9 October 2019
New evidence from a WHO-led study shows that more than
one-third of women in four lower-income countries experienced mistreatment
during childbirth in health facilities. Younger, less-educated women were found
to be the most at risk of mistreatment, which can include physical and verbal
abuse, stigmatization and discrimination, medical procedures conducted without
their consent, use of force during procedures, and abandonment or neglect by
health care workers.
The study “How women are treated during facility-based
childbirth in four countries: a cross-sectional study with labour observations
and community-based surveys” published on 8th October 2019 in the Lancet.
The study, carried out in Ghana, Guinea, Myanmar and
Nigeria, found that 838 (42%) of 2,016 women experienced physical or verbal
abuse, stigma or discrimination. 14% experienced physical abuse – most commonly
being slapped, hit or punched. There
were also high rates of non-consensual caesarean sections, episiotomies
(surgical cuts made at the opening of the vagina during childbirth) and vaginal
WHO guidelines promote respectful maternity care
WHO guidelines promote respectful maternity care for all
women, which is care that maintains ‘dignity, privacy and confidentiality,
ensures freedom from harm and mistreatment, and enables informed choice and
continuous support during labour and childbirth’.
High levels of verbal and physical mistreatment
The study observed 2,016 women during labour and childbirth
in Ghana, Guinea, Myanmar. Interviews were also conducted with 2,672 women
after the birth, finding similar levels of mistreatment to the direct
Among the 2016 women observed by the researchers, 35 (13%)
caesarean births were conducted without the woman’s consent, as were 190 of 253
episiotomies (75%). Vaginal examinations occurred without consent in 59% of
cases (2611 of 4393 exams).
In addition to physical abuse, 752 (38%) of the 2016 women
were observed to experience high levels of verbal abuse – most often, being
shouted at, scolded and mocked. 11 women experienced stigma or discrimination,
typically regarding their race or ethnicity.
The way forward
To tackle mistreatment during childbirth, health systems
must be held accountable, and sufficient resources must be in place to provide
quality, accessible maternal health care and clear policies on women’s rights.
Health-care providers also require support and training to ensure that women
are treated with compassion and dignity.
Possible strategies include:
Redesigning labour wards to meet the needs of women,
including allowing for privacy and labour companionship;
Improving the informed consent process around all medical
Providing sufficient mentoring and support for health workers
to help them deliver better quality care;
Allowing all women who want one to have a companion of their
choice with them throughout labour and childbirth;
Building public demand for high quality maternity services
that provide women-centred care and do not tolerate any form of mistreatment.
Professional associations can also play a crucial role in
promoting and supporting respectful care among midwives, obstetricians and
other maternity providers, and safeguarding their rights. WHO calls upon these
entities to collaborate to ensure that mistreatment during childbirth is
consistently identified and reported, and that locally appropriate measures are
The findings of the study should be used to inform policies
and programmes to ensure that all women have positive pregnancy and childbirth
experiences, supported by empowered healthcare providers within
well-functioning health systems.
This research was made possible by the support of the American People through the United States Agency for International Development (USAID) and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO.
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