Abstract
BackgroundDespite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence on the mistreatment of women during childbirth in health facilities to inform the development of an evidence-based typology of the phenomenon.Methods and FindingsWe searched PubMed, CINAHL, and Embase databases and grey literature using a predetermined search strategy to identify qualitative, quantitative, and mixed-methods studies on the mistreatment of women during childbirth across all geographical and income-level settings. We used a thematic synthesis approach to synthesize the qualitative evidence and assessed the confidence in the qualitative review findings using the CERQual approach. In total, 65 studies were included from 34 countries. Qualitative findings were organized under seven domains: (1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. Due to high heterogeneity of the quantitative data, we were unable to conduct a meta-analysis; instead, we present descriptions of study characteristics, outcome measures, and results. Additional themes identified in the quantitative studies are integrated into the typology.ConclusionsThis systematic review presents a comprehensive, evidence-based typology of the mistreatment of women during childbirth in health facilities, and demonstrates that mistreatment can occur at the level of interaction between the woman and provider, as well as through systemic failures at the health facility and health system levels. We propose this typology be adopted to describe the phenomenon and be used to develop measurement tools and inform future research, programs, and interventions.
Highlights
An estimated 289,000 maternal deaths occurred in 2010, of which 99% occurred in low- and middle-income countries [1]
This systematic review presents a comprehensive, evidence-based typology of the mistreatment of women during childbirth in health facilities, and demonstrates that mistreatment can occur at the level of interaction between the woman and provider, as well as through systemic failures at the health facility and health system levels
We propose this typology be adopted to describe the phenomenon and be used to develop measurement tools and inform future research, programs, and interventions
Summary
An estimated 289,000 maternal deaths occurred in 2010, of which 99% occurred in low- and middle-income countries [1]. In 2000, as Millennium Development Goal (MDG) 5, world leaders set a target of reducing the global maternal mortality ratio—the number of deaths among women caused by pregnancy- or childbirth-related complications (maternal deaths) per 100,000 live births—to a quarter of its 1990 level by 2015. Nearly 300,000 women, 99% them living in lowand middle-income countries, died from pregnancy- or childbirth-related complications Most of these maternal deaths were caused by hemorrhage (severe bleeding) after childbirth, post-delivery infections, obstructed (difficult) labor, or blood pressure disorders during pregnancy. These conditions are largely preventable if women have access to goodquality reproductive health services and if trained birth attendants are present during childbirth
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