Disrespect and abuse of women during childbirth in Nigeria: A systematic review

Abstract

BackgroundPromoting respectful care at childbirth is important to improve quality of care and encourage women to utilize skilled delivery services. However, there has been a relative lack of public health research on this topic in Nigeria. A systematic review was conducted to synthesize current evidence on disrespect and abuse of women during childbirth in Nigeria in order to understand its nature and extent, contributing factors and consequences, and propose solutions.MethodsFive electronic databases were searched for relevant published studies, and five data sources for additional grey literature. A qualitative synthesis was conducted using the Bowser and Hill landscape analytical framework on disrespect and abuse of women during childbirth.ResultsFourteen studies were included in this review. Of these studies, eleven were cross sectional studies, one was a qualitative study and two used a mixed method approach. The type of abuse most frequently reported was non-dignified care in form of negative, poor and unfriendly provider attitude and the least frequent were physical abuse and detention in facilities. These behaviors were influenced by low socioeconomic status, lack of education and empowerment of women, poor provider training and supervision, weak health systems, lack of accountability and legal redress mechanisms. Overall, disrespectful and abusive behavior undermined the utilization of health facilities for delivery and created psychological distance between women and health providers.ConclusionThis systematic review documented a broad range of disrespectful and abusive behavior experienced by women during childbirth in Nigeria, their contributing factors and consequences. The nature of the factors influencing disrespectful and abusive behavior suggests that educating women on their rights, strengthening health systems to respond to specific needs of women at childbirth, improving providers training to encompass interpersonal aspects of care, and implementing and enforcing policies on respectful maternity care are important. This review has also shown that more robust research is needed to explore disrespect and abuse of women during childbirth in Nigeria and propose compelling interventions.

Role of verbal and non-verbal communication of health care providers in general satisfaction with birth care: a cross-sectional study in government health settings of Erbil City, Iraq

“…Younger women with no education and younger women with some education were more likely to experience verbal abuse, compared with older women (≥30 years) [14]. In a cross-sectional study by Okafor et al in Enugu State in Nigeria, 20% of women reported discrimination on the basis of ethnicity, low social class, young age and HIV seropositive status, however, in four cross-sectional studies, women of low socioeconomic status and with no formal education reported experiences of unfriendly and harsh attitudes of staff in higher proportions [12]. Women in labor have a need for companionship, empathy and help, and descriptive studies of women's childbirth experiences have suggested four dimensions to the support that they want during labor: emotional support, informational support, physical support and advocacy [20].…”

“…Studies show that younger women, women with a low education level, rural residents and primiparas reported discrimination and unfriendly behaviors by providers and staff in the delivery room. As a result, they were not satisfied with their labor care [12][13][14]. No research could find on this subject in the Kurdistan region of Iraq; therefore, I investigated midwives' and physicians' communication skills in the delivery room in Erbil city, Iraq.…”

Midwives’ perspectives of respectful maternity care during childbirth: A qualitative study

“…Respectful Maternity Care (RMC) has been recognized as an essential strategy for improving quality and utilization of maternity care [6]. It is defined as a universal human right that encompasses the principles of ethics and respect for women's feelings, dignity, choices and preferences [7]. Indeed, RMC is an approach to care which emphasizes the fundamental rights of women, newborns, and families, and that enhances adequate access to evidence-based care while recognizing the unique needs and preferences of both women and newborns [8].…”

Midwives' Perspectives of Respectful Maternity Care during Childbirth: A Qualitative Study

“…It is around a decade that promoting Respectful Maternity Care (RMC) has been recognized as an essential strategy for improving quality and utilization of maternity care [6]. It is defined as a universal human right that encompasses the principles of ethics and respect for women's feelings, dignity, choices and preferences [7]. Indeed, RMC is an approach to care which emphasizes the fundamental rights of women, newborns, and families, and that enhances adequate access to evidence-based care while recognizing the unique needs and preferences of both women and newborns [8].…”