Abuse during childbirth

Abuse during childbirth (or obstetric violence) is the mistreatment of women during childbirth in the form(s) of neglect, physical abuse and/or lack of respect. This treatment is regarded as a form of violence against women and a violation of women's rights. It is a recurring issue in facilities around the globe per World Health Organization studies, and can have serious consequences for mother and child. Namely, abuse during childbirth may prevent women from seeking pre-natal care and using other health care services in the future.[1]

Further examples of abuse during childbirth include non-consented care, non-confidential care, non-dignified care, discrimination, abandonment of care and detention in facilities.[2] Adolescents, women who are unmarried, women of low socioeconomic status, migrant women, women infected with HIV, and ethnic minority women are at a greater risk of experiencing abuse during childbirth.[1]

Definition and forms of abuse

The World Health Organization notes that abuse during childbirth has yet to be conclusively defined or measured in a scientific way. However, abuse during childbirth is generally defined as neglectful, physical abusive, and/or disrespectful treatment from healthcare professionals towards patients in childbirth. Such mistreatment is regarded as a violation of the woman's human rights.[1]

Abuse during childbirth can occur over a wide spectrum and may be seen in the forms of non-confidential care, non-dignified care, discrimination, overt physical abuse, non-consented care, abandonment of care, and/or detention in facilities.[2]

Non-confidential care means that the woman was physically exposed to others in the facility or had personal medical information disclosed to others without her consent. Non-dignified care involves a provider scolding, threatening, or discouraging the patient in childbirth. Discrimination within this context refers to refusing to provide care because of the age, medical background, or cultural/language background of the patient. Non-consented care occurs when medical procedures, such as caesarean sections or sterilizations, are not explained fully before they are performed. Physical abuse includes hitting, pinching, restraining, withholding of pain-relief medication, and even rape or sexual assault. Abandonment of care is when a provider is absent, or else the patient is ignored or denied companionship from loved ones. Lastly, detention in facilities refers to when providers will not let a patient leave because of outstanding balances, unpaid bribes etc.[2]

Epidemiology and consequences

Investigations into the prevalence of abusive practices in childbirth have been conducted by the World Health Organization. Their studies demonstrate that women giving birth in medical facilities experience disrespectful, abusive, and/or neglectful treatment frequently and globally.[3]

A 2020 study centered in Ghana, Guinea, Myanmar, and Nigeria found that more than 40% of observed women and 35% of surveyed women experienced mistreatment while in childbirth.[4] Furthermore, adolescents, migrant women, women infected with HIV, and ethnic minority women were deemed more likely than others to experience abuse during childbirth.[3][5][6][7][8][9]

Women in childbirth are very vulnerable and often cannot protect themselves against mistreatment, so the consequences of obstetric violence can be serious for both the mother and the child. The abusive relationship that forms between a woman and her healthcare providers as a result of abuse during childbirth often leads to the woman developing a general mistrust in healthcare services. Furthermore, consequences can be extended to include a reluctance to seek pre-natal care, medical assistance during childbirth, and other health care services in the future.[1][3][10]

Geography

North and South America

Some sources refer to North American obstetricians and gynecologists, especially between the 1950s and 1980s, practicing what was called "the husband's stitch," which involves placing extra stitches in the woman's vagina after the episiotomy or the natural tearing that occurs during childbirth. This procedure was supposedly performed to increase the husband's future sexual pleasure and often caused long-term pain and discomfort for the woman. There is no proof that such a practice was widespread in North America,[11][12] but mentions of it frequently appear in studies about episiotomy in certain American countries such as Brazil.[13]

There has been a more recent highlight on North American doctors' treatment of pregnant women. The growing idea is that there has been a "redressing" of obstetric violence and that women's right to choice has been compromised in some situations. In instances where the lives of the woman and the fetus are endangered, the woman has the right to refuse care through procedures such as caesarean section, episiotomy, or vacuum-assisted delivery. Women are often coerced into having these invasive procedures, despite the fact that such coercion has been found to cause long lasting damage with many women comparing the experience to rape.[14]

The term "obstetric violence" is particularly used in Latin American countries, where the law prohibits such mistreatment. These laws exist in several Latin American countries, including Argentina, Puerto Rico and Venezuela.[15]

Research into obstetric violence at two public hospitals in Mexico analyzing the birthing experiences for one month of 2012 found that physical abuse, verbal abuse, and discrimination occurred openly throughout the facilities. Women receiving government assisted insurance were subjected to the most discrimination from the healthcare professionals.[16]

