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Mistreatment of women during childbirth is common

WHO study focuses on lower-income countries

Jo Carlowe

Wednesday, 09 October 2019

New global evidence shows widespread mistreatment of women during childbirth in health facilities.

The study*, led by the World Health Organisation (WHO) and published today in the Lancet, shows that more than one-third of women in 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, carried out in Ghana, Guinea, Myanmar and Nigeria, found that 838 (42%) of 2,016 women experienced physical or verbal abuse, stigma or discrimination. Some 14% 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.

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. Interviews were also conducted with 2,672 women after the birth, finding similar levels of mistreatment to the direct observations.

Among the 2,016 women observed by the researchers, 35 (13%) caesarean births were conducted without the woman’s consent, as were 190 of 253 episiotomies (75%). Vaginal examinations occurred without consent in 59% of cases (2,611 of 4,393 exams).

In addition to physical abuse, 752 (38%) of the 2,016 women were observed to experience high levels of verbal abuse – most often, being shouted at, scolded and mocked. Some 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, the WHO states. Health-care providers also require support and training to ensure that women are treated with compassion and dignity.

Possible strategies 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;
  • Building public demand for high-quality maternity services that provide women-centred care and do not tolerate any form of mistreatment.

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, states the WHO. The organisation calls upon these entities to collaborate to ensure that mistreatment during childbirth is consistently identified and reported, and that locally appropriate measures are implemented.

The findings of the study should be used to inform policies and programmes to ensure that all women have positive pregnancy and childbirth experiences, supported by empowered healthcare providers within well-functioning health systems, state the study authors.


*Bohren MA, Mehrtash H, Fawole B, et al. How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys. The Lancet. Published: October 08, 2019. DOI: 10.1016/S0140-6736(19)31992-0

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