Abuse during childbirth

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Abuse during childbirth (obstetric violence or disrespectful care) is generally defined as interactions or conditions deemed humiliating or undignified by local consensus and interactions or conditions experienced as or intended to be humiliating or undignifying. [1] [2] Bowser and Hill's 2010 landscape analysis defined seven categories of abusive or disrespectful care, including physical abuse, non-consented clinical care, non-confidential care, non-dignified care, discrimination, abandonment, and detention in health facilities. [3]

Contents

This treatment is regarded as a form of violence against women and a violation of women's rights. It is a recurring issue in facilities around the globe per World Health Organization studies, and can have serious consequences for mother and child. Namely, abuse during childbirth may prevent women from seeking pre-natal care and using other health care services in the future. [4] Adolescents, women who are unmarried, women of low socioeconomic status, migrant women, women infected with HIV, and ethnic minority women are at a greater risk of experiencing obstetric violence. [4]

Definition and forms of abuse

The World Health Organization notes that abuse during childbirth has yet to be conclusively defined or measured in a scientific way. However, abuse during childbirth is generally defined as neglectful, physical abusive, and/or disrespectful treatment from healthcare professionals towards patients in childbirth. Such mistreatment is regarded as a violation of the woman's human rights. [4]

Abuse during childbirth can occur over a wide spectrum and may be seen in the forms of non-confidential care, non-dignified care, discrimination, overt physical abuse, non-consented care, abandonment of care, and/or detention in facilities. [3]

Epidemiology and consequences

Investigations into the prevalence of abusive practices in childbirth have been conducted by the World Health Organization. Their studies demonstrate that women giving birth in medical facilities experience disrespectful, abusive, and/or neglectful treatment frequently and globally. [5]

A 2020 study centered in Ghana, Guinea, Myanmar, and Nigeria found that more than 40% of observed women and 35% of surveyed women experienced mistreatment while in childbirth. [6] Furthermore, adolescents, migrant women, women infected with HIV, and ethnic minority women were deemed more likely than others to experience abuse during childbirth. [5] [7] [8] [9] [10] [11]

Women in childbirth are very vulnerable and often cannot protect themselves against mistreatment, so the consequences of obstetric violence can be serious for both the mother and the child. The abusive relationship that forms between a woman and her healthcare providers as a result of abuse during childbirth often leads to the woman developing a general mistrust in healthcare services. Furthermore, consequences can be extended to include a reluctance to seek pre-natal care, medical assistance during childbirth, and other health care services in the future. [4] [5] [12]

Geography

North and South 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 involves placing extra stitches in the woman's vagina after the episiotomy or the natural tearing that occurs during childbirth. This procedure was supposedly performed to increase the husband's future sexual pleasure and often caused long-term pain and discomfort for the woman. There is no proof that such a practice was widespread in North America, [13] [14] but mentions of it frequently appear in studies about episiotomy in certain American countries such as Brazil. [15]

There has been a more recent highlight on North American doctors' treatment of pregnant women. The growing idea is that there has been a "redressing" of obstetric violence and that women's right to choice has been compromised in some situations. In instances where the lives of the woman and the fetus are endangered, the woman has the right to refuse care through procedures such as caesarean section, episiotomy, or vacuum-assisted delivery. Women are often coerced into having these invasive procedures, despite the fact that such coercion has been found to cause long-lasting damage with many women comparing the experience to rape. [16]

The term "obstetric violence" is particularly used in Latin American countries, where the law prohibits such mistreatment. These laws exist in several Latin American countries, including Argentina, Puerto Rico and Venezuela. [17]

Research into obstetric violence at two public hospitals in Mexico analyzing the birthing experiences for one month of 2012 found that physical abuse, verbal abuse, and discrimination occurred openly throughout the facilities. Women receiving government assisted insurance were subjected to the most discrimination from the healthcare professionals. [18]

Africa

Tanzania is an African country with a history of abuse during childbirth. In 2011, Shannon McMahon and others explored whether or not the supposed interventions to decrease the prevalence of abuse during childbirth had been effective. When interviewing women, they initially referred to their experiences as neutral or better. However, after being shown the different aspects of abuse, an overwhelming majority of the women actually reported experiencing abuse during childbirth. [19] In 2013–2014, Hannah Ratcliffe and others formed a study to explore possible interventions to improve the experiences of women in childbirth. They implemented an "open birth day" that facilitated communication between patients and providers and educated them on the procedures surrounding birth. The team also implemented a "respectful maternity care workshop" meant to create conversation surrounding respect between health care 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. [20] During the same time period as Ratcliffe's study, Stephanie Kujawaki and others did a comparative study of births with and without interventions. 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 abuse and disrespect during childbirth after interventions. This study shows that community and health system reforms can help change and reshape norms in which women are mistreated during childbirth. [21]

