Disrespect and abuse during childbirth in district Gujrat, Pakistan: A quest for respectful maternity care

Abstract

BackgroundDisrespectful and abusive practices at health facilities during childbirth discourage many women to seek care at facilities. This may lead to maternal morbidity and mortalities. Despite severe impacts, such practices remain hidden and are rarely reported in developing countries.ObjectivesThe study was carried out to assess the prevalence and determinants of the disrespect and abuse (D & A) during child birth in rural Gujrat, Pakistan.MethodsA cross sectional household based study was conducted in tehsil Kharian of district Gujrat. Data was collected using an interview based questionnaire from the women who had a live birth within the previous two months (n = 360). The D & A scale was based on standard Maternal and Child Health Integrated Programme indicators. Multiple logistic regression was used to find out the determinants of reported D & A.ResultsAlmost all women experienced D & A (99.7%) during childbirth according to objective assessment “experienced D & A”. However, only 27.2% reported subjective experience of D & A “reported D & A”. The main determinant of reported D & A was facility based childbirth (OR = 13.49; 10.10–100.16) and lower socio economic strata (OR = 2.89; 1.63–5.11). The risk of reporting D & A was twice in public health facilities as compared to private. Women who had reported D & A were more likely to opt for changing the place of childbirth for next time (OR = 4.37, 95% CI = 2.41–7.90).ConclusionD & A during childbirth is highly prevalent and under-recognized in Pakistan. High prevalence at facilities and particularly at public facilities can be a reason for underutilization of this sector for childbirth. Maternal health policies in Pakistan need to be revised based on the charter of respectful maternity care.

Person-Centred Maternity Care in a Poor-Resource Setting: Evidence from a Cross-Sectional Study in Enugu State, Nigeria

“…Evidence that type of services such as non-emergency or emergency care and experience of pregnancy complications influence PCMC are mixed. In Pakistan, the type of delivery service did not influence women's experiences of disrespect and abuse [23]. In contrast, women who experienced pregnancy complications reported higher PCMC than those who did not experience complications in Ghana, but not in Kenya and India [11].…”

“…Women with high socio-economic status are usually personally empowered; live in areas with high quality of care; tend to have relationships with healthcare providers, narrow social power between women and providers, higher expectation of care, and capacity to advocate for high quality care [8,21]. Higher incidents of disrespectful and abusive care were reported from women from lower socio-economic strata in Ethiopia and Pakistan [18,22,23]. Women who were younger and less educated were most at risk of disrespect and abuse during childbirth in Ghana, Guinea, Myanmar, and Nigeria [17].…”

“…Disrespect and abuse were more likely to be reported by women delivering at hospitals than health centres in Ethiopia [18]. In Pakistan, the risk of reporting disrespect and abuse was twice in public health facilities as compared to private [23]. Mothers who gave birth in primary level facilities have a tendency to be more satisfied than those who gave birth in hospitals [29].…”

Factors affecting Disrespect and Abuse during facility-based care in rural and urban setting in Kano, northwest Nigeria; A mixed-method study

“…Okafor et al have also reported that maternal characteristics such as age, parity, and educational status did not affect prevalence of DA significantly [Okafor, Ugwu, Obi;. Among the various sociodemographic determinants of DA, SES was found to be a significant one, with odds 3.6 times more among females with low SES [Nawab T, 2015;Azhar, Oyebode, Masud, 2017]. Health providers may treat lower SES females poorly as they are less likely to report it or reply back.…”

“I wouldn’t have hit you, but you would have killed your baby:” Exploring Midwives’ Perspectives on Disrespect and Abusive Care in Ghana.

“…In consonance with this, studies have documented the forms of D&AC childbearing women 4 have experienced in healthcare facilities. 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.…”