Table 5.
Mistreatment of women during childbirth (community survey)
| Ghana (n=836) | Guinea (n=644) | Myanmar (n=631) | Nigeria (n=561) | Total (n=2672) | ||||
|---|---|---|---|---|---|---|---|---|
| Any physical abuse, verbal abuse, or stigma or discrimination | 308 (36·8%) | 235 (36·5%) | 131 (20·8%) | 271 (48·3%) | 945 (35·4%)* | |||
| Any physical abuse | 52 (6·2%) | 124 (19·3%) | 21 (3·3%) | 90 (16·0%) | 287 (10·7%)* | |||
| Any verbal abuse | 284 (34·0%) | 173 (26·9%) | 116 (18·4%) | 248 (44·2%) | 821 (30·7%)* | |||
| Any stigma or discrimination | 31 (3·7%) | 9 (1·4%) | 11 (1·7%) | 28 (5·0%) | 79 (3·0%)* | |||
| Failure to meet professional standards† | ||||||||
| Caesarean section | 118 (14·1%) | 76 (11·8%) | 267 (42·3%) | 22 (3·9%) | 483 (18·1%) | |||
| Non-consented | 24 (20·3%) | 6 (7·9%) | 21 (7·9%) | 1 (4·5%) | 52 (10·8%)* | |||
| Episiotomy (2187 women with vaginal birth)‡ | 92 (12·8%) | 52 (9·2%) | 250 (68·7%) | 132 (24·5%) | 526 (24·1%) | |||
| Non-consented | 38 (41·3%) | 38 (73·1%) | 166 (66·4%) | 53 (40·2%) | 295 (56·1%)* | |||
| Induction of labour | 125 (15·0%) | 3 (0·5%) | 173 (27·4%) | 48 (8·6%) | 349 (13·1%) | |||
| Non-consented | 24 (19·2%) | 1 (33·3%) | 60 (34·7%) | 9 (18·8%) | 94 (26·9%) | |||
| Vaginal examinations | ||||||||
| Woman had any vaginal examination | 808 (96·7%) | 589 (91·5%) | 505 (80·0%) | 543 (96·8%) | 2445 (91·5%) | |||
| No consent before vaginal examination | 379 (46·9%) | 294 (49·9%) | 232 (45·9%) | 309 (56·9%) | 1214 (49·7%)* | |||
| Staff member discussed private health information from vaginal examination so that others could hear | 55 (6·8%) | 67 (11·4%) | 71 (14·1%) | 210 (38·7%) | 403 (16·5%) | |||
| Vaginal examination not done privately | 236 (29·2%) | 292 (49·5%) | 131 (25·9%) | 365 (67·2%) | 1024 (41·9%)* | |||
| General description of experience of vaginal examinations | ||||||||
| Comfortable | 71 (8·8%) | 153 (26·0%) | 375 (74·3%) | 46 (8·5%) | 645 (26·4%)* | |||
| A little uncomfortable | 142 (17·6%) | 193 (32·8%) | 93 (18·4%) | 141 (26·0%) | 569 (23·3%)* | |||
| Quite uncomfortable | 217 (26·9%) | 125 (21·2%) | 21 (4·2%) | 144 (26·5%) | 507 (20·7%)* | |||
| Very uncomfortable | 371 (45·9%) | 115 (19·5%) | 11 (2·2%) | 203 (37·4%) | 700 (28·6%)* | |||
| Pain relief | ||||||||
| Woman not offered pain relief during time in hospital | 511 (61·1%) | 456 (70·8%) | 90 (14·3%) | 471 (83·9%) | 1528 (57·2%)* | |||
| Woman requested pain relief | 85 (10·2%) | 212 (32·9%) | 181 (28·7%) | 51 (9·1%) | 529 (19·8%) | |||
| Woman requested pain relief but did not receive it | 40 (47·1%) | 67 (31·6%) | 15 (8·3%) | 29 (56·9%) | 151 (28·5%)* | |||
| Woman denied pain relief during time in hospital | 46 (5·5%) | 19 (3·0%) | 34 (5·4%) | 50 (8·9%) | 149 (5·6%)* | |||
| Neglect and abandonment | ||||||||
| Staff member not present when the baby came out (2187 women with vaginal birth)‡ | 24 (3·4%) | 2 (0·4%) | 2 (0·6%) | 16 (3·0%) | 44 (2·0%) | |||
| Woman waited for long periods of time before attended by health workers | 281 (33·6%) | 75 (11·7%) | 139 (22·0%) | 92 (16·4%) | 587 (22·0%)* | |||
| Woman felt ignored, neglected, or that presence was a nuisance for health workers or staff | 137 (16·4%) | 72 (11·2%) | 121 (19·2%) | 104 (18·5%) | 434 (16·2%)* | |||
| Communication | ||||||||
| Language interpretation needed | 10 (1·2%) | 15 (2·3%) | 0 | 2 (0·4%) | 27 (100·0%) | |||
| Interpreter not available | 2 (20·0%) | 3 (20·0%) | 0 | 2 (100·0%) | 7 (25·9%)* | |||
| Woman felt that health workers or staff did not listen and respond to her concerns | 105 (12·6%) | 113 (17·6%) | 200 (31·7%) | 59 (10·5%) | 477 (17·9%) | |||
| Supportive care | ||||||||
| Not allowed to have a labour companion during labour and birth | 486 (58·1%) | 336 (52·2%) | 5 (0·8%) | 373 (66·5%) | 1200 (44·9%)* | |||
| Did not have a labour companion present at any point | 437 (52·3%) | 560 (87·0%) | 1 (0·2%) | 320 (57·0%) | 1318 (49·3%)* | |||
| Autonomy | ||||||||
| Did not have easy access to water or oral fluids (2187 women with vaginal birth)‡ | 89 (12·4%) | 74 (13·1%) | 50 (13·7%) | 214 (39·7%) | 427 (19·5%)* | |||
| Not allowed to eat (2187 women with vaginal birth)‡ | 298 (41·6%) | 82 (14·5%) | 1 (0·3%) | 327 (60·7%) | 708 (32·4%)* | |||
| Woman not told to or did not mobilise during labour | 707 (84·6%) | 60 (9·3%) | 317 (50·2%) | 523 (93·2%) | 1607 (60·1%) | |||
| Woman did not have a preferred birthing position | 810 (96·9%) | 517 (80·3%) | 512 (81·1%) | 526 (93·8%) | 2365 (88·5%) | |||
| Woman or baby detained in hospital because of inability to pay hospital bills | 40 (4·8%) | 56 (8·7%) | 7 (1·1%) | 30 (5·4%) | 133 (5·0%) | |||
| Health systems | ||||||||
| Curtains, partitions, or other privacy measures not used | 65 (7·8%) | 339 (52·6%) | 330 (52·3%) | 468 (83·4%) | 1202 (45·0%) | |||
| Staff suggested or asked for a bribe, informal payment, or gift | 104 (12·4%) | 306 (47·5%) | 255 (40·4%) | 60 (10·7%) | 725 (27·1%) | |||
| Woman instructed to clean up own blood, urine, faeces, or amniotic fluid after birth | 8 (1·0%) | 6 (0·9%) | 99 (15·7%) | 5 (0·9%) | 118 (4·4%) | |||
See appendix (pp 11–14) for extended version.
*
Results with significant p values (p<0·05). χ2 test used to compare proportions of mistreatment items across countries.
†
Procedure explained and woman agreed to the procedure (informed consent).
‡
Number of women with vaginal birth per country: Ghana, n=717; Guinea, n=567; Myanmar, n=364; Nigeria, n=539.