DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20211136

Obstetric violence: a health system study

Raksha K. Shetty, Padmaja Y. Samant, Priyanka U. Honavar

Abstract


Background: Disrespect and abuse during facility-based childbirth is a global problem with differing driving factors in different contexts. Obstetric Violence (OV) refers to professional deficiencies in maternity care. The objective of this study was to assess knowledge and attitudes towards OV in a cohort of members of the obstetric healthcare team at a tertiary care, teaching hospital in Western India (Mumbai).

Methods: A questionnaire-based study involving 80 participants comprising of trainee doctors and faculty, nursing students, staff and teachers from the department of Obstetrics and Gynaecology and hospital administration.

Results: 57.97% of participants had heard the term ‘Obstetric violence’ earlier. 75.36% reported verbal abuse as a form of OV, others being physical abuse, non-consented care, discriminatory care, abandonment/neglect or refusal of care and imposition of interventions without scientific basis. 53% and 89.8% of the participants did not consider routine episiotomies and artificial rupture of membrane respectively as forms of OV. 84.06% and 59.4% of participants considered instrumental delivery without consent and Caesarean section citing safety/convenience respectively as forms of OV. 82.6% participants endorsed the need of birth companion. Improving the number and training of healthcare providers and better institutional policies on respectful maternity care were suggested as solutions.

Conclusions: Majority of the participants had witnessed some form of OV. The need for practical training of healthcare personnel and better infrastructure in the healthcare system were emphasised, but there appeared to be a lack of consciousness of the paternalistic mindset and approach to women in labour. Soft skills training of healthcare providers with emphasis on key ethical principles like autonomy, respect and dignity is crucial to address the issue of OV.

 


Keywords


Non-consensual care. Obstetric violence, Professionalism, Respectful maternity care

Full Text:

PDF

References


Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet. 2013;381:1747-55.

Akachi Y, Tarp F, Kelley E, Addison T, Kruk ME. Measuring quality-of-care in the context of sustainable development goal 3: a call for papers. Bull World Health Organ. 2016;94:160-160A.

WHO. WHO recommendations: intrapartum care for a positive childbirth experience. WHO. 2018. Available from: http://www.who.int/reproductivehealth/ publications/intrapartum-care-guidelines/en/

Bowser D, Hill K. Exploring evidence for disrespect and abuse in facility based childbirth. Report of a landscape analysis. Bethesda, MD: USAIDTR Action Project, University Research Corporation, LLC, and Harvard School of Public Health; 2010.

República Bolivariana de Venezuela, Ley Orgánica sobre el derecho de las mujeres a una vida libre de violencia [Organic Law on the Rights of Women to a Life Free of Violence]. 2007, Gaceta Oficial de la República Boliviarana de Venezuela Caracas. Available from: http://www.fiscalia.gov.ve/leyes/10-LEY DERECHOS MUJER.pdf.

Miller S, Lalonde A. The global epidemic of abuse and disrespect during childbirth: history, evidence, interventions, and FIGO’s mother−baby friendly birthing facilities initiative. Int J Gynecol Obstet. 2015;131:S49–-52.

Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS Med. 2015;12: e1001847.

Sharma G, Penn-Kekana L, Halder K, Filippi V. An investigation into mistreatment of women during labour and childbirth in maternity care facilities in Uttar Pradesh, India: a mixed methods study. Reprod Health. 2019;16(1):7.

Prochaska E. UK Supreme Court upholds women's autonomy in childbirth: Montgomery v Lanarkshire Health Board. Birthrights. Available from:https://www.birthrights.org.uk/2015/03/12/uk-supreme-court-upholds-womens-autonomy-in-childbirth-montgomery-v-lanarkshire-health-board.

Kirkup, B. (2015). The Report of the Morecambe Bay Investigation. Availablefrom: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/408480/47487_MBI_Accessible_v0.1.pdf [Retrieved: 7/8/2015]

WHO. Prevention and elimination of abuse, disrespect and mistreatment during childbirth. Available from: https://www.who.int/reproductivehealth/topics/maternal_perinatal/statement-childbirth-data/en/.

