In a new systematic review appearing this week in PLOS Medicine, Meghan Bohren and colleagues of the WHO Department of Reproductive Health and Research, including HRP, and Johns Hopkins Bloomberg School of Public Health synthesize qualitative and quantitative evidence to form a clearer picture of the extent and types of mistreatment that occurs during childbirth in health facilities. Such initiatives are key to developing policies to reduce and ultimately eliminate this inhumane and degrading phenomenon.
One of the United Nations Millennium Development Goals is to bring about a 75% reduction in the maternal mortality ratio. In 2010, some 289,000 maternal deaths occurred worldwide, many in low and middle income countries. While these numbers explain why attention is focused on a reduction in maternal deaths, attention is also needed to defining and measuring the extent of problems around childbirth, such as mistreatment, to better inform constructive changes in policies and practices.
The authors assess 65 published studies undertaken in 34 countries and they identify 7 areas of mistreatment and abuse: physical (such as slapping); sexual; verbal; stigma and discrimination; a failure to meet professional standards of care; poor rapport between women and providers and health system constraints (such as a lack of resources to provide women with privacy). This study is the first to provide a comprehensive and evidence-based typology of the mistreatment of women during childbirth. It can be used to develop tools, policies and programs to prevent the mistreatment of women at an obviously vulnerable time. The authors also call for the adoption of the evidence based typology as a means of documenting and measuring mistreatment. Promoting positive birth experiences for women and their families, and providing clinics with adequate resources and trained staff are essential factors to improve the quality of care for mothers and newborns and is critical to further reduce the burden of morbidity and mortality and to reach the United Nations Millennium Development Goals.
Funding: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding for this project was received from The United States Agency for International Development (USAID) (USAID Amendment #20, WHO Consolidated Grant GHA-G-00-09-0003) 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, World Health Organization. This article represents the views of the named authors only.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. (2015) The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med 12(6): e1001847. doi:10.1371/journal.pmed.1001847
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Population Services International, Washington, D. C., United States of America
Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Dr Meghan A. Bohren