The World Health Organisation (WHO) has come up with new report showing that more than one-third of Nigerian women are abused in health facilities during childbirth.
This is contained in a report entitled ‘New WHO evidence on mistreatment of women during childbirth’ published by the UN agency on its website yesterday.
The study, carried out in Ghana, Guinea, Myanmar and Nigeria showed that women were at the highest risk of experiencing physical and verbal abuse between 30 minutes before birth until 15 minutes after birth.
It stated that younger, less-educated women were most at risk, suggesting inequalities in how women are treated during childbirth.
It said addressing “these inequalities and promoting respectful maternity care for all women is critical to improve health equity and quality.”
The study was built on the results from mixed-methods systematic review conducted in 2015 which developed a typology of what constitutes mistreatment of women during childbirth based on 65 studies conducted in 34 countries.
The review identified physical and verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers and, health system conditions and constraints as primary manifestations experienced by women during childbirth in health facilities.
Verbal and physical abuse
The study observed 2,016 women during labour and childbirth in Ghana, Guinea, Myanmar. Interviews were also conducted with 2,672 women after the birth, finding similar levels of mistreatment to the direct observations.
“Among the 2016 women observed by the researchers, 35 (13 per cent) caesarean births were conducted without the woman’s consent, as were 190 of 253 episiotomies (75 per cent). Vaginal examinations also occurred without consent in 59 per cent of cases (2611 of 4393 exams),” it started.
In addition to physical abuse, 752 (38 per cent) of the 2016 women were observed to experience high levels of verbal abuse – most often, being shouted at, scolded and mocked. 11 women experienced stigma or discrimination, typically regarding their race or ethnicity.
The scenario reported in the study is similar to some of the stories told by women who give birth in public health institutions in Nigeria.
This contravenes WHO guidelines which promote respectful maternity care for all women.
WHO calls for care that maintains ‘dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth.”
The impact of mistreatment during childbirth
The report said mistreatment during childbirth may have both direct and indirect impacts on the woman and her baby.
It stated that its qualitative study in Nigeria, for example, found that women and healthcare providers justified slapping a woman while she was in labour if it was done to encourage the woman to push.
“Women and their families may have such low expectations of maternity care that they are accepting of physical and verbal abuse,” said WHO.
The way forward
The UN agency said there had been progress on understanding the different manifestations of mistreatment during childbirth in different contexts
It said preventing mistreatment during childbirth can only be achieved through inclusive and equitable processes that engage both women and healthcare providers.
To tackle the issue, the agency said health systems must be held accountable for any misdeed.
The agency also tasked the government to put in place sufficient resources (humans, equipment and funds) in order to provide quality, accessible maternal health care.
It also advocated for clear policies on women’s rights.
“The findings of the study should be used to inform policies and programmes to ensure that all women have positive pregnancy and childbirth experiences, supported by empowered healthcare providers within well-functioning health systems,
“Health-care providers also require support and training to ensure that women are treated with compassion and dignity,” it said.
Some of the possible strategies suggested include: redesigning labour wards to meet the needs of women, including allowing for privacy and labour companionship, improving the informed consent process around all medical interventions and providing sufficient mentoring and support for health workers to help them deliver better quality care.
It added that policies supporting women who want to have a companion of their choice with them throughout labour and childbirth should be passed.
It also recommended building public demand for high-quality maternity services that provide women-centred care and do not tolerate any form of mistreatment.
Besides, it tasked professional associations to play a crucial role in promoting and supporting respectful care among midwives, obstetricians and other maternity providers, and safeguarding their rights
The agency called upon these entities to collaborate to ensure that mistreatment during childbirth is consistently identified and reported and that locally appropriate measures are implemented.
It advised that the findings of the study should be used to inform policies and programmes to ensure that all women have positive pregnancy and childbirth experiences and, are supported by empowered healthcare providers within well-functioning health systems.