42% of women in Nigeria, others suffer abuse, stigma during childbirth
According to new evidence from a World Health Organisation (WHO)-led study, published October 9, 2019 in the journal Lancet, more than one-third of women in the four lower-income countries experienced mistreatment during childbirth in health facilities.
Younger, less-educated women were found to be the most at risk of mistreatment, which can include physical and verbal abuse, stigmatisation and discrimination, medical procedures conducted without their consent, use of force during procedures, and abandonment or neglect by health care workers.
The study found that 838 (42 per cent) of 2,016 women experienced physical or verbal abuse, stigma or discrimination. 14 per cent experienced physical abuse – most commonly being slapped, hit or punched. There were also high rates of non-consensual caesarean sections, episiotomies (surgical cuts made at the opening of the vagina during childbirth) and vaginal examinations.
Earlier studies showed Nigeria is a risky place to give birth and around 58,000 mothers die in childbirth yearly, and 240,000 newborns within 28 days of birth.
A 2017 study titled “Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers” and published in journal Reproductive Health concluded: “Moving forward, findings from this study must be communicated to key stakeholders at the study facilities. Measurement tools to assess how often mistreatment occurs and in what manner must be developed for monitoring and evaluation. Any intervention to prevent mistreatment will need to be multifaceted, and implementers should consider lessons learned from related interventions, such as increasing audit and feedback including from women, promoting labor companionship and encouraging stress-coping training for providers.”
Also, a new study found would-be mothers who feel overwhelmed or depressed are at greater risk of suffering a miscarriage if they are pregnant with a boy.
Scientists at Columbia University in New York, United States (U.S.), said that, in many cases, women will not yet have realised they have conceived when the pregnancy fails due to stress.
The team correlated birth outcomes in a group of 187 pregnant women with 27 indicators of psychosocial, physical and lifestyle stress.
They noted that the boy-to-girl ratio in women who were physically stressed was 4:9, and 2:3 in women who were psychologically stressed.
This is compared to 105:100 boy-girl ration across the whole population.
Published in the journal of the Proceedings of the National Academy of Sciences, the study appears to explain longstanding trends showing an increase in births of girls relative to boys following national traumas, such as 9/11, the assassination of JFK and various earthquakes.
The researchers believe the phenomenon may be explained by the fact male foetuses take longer to complete their early developmental stages, leaving them more vulnerable to sub-optimal conditions in the womb.
WHO guidelines promote respectful maternity care for all women, which is care that maintains ‘dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth’.
The study observed 2,016 women during labour and childbirth in Ghana, Guinea, Myanmar and Nigeria. Interviews were also conducted with 2,672 women after birth, finding similar levels of mistreatment to direct observations.
Among the 2016 women observed by the researchers, 35 (13 per cent) caesarean births were conducted without the woman’s consent, as were 190 of 253 episiotomies (75 per cent). Vaginal examinations occurred without consent in 59 per cent of cases (2611 of 4393 exams).
In addition to physical abuse, 752 (38 per cent) of the 2016 women were observed to experience high levels of verbal abuse – most often, being shouted at, scolded and mocked. 11 women experienced stigma or discrimination, typically regarding their race or ethnicity.
To tackle mistreatment during childbirth, health systems must be held accountable, and sufficient resources must be in place to provide quality, accessible maternal health care and clear policies on women’s rights. Health-care providers also require support and training to ensure that women are treated with compassion and dignity.
Possible strategies recommended by the study include: redesigning labour wards to meet the needs of women, including allowing for privacy and labour companionship; improving the informed consent process around all medical interventions; providing sufficient mentoring and support for health workers to help them deliver better quality care; allowing all women who want one to have a companion of their choice with them throughout labour and childbirth; and building public demand for high quality maternity services that provide women-centred care and do not tolerate any form of mistreatment.
According to the study, professional associations can also play a crucial role in promoting and supporting respectful care among midwives, obstetricians and other maternity providers, and safeguarding their rights. The WHO calls upon these entities to collaborate to ensure that mistreatment during childbirth is consistently identified and reported and that locally appropriate measures are implemented.
According to a study titled “WHO model of intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and wellbeing” and published in International Journal of Obstetrics and Gynaecology, there is a shift in the maternal, newborn, and child health agenda from an exclusive focus on survival to the inclusion of drivers for thriving and transformation.
The study noted: “This shift is in line with the third Sustainable Development Goal – ensuring healthy lives and promoting wellbeing for all at all ages – and the new Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030). Through research and the development of norms and standards, the WHO is supporting this global agenda by outlining a vision for high‐quality care for all pregnant women and their newborns, throughout pregnancy, childbirth, and the postnatal period.
“As part of this effort, WHO released new recommendations on antenatal care for a positive pregnancy experience in 2016, and recently published new recommendations on intrapartum care, again stressing the importance of positive experience during childbirth. These recommendations go beyond the prevention of death and morbidity, as they encompass a person‐centred philosophy that includes optimising health and wellbeing for the woman and her baby.”
Meanwhile, the findings of the WHO-led study should be used to inform policies and programmes to ensure that all women have a positive pregnancy and childbirth experiences, supported by empowered healthcare providers within well-functioning health systems.
This research was made possible by the support of the American People through the United States Agency for International Development (USAID) and the United Nations Development Programme (UNDP)/ United Nations Population Fund, formerly the United Nations Fund for Population Activities (UNFPA)/United Nations Children’s Fund, originally known as the United Nations International Children’s Emergency Fund (UNICEF)/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO.
In 2014, WHO issued a statement on the prevention and elimination of disrespect and abuse during facility-based childbirth. The WHO statement positioned mistreatment during childbirth as a violation of rights and trust between women and their healthcare providers. It also called for greater action, dialogue, research and advocacy.
2018 WHO recommendations on intrapartum care for a positive childbirth experience highlight the importance of woman-centred care to optimize women’s experiences of labour and childbirth through a holistic, human rights-based approach. This includes the provision of respectful maternity care that maintains women’s dignity, privacy and confidentiality, enables informed choice and continuous support throughout labour and childbirth, and ensures freedom from mistreatment.