Obstetric violence in South Africa

Chadwick, Rachelle

doi:10.7196/samj.2016.v106i5.10708

Cited by 35 publications

(33 citation statements)

References 13 publications

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“…In this context, disrespect and/or abuse would consist of the abusive use of power when the authority of a doctor, also represented by the team of other professionals that act under his/her orders, is directly or indirectly challenged by “disobedience”, resistance or questioning [ 13 , 31 , 32 ]. It is also important to consider the fact that disrespect and abuse of women during the process of childbirth is permeated by issues of medicalization relating to their bodies and gender, and reflects the depreciation of their sex and the normalization of violence against women [ 20 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Disrespect and abuse of women during the process of childbirth in the 2015 Pelotas birth cohort

Mesenburg

Victora

Serruya³

et al. 2018

Reprod Health

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BackgroundThe disrespect and abuse of women during the process of childbirth is an emergent and global problem and only few studies have investigated this worrying issue. The objective of the present study was to describe the prevalence of disrespect and abuse of women during childbirth in Pelotas City, Brazil, and to investigate the factors involved.MethodsThis was a cross-sectional population-based study of women delivering members of the 2015 Pelotas birth cohort. Information relating to disrespect and abuse during childbirth was obtained by household interview 3 months after delivery. The information related to verbal and physical abuse, denial of care and invasive and/or inappropriate procedures. Poisson regression was used to evaluate the factors associated with one or more, and two or more, types of disrespectful treatment or abuse.ResultsA total of 4275 women took part in a perinatal study. During the three-month follow-up, we interviewed 4087 biological mothers with regards to disrespect and abuse. Approximately 10% of women reported having experienced verbal abuse, 6% denial of care, 6% undesirable or inappropriate procedures and 5% physical abuse. At least one type of disrespect or abuse was reported by 18.3% of mothers (95% confidence interval [CI]: 17.2–19.5); and at least two types by 5.1% (95% CI: 4.4–5.8). Women relying on the public health sector, and those whose childbirths were via cesarean section with previous labor, had the highest risk, with approximately a three- and two-fold increase in risk, respectively.ConclusionsOur study showed that the occurrence of disrespect and abuse during childbirth was high and mostly associated with payment by the public sector and labor before delivery. The efforts made by civil society, governments and international organizations are not sufficient to restrain institutional violence against women during childbirth. To eradicate this problem, it is essential to 1) implement policies and actions specific for this type of violence and 2) formulate laws to promote the equality of rights between women and men, with particular emphasis on the economic rights of women and the promotion of gender equality in terms of access to jobs and education.

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Section: Discussionmentioning

confidence: 99%

Disrespect and abuse of women during the process of childbirth in the 2015 Pelotas birth cohort

Mesenburg

Victora

Serruya³

et al. 2018

Reprod Health

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“…The range in incidence of obstetric violence has previously been reported as 15–97% [[13], [14], [15], [16], [17], [18], [19]] with the risk of being exposed to obstetric violence being influenced by socioeconomic and educational status, particularly in societies where empowerment of women is low [19]. Similarly, facilities which are overwhelmed by workforce shortages, inadequate provider training and supervision, where a lack of accountability exists, promotes an environment for unprofessional behaviours to develop and grow; impacting negatively on obstetric outcomes and childbirth complications [3,13,[20], [21], [22]].…”

Section: Commentmentioning

confidence: 99%

Obstetric violence: Clinical staff perceptions from a video of simulated practice

