Exposing Obstetric Violence in the Eastern Mediterranean Region: A Review of Women's Narratives of Disrespect and Abuse in Childbirth

Abstract

BackgroundObstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve rights-based and respectful health practice and policy. While efforts to improve the quality of maternal health have long-existed, women's experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the said region.AimThis study centered on the experiences of women's mistreatment in childbirth to provide an overview of OV and offer recommendations to improve RMC.MethodsA scoping review was conducted, and a total of 38 articles met the inclusion criteria and were analyzed using Bowser and Hill's framework of the seven typologies of Disrespect and Abuse (D&A) in childbirth. D&A in childbirth (or violations to RMC) is a manifestation of OV and served as a proxy to analyze its prevalence in the EMR.Findings and DiscussionThis study indicated that across the EMR, women experienced every type of D&A in childbirth. This happens regardless of health systems' strength or country's income, with 6 out of 7 types of D&A found in almost two-thirds of included countries. In the EMR, the most common types of D&A in childbirth are physical abuse (especially overused routine interventions) and non-dignified care (embedded in patriarchal socio-cultural norms). The intersections of these abuses enable the objectification of women's bodies and overuse of unconsented routine interventions in a hierarchical and patriarchal system that regards the power and autonomy of doctors above birthing women. If unchecked, the implications include acceptance, continuation, and underreporting of D&A in childbirth, as well as passivity toward human-rights violations, which all further cause the continuing the cycle of OV.ConclusionIn order to eliminate OV, a paradigm shift is required involving infrastructure changes, education, empowerment, advocacy, a women-centered and gender-sensitive approach to health system strengthening, and policy development. Recommendations are given at individual, community, health systems, and policy levels to ensure that every woman achieves her right to health and birth in a dignified, respectful, and empowered manner.

Exploring women’s experiences during childbirth in health facilities during COVID-19 pandemic in occupied palestinian territory: a cross-sectional community survey

“…Still, there is limited information available about the quality of care during the childbirth process in the region. A recent scoping review of the EMR reported that the most common types of mistreatment during childbirth are physical abuse and non-dignified care [ 8 ]. In the past ten years, maternal health indicators have been improving in the occupied Palestinian territory (oPt).…”

An online survey of women’s views of respectful and disrespectful pregnancy and early labour care in the Czech Republic

“…This is an example of very disrespectful care and may be occurring, unacknowledged, in many other countries as a recent systematic review [ 39 ] failed to find any research in this area. Not gaining women’s consent for interventions or procedures is not uncommon, as is shown in systematic reviews [ 40 , 41 ] and in studies conducted in a myriad of settings globally [ 15 – 17 , 41 – 43 ].…”

Intrapartum violence during facility-based childbirth and its determinants: A cross-sectional study among postnatal women in Tanzania

“…11 The knowledge and awareness level of the participants regarding OV and women rights might be more common to people living to urban due to several exposures. 35,48 In another study conducted at Northern Nigeria, it was reported that lack of awareness on RMC because of lower level of education may contribute to their inability to differentiate between acceptable standard of care, and abusive care. 38 We also found that women whose husbands were employed were protected against any form of OV during labor and childbirth compared to their counterparts.…”