A qualitative study of women’s and health providers’ attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea

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.

A qualitative study on acceptability of the mistreatment of women during childbirth in Myanmar

“…Pinching or slapping was acceptable for women and providers if it was used for encouragement or for their sake. These findings on conditions where mistreatment may be acceptable are in accordance similar findings in West Africa (Guinea and Ghana) where these type of mistreatment behaviors were not acceptable for most women unless used to save the life of the woman [17,21]. Furthermore, in Nigeria and Ghana [19,21] some women and providers considered these mistreatment behaviors as appropriate and acceptable measures to gain compliance from the woman, correct perceived "disobediences", and ensure a good outcome for the baby.…”

“…The study used a mixedmethods design to understand and measure the mistreatment of women during childbirth in Myanmar, Nigeria, Ghana and Guinea. In the first phase, formative qualitative research was conducted to understand women's and providers' experiences and acceptability of mistreatment during childbirth [16][17][18][19][20][21]. The formative findings and systematic review [15] were used to inform the development of two measurement tools in the second phase (direct observations of labor and childbirth) and a community-based survey with women during the postpartum period in the same settings [22,23].…”

Women’s perspectives of mistreatment during childbirth at health facilities in Ghana: findings from a qualitative study

“…6,8,21 Other study sites in this WHO-led multi-country study (Nigeria and Guinea) have revealed similar experiences of mistreatment in health facilities. 22,23 Such mistreatment may have negative effects on future maternal health-seeking behaviour and choices regarding facility-based childbirth. A recent systematic review determined the existence of a wide range of disrespectful and abusive treatment of women during childbirth in Nigeria.…”

Respectful maternity care and its related factors in maternal units of public and private hospitals in Tabriz: a sequential explanatory mixed method study protocol

“…Quantitative studies conducted in other countries to determine the level and type of D&A show high abuse rates, especially in African countries [8,20]. Few studies were found to assess women's D&A experiences during childbirth [21][22][23][24]. In Iran, no rigorous study was found to use a standard measurement tool to assess and manage RMC.…”