Gray

Mohan

Lindow

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective(s) Obstetric Violence refers to professional deficiencies in maternity care. Examples include non-dignified care, discrimination and abandonment of care. Obstetric violence has been described in both low and high resource settings. The objective of this study was to assess knowledge and attitudes towards obstetric violence in a cohort of multinational obstetric nursing/midwifery staff and obstetricians at a private maternity hospital in Qatar. Study design An online survey for anonymous completion was sent to the hospital email accounts of obstetric nursing/midwifery staff and obstetricians at Sidra Medicine (n = 640). The survey incorporated a video showing a dramatized scenario of obstetric violence. The survey assessed the participant’s demographics and knowledge of the term obstetric violence. The participants scored their perceptions on the behaviors in the video using a visual analogue scale. The participants were then asked to reflect on their own practice. Comparisons of the survey responses were made between both doctors and nursing/midiwfery staff members using student’s t -test. Results 50 obstetricians and 167 obstetric nursing/midwifery staff fully completed the survey. Fifty two percent had previously heard of the term obstetric violence, and 48% could define it correctly. 136 (63%) had witnessed obstetric violence at some point in their career. Significant differences were seen when each professional group was asked to report on the behavior of the opposite professional team as depicted in the video (p = 0.01 and p < 0.001). Doctors completing the survey were also more critical of the doctors-in-training than were the midwifery/nursing staff (p = 0.06). Obstetricians and nursing/midiwfery responders identified patient dignity, privacy and patient-centred care as the leading professional deficiencies seen in the video. Obstetricians were significantly less likely to change their perceptions of how a care team should interact with a patient compared to the obstetric nursing/midwifery group (p < 0.001). Conclusions This questionnaire study demonstrates that the majority of staff in this cohort were aware of obstetric violence and able to identify negative behaviours in the video and then reflect on how this impacts care they provide. Further studies are needed to identify ways in which obstetric violence can be prevented in both low resource and high resource settings.

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“…Female nurses deployed violence against clients to create social distance and maintain “fantasies of identity and power in their continuous struggle to assert their professional and middle class identity” [ 31 ]. Chadwick argues that undervaluing of women leads to acceptance of “obstetric violence” 3 [ 32 ]. A qualitative and quantitative study of 38 primary health care nurses in South Africa also probed the connection between the violence that health workers experience in their own lives and their perpetration of violence toward clients: male nurses shared perspectives that justify violence, such as “women enjoy punishment,” while female nurses shared their own experiences of violence [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

Expanding the agenda for addressing mistreatment in maternity care: a mapping review and gender analysis

Betron

McClair²,

Currie

et al. 2018

Reprod Health

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BackgroundThis paper responds to the global call to action for respectful maternity care (RMC) by examining whether and how gender inequalities and unequal power dynamics in the health system undermine quality of care or obstruct women’s capacities to exercise their rights as both users and providers of maternity care.MethodsWe conducted a mapping review of peer-reviewed and gray literature to examine whether gender inequality is a determinant of mistreatment during childbirth. A search for peer-reviewed articles published between January 1995 and September 2017 in PubMed, Embase, SCOPUS, and Web of Science databases, supplemented by an appeal to experts in the field, yielded 127 unique articles. We reviewed these articles using a gender analysis framework that categorizes gender inequalities into four key domains: access to assets, beliefs and perceptions, practices and participation, and institutions, laws, and policies. A total of 37 articles referred to gender inequalities in the four domains and were included in the analysis.ResultsThe mapping indicates that there have been important advances in documenting mistreatment at the health facility, but less attention has been paid to addressing the associated structural gender inequalities. The limited evidence available shows that pregnant and laboring women lack information and financial assets, voice, and agency to exercise their rights to RMC. Women who defy traditional feminine stereotypes of chastity and serenity often experience mistreatment by providers as a result. At the same time, mistreatment of women inside and outside of the health facility is normalized and accepted, including by women themselves. As for health care providers, gender discrimination is manifested through degrading working conditions, lack of respect for their abilities, violence and harassment,, lack of mobility in the community, lack of voice within their work setting, and limited training opportunities and professionalization. All of these inequalities erode their ability to deliver high quality care.ConclusionWhile the evidence base is limited, the literature clearly shows that gender inequality—for both clients and providers—contributes to mistreatment and abuse in maternity care. Researchers, advocates, and practitioners need to further investigate and build upon lessons from the broader gender equality, violence prevention, and rights-based health movements to expand the agenda on mistreatment in childbirth and develop effective interventions.Electronic supplementary materialThe online version of this article (10.1186/s12978-018-0584-6) contains supplementary material, which is available to authorized users.

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Obstetric violence in South Africa

Cited by 35 publications

References 13 publications

Disrespect and abuse of women during the process of childbirth in the 2015 Pelotas birth cohort

Disrespect and abuse of women during the process of childbirth in the 2015 Pelotas birth cohort

Obstetric violence: Clinical staff perceptions from a video of simulated practice

Expanding the agenda for addressing mistreatment in maternity care: a mapping review and gender analysis

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