Asia

In 2014–2015, Shreeporna Bhattacharya and T.K. Sundari Ravindran set out to quantitatively determine the prevalence of abuse during childbirth in the Varanasi district of northern India through the use of a questionnaire. Two rural blocks in the Varanasi district with high rates of institutional deliveries were the focus of the study, with subjects selected randomly from the women who lived in the area. Bhattacharya and Ravindran report that the frequency at which abusive behavior occurred was 28.8%, with "abusive behavior" acting as a general term. The two most common forms of abuse were non-dignified care (19.3%) and physical abuse (13.4%). Furthermore, 8.5% of patients reported being neglected or abandoned, 5.6% experienced non-confidential care, and 4.9% faced humiliation due to a lack of cleanliness. The authors also note that 90.5% of subjects were met with inappropriate demands for money. In terms of correlation, there was no significant link between socio-economic status and abuse, though women who faced complications during labor were four times as likely to experience abuse in the facilities. [22]

Fatima Alzyoud and colleagues studied abuse during childbirth in Jordan, specifically in the forms of neglect and verbal abuse. Four government-run Maternal and Child Health Centers were used as the locations of the study, with the subjects being 390 Jordanian women aged 18–45. The Childbirth Verbal Abuse and Neglect Scale (CVANS) found that 32.2% of the subjects experienced neglect and 37.7% faced verbal abuse during their last childbirth. Furthermore, there was a negative correlation between age and neglect/verbal abuse. [23]

Intersectionality of obstetric violence

Race/ethnicity

While global maternal health research and advocacy has brought recent awareness to obstetric violence, historians have noted historical examples. In the United States of America, historians attest that it began during slavery, where enslaved women were physically exploited and experimented on by Antebellum physicians looking to advance the fields of obstetrics and gynaecology. [24] Later, historians confirm that this took the form of forced sterilizations of black and other women of color as part of the eugenics movement. [25] Mississippi appendectomies refer to the experience of forced and coerced sterilization of Black women between 1920 and 1980. [25] Coined by activist Fannie Lou Hamer, Mississippi appendectomies involved Black and other women of color being sterilized without informed consent, knowledge and without valid medical reason. [25] Hamer recalls having received a hysterectomy, without consent, during a surgery to remove a uterine fibroid, rendering her infertile. [26] [27] Researchers confirm that hysterectomies and tubal ligations were given to poor black women by medical residents allowed to "practice" surgical skills. [27]

Scholars show that some of these historical forms of disrespectful care have persisted into the 21st century. Black mothers of all socioeconomic statuses, including Serena Williams, have detailed experiences of being ignored or dismissed while reporting signs of complications or expressing concerns during their pregnancies [28] [29] [30] . A study conducted on maternal and infant health inequalities in California, found that racial inequality in maternal and infant outcomes persists within the wealthiest 20% of families. The study concluded that Black mothers and infants were two times as likely to die than white mothers and infants within this tax bracket. The researchers also found that the rates of maternal mortality among the richest Black women were just as high among the lowest-income white women. [30] Another study noted that women of color experience mistreatment more frequently than other races, with rates of mistreatment consistently higher for them when compared to white counterparts. [31] Research from the New York State Department of Health and the Centers for Disease Control and Prevention found that black women are three to four times more likely than white women to die from pregnancy related complications, where more than 60% of these deaths are preventable if given appropriate and respectful care. [32]

Though studies have found that the impacts of obstetric violence are disproportionately distributed, they also show it is not limited to black women alone. A study conducted during the 1970s found that an estimated one-quarter of Indigenous American women of childbearing age were sterilized in Indian Health Service hospitals. [24]  

See also

Related Research Articles

Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field.

<span class="mw-page-title-main">Childbirth</span> Expulsion of a fetus from the pregnant mothers uterus

Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million human births globally. In the developed countries, most deliveries occur in hospitals, while in the developing countries most are home births.

<span class="mw-page-title-main">Postpartum depression</span> Mood disorder experienced after childbirth

Postpartum depression (PPD), also called postnatal depression, is a mood disorder experienced after childbirth, which can affect women. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.

<span class="mw-page-title-main">Doula</span> Non-medical companion who supports a person through significant health-related experiences

A doula is a non medical professional who provides guidance for the service of others and who supports another person through a significant health-related experience, such as childbirth, miscarriage, induced abortion or stillbirth, as well as non-reproductive experiences such as dying. A doula might also provide support to the client's partner, family, and friends.

<span class="mw-page-title-main">Obstetric fistula</span> Hole that develops in the birth canal as a result of childbirth

Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may include depression, infertility, and social isolation.

<span class="mw-page-title-main">Maternal death</span> Aspect of human reproduction and medicine

Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while she is pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.

