An alarming number of women are mistreated while giving birth, says study

In a study conducted in 2019, the World Health Organization (WHO) revealed that more than one-third of women across the globe experience mistreatment during childbirth in health facilities. The organization determined that four in ten women in these scenarios experienced physical or verbal abuse, stigma, and discrimination [1].

The situation in the United States, unfortunately, is not much better. According to a 2019 survey published in the Reproductive Health journal, one in six American women report being mistreated during labor. This mistreatment included “loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help.” [2]

When women are mistreated during birth, it can have lasting consequences for the physical and mental health of the mother as well as the physical health of her newborn baby. For this reason, it is of crucial importance that this issue is brought to light in order to prevent it from continuing.

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The Seven Types of Abuse

WHO researchers described seven dimensions of mistreatment in maternity care that adversely impact both quality and safety during the birthing process. Those seven domains are as follows:

1. Physical abuse – for example, slapping or pinching during delivery
2. Sexual abuse – for example, unconsented vaginal exams
3. Verbal abuse – for example, the use of harsh or rude language
4. Stigma and discrimination – based on age, ethnicity, socioeconomic status, or medical conditions
5. Failure to meet professional standards of care – for example, neglect during delivery
6. Poor rapport between women and providers – including ineffective communication, lack of supportive care, and loss of autonomy
7. Health system conditions and constraints – for example, a lack of resources needed to provide women with privacy [3]

The most common type of reported abuse was being shouted at or scolded by a healthcare provider, followed by “health care providers ignoring women, refusing their request for help, or failing to respond to requests for help in a reasonable amount of time” [2].

Which Women are Being Mistreated During Birth?

While mistreatment was observed across all ethnicities and socioeconomic statuses, the research from the Reproductive Health journal showed that the instance of abuse was notably higher in women of color, single women, and women under the age of thirty [2].

The study also found that 5.1 percent of women who gave birth at home reported mistreatment, while over 28 percent of women who gave birth at the hospital reported mistreatment. They noted that race seemed to play the most substantial role in mistreatment, with 27.2 percent of women of color with low socioeconomic status reported mistreatment, compared with 18.7 percent of white women with low socioeconomic status. Even just having a partner who was black increased reported mistreatment [2].

Younger women who were less educated were also more at risk for mistreatment [4].

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The Consequences of Mistreatment During Childbirth

Mistreatment during childbirth has both a direct and indirect impact on the mother and her child. In many cases, women and their families have such low expectations for their treatment during birth that they accept a lower standard of care, or physical and verbal abuse.

For example, a study conducted in Nigeria found that women and healthcare providers deemed it acceptable for a healthcare provider to slap a woman during childbirth if it was done to encourage her to push [5].

The WHO released a statement speaking out against mistreatment during childbirth, positioning it as a violation of rights and trust between women and their healthcare providers. The statement included the following:

“Many women experience disrespectful and abusive treatment during childbirth in facilities worldwide. Such treatment not only violates the rights of women to respectful care, but can also threaten their rights to life, health, bodily integrity, and freedom from discrimination. This statement calls for greater action, dialogue, research and advocacy on this important public health and human rights issue.” [6]

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The Way Forward

These findings indicate that not only is there mistreatment happening at the level of interaction between a woman and the healthcare provider, but that there are systemic failings at the level of the healthcare facility and the health system that are contributing to the problem.

At the level of the healthcare facility and health system, there are a number of challenges that need to be addressed, including poor supervisory structures, insufficient staffing, inadequate supply chains, poor physical conditions, and power dynamics that systematically disempower women [7].

The WHO has released recommendations on intrapartum care which highlight the importance of women-centered care, and use a holistic, human rights-based approach to improve the experience of labor and childbirth. 

The recommendations include “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.” [7]

The guidelines state that the only way to prevent the mistreatment of women during childbirth is through inclusive and equitable processes that engage both women and healthcare providers, and suggest the following four possible strategies:

• Redesigning labour wards to allow for privacy and labour companionship
• Providing skills-building exercises for effective communication and on the informed consent process for all procedures
• Teaching providers stress-coping mechanisms
• Ensuring that healthcare providers are empowered and supported through supervisory structures; that workloads are manageable; and that remuneration is adequate [7].

Supporting Healthcare Workers

The recommendations also highlight the role of professional associations in supporting midwives, obstetricians, and other maternity providers and protecting their rights. It is the responsibility of these organizations to consistently identify and report instances of mistreatment during childbirth and to implement locally appropriate measures when and where they are needed [7].

Further research is also necessary in order to properly quantify the mistreatment of women during childbirth, as well as to identify the characteristics of facilities that either precipitate or mitigate the mistreatment of women [3].

For now, midwife Diana Spalding has one thing to say to caregivers who are mistreating their patients:

“To be entrusted with the responsibility of caring for a woman giving birth is one of the single greatest honors available in the human experience. If the day has come that you are too stressed, too tired, too jaded to treat women with respect, then the day has come for you to leave this profession.” [8]

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