The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review

Abstract

BackgroundDespite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence on the mistreatment of women during childbirth in health facilities to inform the development of an evidence-based typology of the phenomenon.Methods and FindingsWe searched PubMed, CINAHL, and Embase databases and grey literature using a predetermined search strategy to identify qualitative, quantitative, and mixed-methods studies on the mistreatment of women during childbirth across all geographical and income-level settings. We used a thematic synthesis approach to synthesize the qualitative evidence and assessed the confidence in the qualitative review findings using the CERQual approach. In total, 65 studies were included from 34 countries. Qualitative findings were organized under seven domains: (1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. Due to high heterogeneity of the quantitative data, we were unable to conduct a meta-analysis; instead, we present descriptions of study characteristics, outcome measures, and results. Additional themes identified in the quantitative studies are integrated into the typology.ConclusionsThis systematic review presents a comprehensive, evidence-based typology of the mistreatment of women during childbirth in health facilities, and demonstrates that mistreatment can occur at the level of interaction between the woman and provider, as well as through systemic failures at the health facility and health system levels. We propose this typology be adopted to describe the phenomenon and be used to develop measurement tools and inform future research, programs, and interventions.

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“…The themes relating to process of care emerging in this study, including privacy, expectation of good care and safe delivery with no complications, maintaining hygiene and cleanliness, sharing of information, prompt care, constant attention, maintaining privacy and respectful care are all universally recognised themes of quality maternity care in similar study settings [27,37,41–48]. …”

WHO model of intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and wellbeing

“…In addition, the high level of mistreatment reported by women during facility‐based childbirth, and its implications for a woman's birth experience, is of significant concern 13. Accounts of non‐dignified and abusive care are not region‐ or culture‐specific, as they have been reported by women in low‐, middle‐, and high‐income settings 14…”

Satisfaction with childbirth services provided in public health facilities: results from a cross- sectional survey among postnatal women in Chhattisgarh, India

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