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(Reuters Health) - Around the world, women giving birth are facing physical and verbal abuse, neglect, and discrimination, largely because of health system failures, a new study suggests.
“Every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful health care throughout pregnancy and childbirth, as well as the right to be free from violence and discrimination,” said Meghan Bohren, the study’s lead author, in an email.
Mistreatment during childbirth can amount to a violation of a woman’s fundamental human rights, said Bohren, a doctoral student at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
Strategies for reducing maternal mortality include encouraging women to get good prenatal and pregnancy care, and to deliver their babies in healthcare facilities, Bohren and colleagues write in PLOS Medicine.
But those goals are challenging because of cultural and physical obstacles, they write, and require “efforts to improve the coverage and quality of care provided to women at health facilities, including women’s rights to dignified and respectful care.”
The first step in improving the quality of care is documenting the problems, the researchers say.
“One key gap that we identified was that there were no standardized and agreed upon classification systems of how women are mistreated during childbirth,” Bohren said. “This complicated efforts to measure how often this mistreatment was occurring and to develop interventions to prevent its occurrence.”
The analysis reviewed childbirth experiences as reported in 65 earlier studies from 34 countries.
Women complained of being beaten, pinched and slapped by health providers during childbirth, and being physically restrained. Healthcare providers spoke to them harshly or rudely and “shamed” them with inappropriate comments about their sexual activity, especially adolescents and unmarried women. Healthcare providers also threatened to withhold care or not offer good care because of misbehavior.
Many women felt discriminated against based on their ethnic, racial or religious backgrounds, socioeconomic status, age and having HIV, making them feel alienated from health care workers.
Women also reported painful or excessive number of vaginal exams, staff who refused to offer pain relief, lack of informed consent and breaches of confidentiality.
Women felt scared of some medical procedures because of poor communication with health providers. Some women said their companions weren’t allowed to stay with them during childbirth and they were forced to deliver lying down, rather than squatting or kneeling.
Overworked healthcare workers and staff shortages led to long patient waits and feelings of neglect. Medication, gloves and blood could sometimes be scarce. In some facilities, women said they had to pay bribes to receive adequate treatment.
Women complained about a lack of privacy during vaginal and abdominal exams. They also said they were afraid to complain about mistreatment or didn’t know their rights.
And many women said their negative experiences made them want to deliver their next child at home rather than in a healthcare facility.
“Providing quality care during pregnancy and childbirth should be tantamount to any efforts to reduce mortality and morbidity, and this care must be provided in a respectful and woman-centered way,” Bohren said.
Sheela Raja, a clinical psychologist at the University of Illinois at Chicago, said the results were striking because childbirth was a time when women were often at their most vulnerable.
“They don’t know what to expect and what the outcome will be and to have a supportive environment can help them feel good and help them (want to) bring their children back for pediatric care and for them to get postnatal care,” Raja told Reuters Health.
Raja, who was not involved in this study, said her own research on dehumanization in the health care system showed lack of privacy, poor rapport with health care providers and feeling judged or demeaned because of their socioeconomic and insurance status were also issues for lower income women in the U.S.
“There’s a lot here that applies not only across the globe but to our healthcare system, as well,” she said. “Thankfully we have some good rules in place about the need to explain things but I think we can work more at doing some of that.”