Africa

Tanzania is an African country with a history of abuse during childbirth. In 2011, Shannon McMahon and others explored whether or not the supposed interventions to decrease the prevalence of abuse during childbirth had been effective. When interviewing women, they initially referred to their experiences as neutral or better. However, after being shown the different aspects of abuse, an overwhelming majority of the women actually reported experiencing abuse during childbirth.[17] In 2013-2014, Hannah Ratcliffe and others formed a study to explore possible interventions to improve the experiences of women in childbirth. They implemented an "open birth day" that facilitated communication between patients and providers and educated them on the procedures surrounding birth. The team also implemented a "respectful maternity care workshop" meant to create conversation surrounding respect between health care staff and patients. What they found was that this approach was successful in helping reconstruct systems without costing much. There was an increase of 60% in satisfaction with women's delivery experience.[18] During the same time period as Ratcliffe's study, Stephanie Kujawaki and others did a comparative study of births with and without interventions. The baseline for the study was conducted in 2011-2012 and the final half of the study was conducted in 2015. What they found is that there was a 66% reduction in abuse and disrespect during childbirth after interventions. This study shows that community and health system reforms can help change and reshape norms in which women are mistreated during childbirth.[19]

Asia

In 2014-2015, Shreeporna Bhattacharya and T.K. Sundari Ravindran set out to quantitatively determine the prevalence of abuse during childbirth in the Varanasi district of northern India through the use of a questionnaire. Two rural blocks in the Varanasi district with high rates of institutional deliveries were the focus of the study, with subjects selected randomly from the women who lived in the area. Bhattacharya and Ravindran report that the frequency at which abusive behavior occurred was 28.8%, with "abusive behavior" acting as a general term. The two most common forms of abuse were non-dignified care (19.3%) and physical abuse (13.4%). Furthermore, 8.5% of patients reported being neglected or abandoned, 5.6% experienced non-confidential care, and 4.9% faced humiliation due to a lack of cleanliness. The authors also note that 90.5% of subjects were met with inappropriate demands for money. In terms of correlation, there was no significant link between socio-economic status and abuse, though women who faced complications during labor were four times as likely to experience abuse in the facilities. [20]

Fatima Alzyoud and colleagues studied abuse during childbirth in Jordan, specifically in the forms of neglect and verbal abuse. Four government-run Maternal and Child Health Centers were used as the locations of the study, with the subjects being 390 Jordanian women aged 18-45. The Childbirth Verbal Abuse and Neglect scale (CVANS) found that 32.2% of the subjects experienced neglect and 37.7% faced verbal abuse during their last childbirth. Furthermore, there was a negative correlation between age and neglect/verbal abuse.[21]

