Sexual and reproductive health

Women face diverse forms of mistreatment and abuse during childbirth in health facilities worldwide

30 JUNE 2015: GENEVA In many settings worldwide, women face mistreatment during childbirth. According to the authors of a new WHO-led systematic review published in the journal PLOS Medicine, this can include physical, sexual and verbal abuse, a lack of supportive care, neglect, discrimination and a denial of autonomy.

A mother with her newborn baby recovers in a postnatal ward, Bostwana.

Health-care providers may be the perpetrators of this mistreatment, however mistreatment may also result from a complex range of factors, including diverse systemic failures within health facilities and throughout health systems. The typology of how women are mistreated during childbirth presented in this systematic review is based on a synthesis of qualitative and quantitative evidence from 65 studies conducted in 34 countries.

Quality of care and human rights

An estimated 289,000 maternal deaths occurred in 2010, of which 99% occurred in low- and middle-income countries. Improving quality of care, particularly around the time of childbirth, is crucial to reduce preventable deaths and disabilities of women and infants. The review notes that mistreatment of women during childbirth constitutes a violation of human rights to dignified, respectful sexual and reproductive health care, including during childbirth.

“We must seek to find a process by which women and healthcare providers engage to promote and protect women’s participation in safe and positive childbirth experiences, including respecting a woman’s autonomy and dignity over her body and her choices,”

Meghan Bohren, author of the article

Categories for consensus

The authors state that whilst there is now growing recognition that women experience mistreatment, there is, "no consensus at a global level on how these occurrences are defined and measured".

With this in view, the new WHO-led review proposes a comprehensive, evidence-based global typology, where types of mistreatment women experience during childbirth in health facilities are clearly defined. This typology has been created with the aim of helping to inform future research with indicators and tools to measure the prevalence of the mistreatment of women during childbirth and to develop and evaluate interventions to reduce mistreatment and promote respectful care.

“Such efforts are needed to improve the quality of maternity care, increase demand for facility-based childbirth, and more broadly to protect women’s fundamental human rights,” says Bohren.

The findings also aim to help inform policies and identify interventions which can prevent such mistreatment. The authors’ objective is to help efforts to develop global consensus on the definition of the mistreatment of women during childbirth.