Disrespect and abuse of women during childbirth at health facilities in Eastern Africa: systematic review and meta-analysis

Abstract

BackgroundDisrespectful and abusive maternity care is a sign of poor treatment that influences women’s choice to deliver their babies in institutions. Such malpractices continue to go unreported and are rarely exposed in developing countries, despite their serious burden. Therefore, this meta-analysis study aimed to estimate disrespect and abuse of women during childbirth in East Africa.MethodsPubMed, Google Scholar, Scopus, and Science Direct databases were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Publication bias was checked by forest plot, Begg’s rank test, and Egger’s regression test. To look for heterogeneity, I2 was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by study region, sample size, and publication. The pooled odds ratio for associated factors was also computed.ResultsOut of 654 articles assessed, 18 met the criteria and were included in this study. There were a total of 12,434 study participants. The pooled prevalence of disrespect and abuse of women during childbirth in East Africa was 46.85% (95% CI: 45.26.72–66.98), I2 = 81.9%. It was lower in studies with sample size greater than 5000 (33%). The disrespect and abuse rates between community-based studies (44.96%) and institutional-based studies (47.35%) did not differ significantly, though. Instrumental delivery (AOR = 2.70; 95%CI: 1.79–4.08), presence of complications (AOR = 6.41; 95% CI: 1.36–30.14), receiving care at government hospitals (AOR = 3.66; 95% CI: 1.09–12.23), and poor wealth index (AOR = 2.16; 95% CI: 1.26–3.70) were associated factors.ConclusionIn East Africa, disrespect and abuse of women during childbirth was high. Instrumental delivery, presence of complications during childbirth, receiving care at government hospitals and poor wealth index were predictors of maternal disrespect and abuse. Safe delivery practice should be promoted. Training in compassionate and respectful maternity care, particularly in public hospitals, has also been recommended.

Some scandals in gender-based violence and intimate partner violence

“…All the incidents of abuse exemplify disrespect, as the perpetrators are not considerate when imposing themselves on the victims. This point is echoed by several authors (Adinew et al, 2023;Gebeyehu et al, 2023;Mwasha et al, 2023;Yalley et al, 2023) who all view abuse and humiliation as being equivalent concepts that express disrespect for the victims.…”

Impact of disrespectful maternity care on childbirth complications: a multicentre cross-sectional study in Ethiopia

“…Various factors contribute to disrespectful care, such as complications, instrumental deliveries, care provided in government hospitals, and low wealth index. Women who have experienced complications are six times more likely to be disrespected and abused during childbirth, whereas those who undergo instrumental deliveries are 2.7 times more likely to face disrespect and abuse compared to those who have spontaneous vaginal deliveries [ 44 , 45 ]. Research highlights the importance of addressing disrespectful treatment and providing respectful care to all women, regardless of their country of origin, mode of birth and place of birth.…”

Evidence-based intrapartum care during vaginal births: Direct observations in a tertiary care hospital in Central Sri Lanka

“…Lack of privacy in healthcare settings will reduce the quality of care, and cause irreversible harm to the patient [ 31 ]. Privacy preservation is one of the key aspects of respectful maternity care which is recommended by the WHO [ 32 ], and it is one of the most important reasons for childbirth satisfaction among mothers, which leads to positive childbirth experiences [ 31 ]. However, a lack of privacy during labour and childbirth keeps women from using maternal health services [ 32 , 33 ], diminishes their satisfaction and confidence in the healthcare system, and results in unfavourable pregnancy outcomes [ 32 , 34 ].…”

“…Privacy preservation is one of the key aspects of respectful maternity care which is recommended by the WHO [ 32 ], and it is one of the most important reasons for childbirth satisfaction among mothers, which leads to positive childbirth experiences [ 31 ]. However, a lack of privacy during labour and childbirth keeps women from using maternal health services [ 32 , 33 ], diminishes their satisfaction and confidence in the healthcare system, and results in unfavourable pregnancy outcomes [ 32 , 34 ]. Therefore, respecting women's needs as well as maintaining privacy and confidentiality is considered foundational to high-quality intrapartum care [ 35 ].…”