Multistakeholder perspectives on the mistreatment of indigenous women during childbirth in Colombia: drivers and points for intervention

Abstract

Background Abusive and disrespectful treatment of women during childbirth is a critical global issue that threatens women’s sexual rights and reproductive rights and access to quality maternal care. This phenomenon has been documented in Colombia. However, little emphasis has been placed on identifying the drivers of and potential interventions against disrespect and abuse against particularly vulnerable populations in the country, including internally displaced indigenous women. Methods This report is a sub-analysis of a larger project. Semi-structured interviews were conducted with indigenous (Embera) women with childbirth experience (n = 10), maternal healthcare workers (n = 6), and community stakeholders (n = 5) in Medellín, Colombia. Qualitative analysis techniques, consisting of inductive and deductive approaches, were used to identify and characterize the drivers of disrespect and abuse against indigenous women during childbirth and points for intervention. Existing frameworks were adapted to thematically organize drivers and potential solutions into four interrelated subsystems: individual and community factors, clinician factors, facility factors, and national health system factors. Results Participants highlighted disrespect and abuse as stemming from (within the individual and community level) its normalization, lack of autonomy and empowerment among indigenous women, lacking antenatal care, (within the clinician level) prejudice, linguistic or cultural barriers to communication, lack of understanding of indigenous culture, medical culture and training, burnout and demoralization, (within the facility level) inadequate infrastructure, space, and human resources, and (within the national systems level) lack of clear policies and the devaluing of respectful maternity care. They called for interventions specific to these drivers, grounded in dignity and respect for indigenous culture. Conclusion This paper expands upon the growing literature on global mistreatment during childbirth by highlighting drivers of mistreatment and identifying points for intervention in a previously unstudied population. Our data show that indigenous women are especially vulnerable to mistreatment due to cultural and linguistic barriers and prejudice. Broad and meaningful action is urgently needed to realize these women’s rights to respectful maternity care. Interventions must be multifaceted and locally specific, taking into account the needs and wants of the women they serve.

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

“…Second, failure to hold the childbirth preparation classes routinely and poor supervising of their implementation could have provided the ground for poor attendance of women in classes, as well as the presence of untrained companions. The importance of attending routine antenatal care (ANC) and accessing information and preparing for childbirth to prevent mistreatment is highlighted in other studies too [ 8 , 20 , 44 , 45 ].…”

“…Drivers for mistreatment during childbirth have been identified in some studies, mostly conducted in African countries. The drivers included women's lack of cooperation [ 15 ] and discrimination based on age, education, socioeconomic status [ 16 ]; type of healthcare provider [ 17 ] and their beliefs and attitudes [ 18 ]; poor rewards and motivation [ 19 ]; lack of equipment [ 20 ]; poor supervision [ 21 ]; normalization of mistreatment and violence [ 22 ]; and high costs of maternity care [ 8 ]. However, much has not yet been learned about the drivers of mistreatment in maternity care, in the light of different context-oriented cultural, social, and economic conditions, as well as from the perspectives of multiple stakeholders [ 23 ].…”

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

“…Second, failure to hold the childbirth preparation classes routinely and poor supervising of their implementation could have provided the ground for poor attendance of women in classes, as well as the presence of untrained companions. The importance of attending routine antenatal care (ANC) and accessing information and preparing for childbirth to prevent mistreatment is highlighted in other studies too [7,20,35,36]. Halil et al reported in their study that attending ANC visits and existence of companion during childbirth reduced the risk of experiencing mistreatment by 50% and 60%, respectively [13].…”

“…These drivers that have been reported from the perspectives of multiple stakeholders (e.g. women, healthcare providers, and health managers) include: women (such as discrimination based on their age, education, socioeconomic status, perceived 'lack of cooperation' with healthcare providers), healthcare providers (such as beliefs and attitudes, power imbalances, poor rewards and motivation, poor education), health systems (such as lack of equipment, poor supervision), community (such as social pressure, normalization of mistreatment and violence), and policy (such as lack and/or weakness of policy, high costs of maternity care) [7,[17][18][19][20][21][22]. Due to the differences in the cultural, social and economic characteristics of societies, it is necessary to explore the drivers of mistreatment in maternity care in different contexts as well as from the perspective of multiple stakeholders.…”