Galle A, Manaharlal H, Cumbane E, Picardo J, Grin S, Osman N, et al. Disrespect and abuse during facility-based childbirth in southern Mozambique: a cross-sectional study. BMC pregnancy and childbirth. 2019;19(1):369.

Adinew YM, Hall H, Marshall A, Kelly J. Disrespect and Abuse During Facility‐Based Childbirth in North Showa Zone, Ethiopia. Research Square. 2020.

Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2009;(1):CD000081.

Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in cesarean section rates: global, regional and national estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.

Singh P, Hashmi G, Swain PK. High prevalence of cesarean section births in private sector health facilities- analysis of district level household survey-4 (DLHS-4) of India. BMC Public Health. 2018;18(1):613.

Turan JM, Miller S, Bukusi EA, Sande J, Cohen CR. HIV/AIDS and maternity care in Kenya: how fears of stigma and discrimination affect uptake and provision of labor and delivery services. AIDS Care. 2008;20:938-45.

Sando D, Kendall T, Lyatuu G, Ratcliffe H, McDonald K, Mwanyika-Sando M, et al. Disrespect and abuse during childbirth in Tanzania: are women living with HIV more vulnerable? J Acquir Immune Defic Syndr. 2014;67(Suppl 4): S228-34.

Asefa A, Bekele D. Status of respectful and non-abusive care during facility-based childbirth in a hospital and health centers in Addis Ababa, Ethiopia. Reproductive health. 2015;12:33.

Banks KP, Karim AM, Ratcliffe HL, Betemariam W, Langer A. Jeopardizing quality at the frontline of healthcare: prevalence and risk factors for disrespect and abuse during facility-based childbirth in Ethiopia. Health policy and planning. 2018;33:317-27.

Bobo FT, Kasaye HK, Belachew Etana MW, Feyissa TR. Disrespect and abuse during childbirth in Western Ethiopia: Should women continue to tolerate? PloS one. 2019;14(6).

Shrivastava S, Sivakami M. Evidence of 'obstetric violence' in India: an integrative review. J Biosoc Sci. 2020;52:610-28.

Souza J, Gulmezoglu A, Lumbiganon P. Cesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO global survey on maternal and perinatal health. BMC Med. 2010;8:71.

Diniz SG, Chacham AS. “The Cut Above” and “the Cut Below”: The Abuse of Caesareans and Episiotomy in São Paulo, Brazil, Reproductive Health Matters. 2004;12:23,100-10.

Unwarranted C-sections harmful for mother and baby: HC. India Today. February 13, 2018. Available from: https://www.indiatoday.in/pti-feed/story/unwarranted-c-sections-harmful-for-mother-and-baby-hc-1168864-2018-02-13.

World Health Organisation. Standards for improving quality of maternal and newborn care in health facilities; 2016. Available from: https://extranet.who.int/rhl/guidelines/standards-improvingquality-maternal-and-newborn-care-health-facilities.

Bohren MA, Berger BO, Munthe-Kaas H, Tunçalp Ö. Perceptions and experiences of labour companionship: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2019;3(3):CD012449.

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2015;(7):CD003766.

Vogel JP, Bohren MA, Tunçalp Ö, Oladapo OT, Gülmezoglu AM. Promoting respect and preventing mistreatment during childbirth. BJOG. 2016;123(5):671-4.

Kabakian-Khasholian T, El-Nemer A, Bashour H. Perceptions about labour companionship at public teaching hospitals in three Arab countries. Int J Gynaecol Obstet. 2015;129(3):223-6.

Santos R, Souza N. Institutional obstetric violence in Brazil: systematic review. Scientific Station (UNIFAP). 2015;5(1):57-68.

Marques de AJ, d'Oliveira, Ana Flávia Pires Lucas, Schraiber LB. Institutional violence, medical authority and power in maternity hospitals from the perspective of health professionals. Cadernos de Saúde Pública. 2013;29(11):2287-96.

Freedman LP, Kruk ME. Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas. The Lancet. 2014;384(9948):e42-e4.

CRR W. Broken Promises: Human Rights, Accountability, and Maternal Death in Nigeria. Center for Reproductive Rights/Women Advocates Research and Documentation Centre, United States. 2008.