‘When helpers hurt’: women’s and midwives’ stories of obstetric violence in state health institutions, Colombo district, Sri Lanka

Abstract

BackgroundThe paper explores how age, social position or class, and linguistic and cultural background intersect and place women in varying positions of control and vulnerability to obstetric violence in state health institutions in Colombo district, Sri Lanka. Obstetric violence occurs during pregnancy, childbirth and the immediate postpartum period; hence, it is violence that directly affects women. The authors aim to break the traditional culture of silence around obstetric violence and bring attention to the resulting implications for quality of care and patient trust in obstetric care facilities or providers.MethodsFive focus group discussions were held with 28 public health midwives who had prior experience working in labor rooms. Six focus group discussions were held with 38 pregnant women with previous childbirth experience. Additionally, 10 of the 38 women, whom felt they had experienced excessive pain, fear, humiliation, and/or loss of dignity as patients in labor, participated in individual in-depth interviews. An intersectional framework was used to group the qualitative data into categories and themes for analysis.ResultsObstetric violence appears to intersect with systems of power and oppression linked to structural gender, social, linguistic and cultural inequities in Sri Lanka. In our dataset, younger women, poorer women, and women who did not speak Sinhala seemed to experience more obstetric violence than those with relevant social connections and better economic positions. The women in our study rarely reported obstetric violence to legal or institutional authorities, nor within their informal social support networks. Instead, they sought obstetric care, particularly for childbirth, in other state hospitals in subsequent pregnancies.ConclusionsThe quality of obstetric care in Sri Lanka needs improvement. Amongst other initiatives, policies and practices are required to sensitize health providers about the existence of obstetric violence, and repercussions are required for abusive or discriminatory practices. The ethics of care should be further reinforced in the professional training of obstetric health providers.

“At Least Your Baby Is Healthy” Obstetric Violence or Disrespect and Abuse in Childbirth Occurrence Worldwide: A Literature Review

“…Talk in a language that patients do not understand [15] Allow medical students to perform unnecessary medical procedures on patients in public facilities to learn, while refraining to do so for patients with private healthcare [7] 6. Abandonment of Care…”

Interseccionalidades de género y violencias obstétricas.

“…Se ha demostrado cómo la violencia obstétrica aparece relacionada con condicionantes de género, la clase socioeconómica, el origen étnico, el idioma hablado (mejor dicho, no hablado), la orientación sexual, las creencias religiosas, etc. (Dinusha-Perera et al, 2018;Leal et al, 2017), hasta el punto de que se puede hablar de descolonizar el parto (Decolonizing the USVI, 2015). La asunción de las diversidades culturales en el itinerario asistencial sigue siendo un punto débil en el sistema de salud (Brigidi, 2009) y esto resulta evidente no solo en la literatura científica, sino en los foros digitales donde tanto pacientes como profesionales relatan casos vividos y observados de xenofobia y prejuicios culturales.…”

Feasibility of Participatory Theater Workshops to Increase Staff Awareness of and Readiness to Respond to Abuse in Health Care: A Qualitative Study of a Pilot Intervention Using Forum Play among Sri Lankan Health Care Providers

“…We refer to this global phenomenon as abuse in health care (AHC). AHC experienced by women in childbirth, particularly disrespectful behavior and physical violence, has been documented in numerous studies [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. It is sometimes referred to as obstetric violence or disrespect and abuse (D&A) during facility-based childbirth.…”

“…The global literature reveals a range of intentional and unintentional acts of emotional, verbal, physical, and sexual violence perpetrated by health providers in a vast array of contexts that may inadvertently cause patient suffering and contravene international recommendations for optimal interpartum care [ 2 , 10 , 14 ]. We have documented transgressions of the ethics of care to patients in health care settings in the global north and south [ 8 , 15 , 16 , 17 , 18 , 19 ], including in Sri Lanka where nearly all women (98%) give birth in health facilities [ 20 ]. In the different contexts of our work, experiences of AHC were related to diminished trust in and avoidance of the health care system.…”