Abstract
BackgroundReducing maternal morbidity and mortality remains a key health challenge in Guinea. Anecdotal evidence suggests that women in Guinea are subjected to mistreatment during childbirth in health facilities, but limited research exists on this topic. This study was conducted to better understand the social norms and the acceptability of four scenarios of mistreatment during childbirth, from the perspectives of women and service providers.MethodsThis study used qualitative methods including in-depth interviews (IDIs) and focus group discussions (FGDs) with women of reproductive age, midwives, nurses and doctors. This study was conducted in one urban area (Mamou) and one peri-urban area (Pita) in Guinea. Participants were presented with four scenarios of mistreatment during childbirth, including a provider: (1) slapping a woman; (2) verbally abusing a woman; (3) refusing to help a woman; and (4) forcing a woman to give birth on the floor. Data were collected in local languages (Pular and Malinké) and French, and transcribed and analyzed in French. We used a thematic analysis approach and manually coded the data using a codebook developed for the project.ResultsA total of 40 IDIs and eight FGDs were conducted with women of reproductive age, 5 IDIs with doctors, and 13 IDIs with midwives. Most women were not accepting of any of the scenarios, unless the action was perceived to be used to save the life of the mother or child. However, they perceived a woman’s disobedience and uncooperativeness to contribute to her poor treatment. Women reacted to this mistreatment by accepting poor treatment, refusal to use the same hospital, revenge against the provider or complaints to hospital management. Service providers were accepting of mistreatment when women were disobedient, uncooperative, or to save the life of the baby.ConclusionsThis is the first known study on mistreatment of women during childbirth to be conducted in Guinea. Both women and service providers were accepting of mistreatment during childbirth under certain conditions. Any approach to preventing and eliminating mistreatment during childbirth must consider these important contextual and social norms and develop a comprehensive intervention that addresses root causes. Further research is needed on how to measure mistreatment during childbirth in Guinea.
Highlights
Reducing maternal morbidity and mortality remains a key health challenge in Guinea
We used qualitative methods to explore how attitudes and social norms influence how women are treated during childbirth, from the perspectives of women and healthcare providers in Guinea
Research participants were presented with four scenarios detailing forms of mistreatment of women during childbirth: (1) a provider pinching or slapping a woman in labor; (2) a provider yelling or shouting at a woman in labor; (3) a provider refusing to help a woman in labor; and (4) forcing a woman to deliver on the floor of the hospital
Summary
Reducing maternal morbidity and mortality remains a key health challenge in Guinea. Anecdotal evidence suggests that women in Guinea are subjected to mistreatment during childbirth in health facilities, but limited research exists on this topic. Pregnancy and childbirth continue to place women at a substantial risk of mortality and morbidity, in low- and middle-income countries (LMICs) [1]. A report from the World Health Organization estimates that 303,000 maternal deaths occurred in 2015, despite global efforts to reduce maternal mortality as part of the Millennium Development Goals (MDGs) [1]. Efforts to improve quality of care have historically focused on improving the provision of care, and research on how to improve women’s experiences of childbirth care has been largely neglected
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