New evidence shows significant mistreatment of women during childbirth
New evidence from a WHO-led study, published in the Lancet, shows that more than one-third of women in four lower-income countries experienced mistreatment during childbirth in health facilities. Younger, less-educated women were found to be the most at risk of mistreatment, which can include physical and verbal abuse, stigmatization and discrimination, medical procedures conducted without their consent, use of force during procedures, and abandonment or neglect by health care workers.
The study, carried out in Ghana, Guinea, Myanmar and Nigeria, found that 838 (42%) of 2,016 women experienced physical or verbal abuse, stigma or discrimination. 14% experienced physical abuse - most commonly being slapped, hit or punched. There were also high rates of non-consensual caesarean sections, episiotomies (surgical cuts made at the opening of the vagina during childbirth) and vaginal examinations.
WHO guidelines promote respectful maternity care for all women, which is 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 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%) caesarean births were conducted without the woman’s consent, as were 190 of 253 episiotomies (75%).
Vaginal examinations occurred without consent in 59% of cases (2611 of 4393 exams).
In addition to physical abuse, 752 (38%) 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.