27 , 28 ]. This study used an exploratory descriptive qualitative design.…”

“…Despite every woman’s right to have a positive birth experience, the mistreatment during childbirth has been documented worldwide in health facilities [ 1 – 4 ]. Recent studies from Iran have reported a high rate of mistreatment, including verbal abuse, frequent and painful vaginal examinations, neglect and abandonment, lack of supportive care, physical abuse [ 5 ], denial of mobility [ 5 – 7 ], and pain relief [ 5 , 8 ]. Additionally, women are typically not allowed to choose their labour positions [ 6 ] or have a birth companion [ 7 ].…”

Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the Consolidated Framework for Implementation Research

“…The project was initiated in October 2021 in five public teaching hospitals in Tehran, Iran, and consists of five phases: (1) needs assessment (to assess knowledge, attitudes and practices of maternity healthcare providers about mistreatment of women during labour and childbirth, and the manifestations of mistreatment and its influencing factors), (2) identifying interventions to reduce mistreatment of women during childbirth, (3) identifying the implementation challenges of interventions, (4) designing implementation strategies for the intervention, and (5) testing implementation strategies in a real-life setting. The findings of phase 1 of the project are described elsewhere [ 11 , 36 ].…”

“… Presence of birth companions The possibility of presence of birth companions was provided by redesigning maternity wards to promote vaginal childbirth. However, most birth facilities do not provide birth companions [ 11 , 25 ]. Healthcare provider level Integrating RMC into in-service training of maternity staff In Iran, the first “congress on ethics in midwifery and reproductive health” with a focus on maternal dignity and the aim of increasing the knowledge, attitude, and behavioral intention of maternity hospital supervisors, was implemented at an online national workshop by the Ministry of Health and Medical Education (MOHME) in August 2022.…”

“…The prevalence in Iran is likewise high, reported as 75.7% [ 9 ] and 100% [ 10 ]. Women in Iran have experienced verbal abuse, frequent and painful vaginal examinations, lack of continuity of care, empathy, participation in decision-making, choice of preferred birth position, privacy, and birth companions [ 11 – 14 ].…”