Beyond measurement: the drivers of disrespect and abuse in obstetric care

Abstract

Concerns about disrespect and abuse (D&A) experienced by women during institutional birth have become critical to the discourse on maternal health. The rapid growth of the field from diverse points of origin has given rise to multiple and, at times, confusing interpretations of D&A, pointing to the need for greater clarity in the concepts themselves. Furthermore, attention to measurement of the problem has been excessive when viewed in relation to the small amount of work on critical drivers of disrespect and abuse. This paper raises some key issues of conceptualisation and measurement for the field, puts forward a working definition, and explores two critical drivers of D&A - intersecting social and economic inequality, and the institutional structures and processes that frame the practice of obstetric care. By identifying gaps and raising questions about the deeper causes of D&A, we point to potentially fruitful directions for research and action.

“I wouldn’t have hit you, but you would have killed your baby:” exploring midwives’ perspectives on disrespect and abusive Care in Ghana

“…However, the practice of detaining clients for non-payment of bills is a frequent practice in our study setting. These revelations confirmed Sen et al (2018)'s view that patients who belonged to marginalized and vulnerable groups in society were often at risk of D&AC in healthcare facilities [26]. Other studies also confirm the findings of our study [20][21][22].…”

“…The women in these studies reported that they were physically abused [19], psychologically abused [19], detained for non-payment of bills [20], examined without consent [21,22], discriminated against because of their social status [21,22], denied of their choice of birthing position because of facility-recommended guidelines [22][23][24], and subjected to iatrogenic procedures such as episiotomies, in some instances done without anaesthesia, and with improper pelvic examinations [25]. This D&AC, Sen, Reddy & Iyer [26] argued, is driven by socioeconomic inequalities and institutional structures and processes.…”

An Innovative Intervention to Improve Respectful Maternity Care in Three Districts in Ethiopia

“…Lack of training on interpersonal communication, poor working environments and high workloads are among the drivers of mistreatments (6,13,25). Such mistreatments tend to be accepted as the 'norm' both by the clients and HCPs and may not be raised as concerns (4,9,12,(26)(27)(28).…”

How respectfully women are treated during difficult phase like childbirth? A primary survey of differently-managed health facilities in Odisha, India

“…Respectful and non-abusive birth care for all women has achieved agreed importance among maternal health and human rights stakeholders in India recently, 20 yet, there has been a relative lack of formal research around this topic. With this backdrop, the present study attempted to shed light on, how respectfully women are treated during childbirth -which happened to be the most vulnerable phase of women's life.…”