Women's health differs from that of men's health in many unique ways. Women's health is an example of population health, where health is defined by the World Health Organization (WHO) as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Often treated as simply women's reproductive health, many groups argue for a broader definition pertaining to the overall health of women, better expressed as "The health of women". These differences are further exacerbated in developing countries where women, whose health includes both their risks and experiences, are further disadvantaged.

<span class="mw-page-title-main">Traditional birth attendant</span> Person who provides maternity care informally

A traditional birth attendant (TBA), also known as a traditional midwife, community midwife or lay midwife, is a pregnancy and childbirth care provider. Traditional birth attendants provide the majority of primary maternity care in many developing countries, and may function within specific communities in developed countries.

Maternal health is the health of women during pregnancy, childbirth, and the postpartum period. In most cases, maternal health encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to ensure a positive and fulfilling experience. In other cases, maternal health can reduce maternal morbidity and mortality. Maternal health revolves around the health and wellness of pregnant women, particularly when they are pregnant, at the time they give birth, and during child-raising. WHO has indicated that even though motherhood has been considered as a fulfilling natural experience that is emotional to the mother, a high percentage of women develop health problems and sometimes even die. Because of this, there is a need to invest in the health of women. The investment can be achieved in different ways, among the main ones being subsidizing the healthcare cost, education on maternal health, encouraging effective family planning, and ensuring progressive check up on the health of women with children. Maternal morbidity and mortality particularly affects women of color and women living in low and lower-middle income countries.

<span class="mw-page-title-main">Health in Haiti</span> Sanitation, nutrition, and health services in Haiti

Deficient sanitation systems, poor nutrition, and inadequate health services have pushed Haiti to the bottom of the World Bank’s rankings of health indicators. According to the United Nations World Food Programme, 80 percent of Haiti’s population lives below the poverty line. In fact, 75% of the Haitian population lives off of $2.50 per day. Consequently, malnutrition is a significant problem. Half the population can be categorized as "food insecure," and half of all Haitian children are undersized as a result of malnutrition. Less than half the population has access to clean drinking water, a rate that compares poorly even with other less-developed nations. Haiti's healthy life expectancy at birth is 63 years. The World Health Organization (WHO) estimates that only 43 percent of the target population receives the recommended immunizations.

<span class="mw-page-title-main">Non-pneumatic anti-shock garment</span> Device used to treat hypovolemic shock

The non-pneumatic anti-shock garment (NASG) is a low-technology first-aid device used to treat hypovolemic shock. Its efficacy for reducing maternal deaths due to obstetrical hemorrhage is being researched. Obstetrical hemorrhage is heavy bleeding of a woman during or shortly after a pregnancy. Current estimates suggest over 300,000 women die from obstetrical hemorrhage every year with 99% of cases occurring in developing countries; many of these deaths are preventable. Many women in resource-poor settings deliver far from health-care facilities. Once hemorrhage has been identified, many women die before reaching or receiving adequate treatment. The NASG can be used to keep women alive until they can get the treatment they need.

<span class="mw-page-title-main">Maternal health in Uganda</span>

Uganda, like many developing countries, has high maternal mortality ratio at 153 per 100,000 live births. According to the World Health Organization (WHO), a maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. In situations where attribution of the cause of death is inadequate, another definition, pregnancy-related death was coined by the US Centers for Disease Control (CDC), defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death.

<span class="mw-page-title-main">Maternal mortality in the United States</span> Overview of maternal mortality in the United States

Maternal mortality refers to the death of a woman during her pregnancy or up to a year after her pregnancy has terminated; this metric only includes causes related to the pregnancy, and does not include accidental causes. Some sources will define maternal mortality as the death of a woman up to 42 days after the pregnancy has ended, instead of one year. In 1986, the CDC began tracking pregnancy-related deaths to gather information and determine what was causing these deaths by creating the Pregnancy-Related Mortality Surveillance System. According to a 2010-2011 report although the United States was spending more on healthcare than any other country in the world, more than two women died during childbirth every day, making maternal mortality in the United States the highest when compared to 49 other countries in the developed world.

The husband stitch or husband's stitch, also known as the daddy stitch, husband's knot and vaginal tuck, is a medically unnecessary and potentially harmful surgical procedure in which one or more additional sutures than necessary are used to repair a woman's perineum after it has been torn or cut during childbirth. The purported purpose is to tighten the opening of the vagina and thereby enhance the pleasure of the patient's male sex partner during penetrative intercourse.

<span class="mw-page-title-main">Abortion in Kenya</span> Termination of pregnancy in Kenya

Abortion in Kenya is prohibited with the exception of certain circumstances including danger to the life and health of the expectant mother, and rape. Unsafe abortions are a major cause of deaths and health complications for women in Kenya.

