The shocking abuse of women worldwide during childbirth

The World Health Organisation has published a remarkable study that documents the abuse women worldwide experience during childbirth.

Published in a scholarly journal, it hasn’t yet received very much attention – which is a shame, because the treatment it highlights is deeply shocking.

The study is a systematic review, which means that it looks at research already published on this topic. It looks at 65 studies undertaken in 34 countries looking at the mistreatment of women during childbirth. The authors identify seven categories of abuse: physical abuse; sexual abuse; verbal abuse; stigma and discrimination like age or race; failure to meet professional standards of care; poor rapport between women and their healthcare providers; and health system conditions such as lack of privacy.

This is what the study says about the first of these – physical abuse:

“Physical abuse during childbirth was perpetrated by nurses and doctors. Women sometimes reported specific acts of violence, but often referred to these experiences more generally, describing beatings, aggression, physical abuse, a ‘rough touch,’ and the use of extreme force. Hitting and slapping, with an open hand or an instrument, were the most commonly reported specific acts of physical violence. Women also reported being pinched, particularly on the thighs and kicked. Some women were physically restrained during labor with bed restraints and mouth gags.”

It’s difficult to understand how anyone can imagine that this might be the appropriate way to treat a woman giving birth. Elsewhere, the study paints a picture of women having their babies in filthy conditions, being shouted at or threatened by health workers or having procedures forced on them without their consent.

Most of this abuse occurs in low- to middle-income countries – though we know that some categories (such as verbal abuse or consent not being sought for certain procedures) can occur in wealthier countries too.

The findings exist against a backdrop in which nearly 300,000 women, 99% them living in low- and middle-income countries, die each year from pregnancy- or childbirth-related complications. These deaths are almost all preventable with proper care. But there are other long-term consequences of poor care, including physical damage (such as obstetric fistula) and mental ill-health, such as depression or post-traumatic stress disorder. These – to put it at its mildest – have a lasting impact on women’s ability to look after or provide for their children.

Depressing though the study is, we should welcome this recognition by the WHO that abuse of women in childbirth is a problem that needs dealing with. Its identification of seven categories of abuse provides a framework for future research and policy-making.

And the message it sends out is one that policymakers everywhere – not just in the developing world – should take notice of:

“A woman’s autonomy and dignity during childbirth must be respected, and her health care providers should promote positive birth experiences through respectful, dignified, supportive care, as well as by ensuring high-quality clinical care.”