More than one-third of women in Nigeria and some other lower-income countries experience mistreatment during childbirth in health facilities, a new study has shown.
The World Health Organisation (WHO)-led study published on Wednesday in the Lancet was carried out in four countries – Nigeria, Ghana, Myanmar, and Guinea.
According to the report, 838 (42 per cent) of 2,016 women experienced physical or verbal abuse, stigma or discrimination while 14 per cent experienced physical abuse – most commonly being slapped, hit or punched.
The study said that younger, less-educated women were found to be the most at risk of mistreatment, which can include physical and verbal abuse, stigmatisation and discrimination, medical procedures conducted without their consent, use of force during procedures, and abandonment or neglect by health care workers.
It also noted high rates of non-consensual caesarean sections, episiotomies (surgical cuts made at the opening of the vagina during childbirth) and vaginal examinations.
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’.
To tackle the mistreatment during childbirth, the UN health 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.
WHO also 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
WHO called upon these entities to collaborate to ensure that mistreatment during childbirth is consistently identified and reported and that locally appropriate measures are implemented.