Abuse during childbirth

Abuse during childbirth (or obstetric violence) is the neglect, physical abuse and lack of respect during childbirth. This treatment is regarded as a form of violence against women and violation of the woman's rights. It is a global and frequent problem per World Health Organization studies, and can have lasting serious consequences for mother and child plus as well as prevent women from seeking pre-natal care and using other health care services.[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. Adolescents, migrant women, women infected with HIV, and ethnic minority women are more likely than others to experience abuse during childbirth.

Definition and forms of abuse

Abuse during childbirth or obstetric violence is the neglect, physical abuse and lack of respect during childbirth. This treatment is regarded as a violation of the woman's rights.[1]

Abuse during childbirth can occur in the full spectrum from non-confidential care, non-dignified care, discrimination, over frank physical abuse, non-consented care, abandonment of care to detention in facilities.[2]

Non-confidential care means that the woman was exposed or has any personal medical information disclosed without consent. Non-dignified care refers to a provider being scolding, threatening, negative or discouraging. Discrimination within this context refers to refusing care because of age, medical background, or cultural/language background. Non-consented care refers to when procedures such as caesarean section or sterilization, were not explained before being performed. Physical abuse refers to hitting, pinching, restraining, not giving pain-relief medication and even rape/sexual assault. Abandonment of care is when a provider is absent, 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

Investigations into the prevalence of these practices have been conducted by the World Health Organization. Their studies demonstrate that this is a frequent and global problem. Women experience disrespectful, abusive or neglectful treatment during their childbirth, when the birth occurs in medical and health facilities. The abusive relationship and trust between women and health providers can create a great reluctance to obtain medical assistance during birth. Disrespectful and abusive treatment can be experienced during pregnancy. During childbirth, a woman is very vulnerable and cannot protect herself.[3]

In a 2020 study of Ghana, Guinea, Myanmar, and Nigeria more than 40% of observed women and 35% of surveyed women experienced mistreatment.[4] Adolescents, migrant women, women infected with HIV, and ethnic minority women are more likely than others to experience abuse during childbirth.[3][5][6][7][8][9]

Consequences

Obstetric violence has the effect of preventing women from seeking pre-natal care and using other health care services.[1] The abusive relationship and loss of trust between women and health providers can create great reluctance to obtain medical assistance during birth. Disrespectful and abusive treatment can be experienced during pregnancy. During childbirth, a woman is very vulnerable and cannot protect herself. Results of this abuse can be very negative consequences for the infant and the mother.[3]

Geography

North 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 is placing extra stitches in the woman's vagina after the episiotomy or natural tearing, supposedly to increase the husband's future sexual pleasure and often causing long-term pain and discomfort to the woman. However, there is no proof that such a practice was widespread in North America,[10][11] but mentions of it frequently appear in studies about episiotomy in other American countries such as Brazil.[12] There has been a more recent highlight on North American doctors' treatment of pregnant women. The more recent idea is that there has been a "redressing" of obstetric violence and that women's right of choice has been compromised in some situations. Although the life of the woman and the fetus is endangered, the woman has the right to refuse care; such as, a caesarean section, episiotomy, and vacuum-assisted delivery. Being coerced into having these invasive procedures has been found to cause long lasting damage, with many women comparing the experience to rape.[13]

South America

The term "obstetric violence" is particularly used in Latin American countries, where the law prohibits such behavior. Such laws exist in several countries, including Argentina, Puerto Rico and Venezuela.[14] Research into obstetric violence at two public hospitals in Mexico analyzing the birthing experiences for one month in 2012 found that there was physical, verbal abuse and discrimination happened openly. Women receiving government assisted insurance were subjected to the most discrimination from the healthcare professionals.[15]

Africa

Tanzania is a country with a history of abuse during childbirth. In 2011, Shannon McMahon and others explored whether or not the supposed interventions to lower abuse during childbirth have been effective. When interviewing women, they referred to their experiences as neutral or better. However, after being shown the different aspects of abuse, an overwhelming majority of the women had actually experienced abuse during childbirth.[16] In 2014, Hannah Ratcliffe and others explored possible interventions to improve the experiences of disrespect and abuse during childbirth. This study was conducted between 2013 and 2014. They implemented an "open birth day" which facilitated communication between patients and providers and educated them on the procedures surrounding birth. Aside from open birth day, they also implemented a "respectful maternity care workshop" which was meant to help create conversation surrounding respect between the 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.[17] During the same time period as Ratcliffe's study, Stephanie Kujawaki and others did a comparative study of births with and without an intervention. 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 experiencing abuse and disrespect during childbirth. This study shows that community and health system reforms can help change and reshape norms in which women are mistreated during childbirth.[18]

See also
  • Angel of mercy (criminology)–includes both homicide by health care workers and also harm caused to the patient with the attempt of making the health care worker look like a hero

References

Using Wikipedia for Research

  1. "Prevention and elimination of disrespect and abuse during childbirth". World Health Organization. 3 September 2014. Retrieved 3 August 2017.
  2. 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. "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: CD003766. doi:10.1002/14651858.CD003766.pub6. PMC 6483123. PMID 28681500.
  10. 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.
  11. Northrup, Christiane (2006). Women's bodies, women's wisdom: the creating physical and emotional health and healing. New York: Bantam Books. ISBN 9780553804836.
  12. 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.
  13. 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.
  14. 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:
  15. 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.
  16. 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.
  17. 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.
  18. 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.
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