See also

References

Using Wikipedia for Research

  1. 1 2 3 4 "Prevention and elimination of disrespect and abuse during childbirth". World Health Organization. 3 September 2014. Retrieved 3 August 2017.
  2. 1 2 3 Sando, David; Abuya, Timothy; Asefa, Anteneh; Banks, Kathleen P.; Freedman, Lynn P.; Kujawski, Stephanie; Markovitz, Amanda; Ndwiga, Charity; Ramsey, Kate; Ratcliffe, Hannah; Ugwu, Emmanuel O.; Warren, Charlotte E.; Jolivet, R. Rima (11 October 2017). "Methods used in prevalence studies of disrespect and abuse during facility based childbirth: lessons learned". Reproductive Health. 14 (1): 127. doi:10.1186/s12978-017-0389-z. ISSN 1742-4755. PMC 5637332. PMID 29020966.
  3. 1 2 3 "The prevention and elimination of disrespect and abuse during facility-based childbirth" (PDF). World Health organization. Retrieved 3 August 2017.
  4. ↑ Bohren, Meghan A; Mehrtash, Hedieh; Fawole, Bukola; Maung, Thae Maung; Balde, Mamadou Dioulde; Maya, Ernest; Thwin, Soe Soe; Aderoba, Adeniyi K; Vogel, Joshua P; Irinyenikan, Theresa Azonima; Adeyanju, A Olusoji (November 2019). "How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys". The Lancet. 394 (10210): 1750–1763. doi:10.1016/s0140-6736(19)31992-0. ISSN 0140-6736. PMC 6853169. PMID 31604660.
  5. ↑ Sando, David; Kendall, Tamil; Lyatuu, Goodluck; Ratcliffe, Hannah; McDonald, Kathleen; Mwanyika-Sando, Mary; Emil, Faida; Chalamilla, Guerino; Langer, Ana (1 December 2014). "Disrespect and Abuse During Childbirth in Tanzania: Are Women Living With HIV More Vulnerable?". Journal of Acquired Immune Deficiency Syndromes. 67 (Suppl 4): S228–S234. doi:10.1097/QAI.0000000000000378. PMC 4251905. PMID 25436822.
  6. ↑ Okafor, Innocent I.; Ugwu, Emmanuel O.; Obi, Samuel N. (1 February 2015). "Disrespect and abuse during facility-based childbirth in a low-income country". International Journal of Gynaecology and Obstetrics. 128 (2): 110–113. doi:10.1016/j.ijgo.2014.08.015. PMID 25476154. S2CID 25851602.
  7. ↑ Kujawski, Stephanie; Mbaruku, Godfrey; Freedman, Lynn P.; Ramsey, Kate; Moyo, Wema; Kruk, Margaret E. (1 October 2015). "Association Between Disrespect and Abuse During Childbirth and Women's Confidence in Health Facilities in Tanzania". Maternal and Child Health Journal. 19 (10): 2243–2250. doi:10.1007/s10995-015-1743-9. PMID 25990843. S2CID 25074191.
  8. ↑ Kujawski, Stephanie A.; Freedman, Lynn P.; Ramsey, Kate; Mbaruku, Godfrey; Mbuyita, Selemani; Moyo, Wema; Kruk, Margaret E. (1 July 2017). "Community and health system intervention to reduce disrespect and abuse during childbirth in Tanga Region, Tanzania: A comparative before-and-after study". PLOS Medicine. 14 (7): e1002341. doi:10.1371/journal.pmed.1002341. PMC 5507413. PMID 28700587.
  9. ↑ Bohren, Meghan A (2017). "Continuous support for women during childbirth". Cochrane Database of Systematic Reviews. 7 (8): CD003766. doi:10.1002/14651858.CD003766.pub6. PMC 6483123. PMID 28681500.
  10. ↑ Bohren, Meghan A.; Vogel, Joshua P.; Hunter, Erin C.; Lutsiv, Olha; Makh, Suprita K.; Souza, João Paulo; Aguiar, Carolina; Saraiva Coneglian, Fernando; Diniz, Alex Luíz Araújo; Tunçalp, Özge; Javadi, Dena (2015-06-30). "The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review". PLOS Medicine. 12 (6): e1001847. doi:10.1371/journal.pmed.1001847. ISSN 1549-1277. PMC 4488322. PMID 26126110.
  11. ↑ Dobbeleir, Julie M.L.C.L.; Landuyt, Koenraad Van; Monstrey, Stan J. (May 2011). "Aesthetic surgery of the female genitalia". Seminars in Plastic Surgery. Thieme. 25 (2): 130–141. doi:10.1055/s-0031-1281482. PMC 3312147. PMID 22547970.
  12. ↑ Northrup, Christiane (2006). Women's bodies, women's wisdom: the creating physical and emotional health and healing. New York: Bantam Books. ISBN 9780553804836.
  13. ↑ Diniz, Simone G.; Chacham, Alessandra S. (2004). ""The Cut Above" and "the Cut Below'": abuse of caesareans and episiotomy in São Paulo, Brazil". Reproductive Health Matters. Taylor and Francis. 12 (23): 100–110. doi:10.1016/S0968-8080(04)23112-3. PMID 15242215.
  14. ↑ Borges, Maria T. R. (2018). "A Violent Birth: Reframing Coerced Procedures During Childbirth as Obstetric Violence". Duke Law Journal. 67 (4): 827–862. PMID 29469554.
  15. ↑ WHO (2015). "Sexual and reproductive health: Prevention and elimination of disrespect and abuse during childbirth". who.int. World Health Organization. Retrieved 21 October 2017.
    See also:
  16. ↑ Santiago, Rosario Valdez; Monreal, Luz Arenas; Rojas Carmona, Anabel; Domínguez, Mario Sánchez (18 June 2018). ""If we're here, it's only because we have no money…" discrimination and violence in Mexican maternity wards". BMC Pregnancy and Childbirth. 18 (1): N.PAG. doi:10.1186/s12884-018-1897-8. PMC 6006746. PMID 29914421.
  17. ↑ McMahon, Shannon A; George, Asha S; Chebet, Joy J; Mosha, Idda H; Mpembeni, Rose NM; Winch, Peter J (12 August 2014). "Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania". BMC Pregnancy and Childbirth. 14 (1): 268. doi:10.1186/1471-2393-14-268. ISSN 1471-2393. PMC 4261577. PMID 25112432.
  18. ↑ Ratcliffe, Hannah L.; Sando, David; Lyatuu, Goodluck Willey; Emil, Faida; Mwanyika-Sando, Mary; Chalamilla, Guerino; Langer, Ana; McDonald, Kathleen P. (18 July 2016). "Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital". Reproductive Health. 13 (1): 79. doi:10.1186/s12978-016-0187-z. ISSN 1742-4755. PMC 4948096. PMID 27424608.
  19. ↑ Kujawski, Stephanie A.; Freedman, Lynn P.; Ramsey, Kate; Mbaruku, Godfrey; Mbuyita, Selemani; Moyo, Wema; Kruk, Margaret E. (11 July 2017). "Community and health system intervention to reduce disrespect and abuse during childbirth in Tanga Region, Tanzania: A comparative before-and-after study". PLOS Medicine. 14 (7): e1002341. doi:10.1371/journal.pmed.1002341. ISSN 1549-1676. PMC 5507413. PMID 28700587.
  20. ↑ Bhattacharya, Shreeporna; Sundari Ravindran, T. K. (2018-08-20). "Silent voices: institutional disrespect and abuse during delivery among women of Varanasi district, northern India". BMC Pregnancy and Childbirth. 18 (1): 338. doi:10.1186/s12884-018-1970-3. ISSN 1471-2393. PMC 6102865. PMID 30126357.
  21. ↑ Alzyoud, Fatima; Khoshnood, Kaveh; Alnatour, Ahlam; Oweis, Arwa (2018-03-01). "Exposure to verbal abuse and neglect during childbirth among Jordanian women". Midwifery. 58: 71–76. doi:10.1016/j.midw.2017.12.008. ISSN 0266-6138. PMID 29306737.
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