<span class="mw-page-title-main">Maternal mortality in India</span> Overview of maternal mortality in India

Maternal mortality in India is the maternal death of a woman in India during pregnancy or after pregnancy, including post-abortion or post-birth periods. Different countries and cultures have different rates and causes for maternal death. Within India, there is a marked variation in healthcare access between regions and in socioeconomic factors, accordingly, there is also variation in maternal deaths for various states, regions, and demographics of women.

Monica Rose McLemore is an American nurse who is an associate professor of Family Health Nursing at the University of California, San Francisco. Her work considers reproductive justice and medical care for marginalised communities, with an overarching aim to eliminate healthcare inequalities. During the COVID-19 pandemic, McLemore studied the impact of coronavirus disease during pregnancy.

Black maternal mortality in the United States refers to the death of women, specifically those who identify as Black or African American, during or after child delivery. In general, maternal death can be due to a myriad of factors, such as the nature of the pregnancy or the delivery itself, but is not associated with unintentional or secondary causes. In the United States, around 700 women die from pregnancy-related illnesses or complications per year. This number does not include the approximately 50,000 women who experience life-threatening complications during childbirth, resulting in lifelong disabilities and complications. However, there are stark differences in maternal mortality rates for Black American women versus Indigenous American, Alaska Native, and White American women.

Maternal health outcomes differ significantly between racial groups within the United States. The American College of Obstetricians and Gynecologists describes these disparities in obstetric outcomes as "prevalent and persistent." Black, indigenous, and people of color are disproportionately affected by many of the maternal health outcomes listed as national objectives in the U.S. Department of Health and Human Services's national health objectives program, Healthy People 2030. The American Public Health Association considers maternal mortality to be a human rights issue, also noting the disparate rates of Black maternal death. Race affects maternal health throughout the pregnancy continuum, beginning prior to conception and continuing through pregnancy (antepartum), during labor and childbirth (intrapartum), and after birth (postpartum).

<span class="mw-page-title-main">Roses Revolution</span> International movement

Roses Revolution is an international movement against obstetric violence, originally founded in Spain in 2011. It observes November 25, the International Day for the Elimination of Violence against Women, additionally as "Roses Revolution Day". Women place roses in front of the delivery rooms or hospitals where they suffered varying forms of physical or psychological violence as a sign of protest.

References

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  1. ↑ Freedman, Lynn P; Ramsey, Kate; Abuya, Timothy; Bellows, Ben; Ndwiga, Charity; Warren, Charlotte E; Kujawski, Stephanie; Moyo, Wema; Kruk, Margaret E; Mbaruku, Godfrey (2014-12-01). "Defining disrespect and abuse of women in childbirth: a research, policy and rights agenda". Bulletin of the World Health Organization. 92 (12): 915–917. doi:10.2471/BLT.14.137869. ISSN   0042-9686. PMC   4264393 . PMID   25552776.
  2. ↑ Freedman, Lynn P; Kruk, Margaret E (September 2014). "Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas". The Lancet. 384 (9948): e42–e44. doi:10.1016/s0140-6736(14)60859-x. ISSN   0140-6736. PMID   24965825. S2CID   20380618.
  3. 1 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.
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    See also:
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ Bhattacharya, Shreeporna; Sundari Ravindran, T. K. (2018-08-20). "Silent voices: institutional disrespect and abuse during delivery among women of Varanasi district, northern India". BMC Pregnancy and Childbirth. 18 (1): 338. doi: 10.1186/s12884-018-1970-3 . ISSN   1471-2393. PMC   6102865 . PMID   30126357.
  23. ↑ Alzyoud, Fatima; Khoshnood, Kaveh; Alnatour, Ahlam; Oweis, Arwa (2018-03-01). "Exposure to verbal abuse and neglect during childbirth among Jordanian women". Midwifery. 58: 71–76. doi:10.1016/j.midw.2017.12.008. ISSN   0266-6138. PMID   29306737.
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  31. ↑ the GVtM-US Steering Council; Vedam, Saraswathi; Stoll, Kathrin; Taiwo, Tanya Khemet; Rubashkin, Nicholas; Cheyney, Melissa; Strauss, Nan; McLemore, Monica; Cadena, Micaela; Nethery, Elizabeth; Rushton, Eleanor; Schummers, Laura; Declercq, Eugene (December 2019). "The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States". Reproductive Health. 16 (1): 77. doi: 10.1186/s12978-019-0729-2 . ISSN   1742-4755. PMC   6558766 . PMID   31182118.
  32. ↑ "Taskforce on Maternal Mortality and Disparate Racial Outcomes". www.health.ny.gov. Retrieved 2023-02-14.
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