Vaginal examinations and mistreatment of women during facility-based childbirth in health facilities: secondary analysis of labour observations in Ghana, Guinea and Nigeria

Abstract

BackgroundPrevious research on mistreatment of women during childbirth has focused on physical and verbal abuse, neglect and stigmatisation. However, other manifestations of mistreatment, such as during vaginal examinations, are relatively underexplored. This study explores four types of mistreatment of women during vaginal examinations: (1) non-consented care, (2) sharing of private information, (3) exposure of genitalia and (4) exposure of breasts.MethodsA secondary analysis of data from the WHO multicountry study ‘How Women Are Treated During Childbirth’ was conducted. The study used direct, continuous labour observations of women giving birth in facilities in Ghana, Guinea and Nigeria. Descriptive and multivariable logistic regression analyses were used to describe the different types of mistreatment of women during vaginal examinations and associated privacy measures (ie, availability of curtains).ResultsOf the 2016 women observed, 1430 (70.9%) underwent any vaginal examination. Across all vaginal examinations, 842/1430 (58.9%) women were observed to receive non-consented care; 233/1430 (16.4%) women had their private information shared; 397/1430 (27.8%) women had their genitalia exposed; and 356/1430 (24.9%) had their breasts exposed. The observed prevalence of mistreatment during vaginal examinations varied across countries. There were country-level differences in the association between absence of privacy measures and mistreatment. Absence of privacy measures was associated with sharing of private information (Ghana: adjusted OR (AOR) 3.8, 95% CI 1.6 to 8.9; Nigeria: AOR 4.9, 95% CI 1.9 to 12.7), genitalia exposure (Ghana: AOR 6.7, 95% CI 2.9 to 14.9; Nigeria: AOR 6.5, 95% CI 2.9 to 14.5), breast exposure (Ghana: AOR 5.9, 95% CI 2.8 to 12.9; Nigeria: AOR 2.7, 95% CI 1.3 to 5.9) and non-consented vaginal examination (Ghana: AOR 2.5, 95% CI 1.4 to 4.7; Guinea: AOR 0.21, 95% CI 0.12 to 0.38).ConclusionOur results highlight the need to ensure better communication and consent processes for vaginal examination during childbirth. In some settings, measures such as availability of curtains were helpful to reduce women’s exposure and sharing of private information, but context-specific interventions will be required to achieve respectful maternity care globally.

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

“…Some women also reported physical abuse such as fundal pressure. Our findings are consistent with previous studies conducted in other settings globally, in which women experienced verbal abuse, neglect and abandonment, lack of supportive care [ 38 , 40 , 41 ], frequent vaginal examinations [ 40 , 42 ], and denial of pain relief [ 40 ].…”

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

“…While this type of care was unacceptable to all women, some healthcare providers justi ed it and did not consider it as mistreatment. Our ndings are consistent with previous studies conducted in other settings globally, in which women experienced verbal abuse, neglect and abandonment, lack of supportive care [29][30][31], frequent vaginal examinations [29,32], and denial of pain relief [29].…”

Directly observed and reported respectful maternity care received during childbirth in public health facilities, Ibadan Metropolis, Nigeria

“…However, there have been calls recommending a mixed-method approach, including independent observations to measure RMC [13,19,20]. There are few documented RMC observational studies from Nigeria [21,22]. Observational studies are often challenged by the possibility of a Hawthorne effect, the ethics of observing women during labour and the cost of conducting the research compared to a client interview.…”