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Report shows mistreatment by health workers during childbirth

They are slapped and pinched during labor, yelled at, denied pain medicine, neglected and forced to share beds with other women who just gave birth. And that is just a partial list of the abuses and humiliations inflicted on women around the world as their babies are born.

A new report based on information from 34 countries, published in the journal PLOS Medicine, finds that "many women globally experience poor treatment during childbirth, including abusive, neglectful or disrespectful care."

This kind of mistreatment can drive women away from hospitals and undermine international goals of reducing deaths during childbirth — now about 300,000 a year. Most maternal deaths are preventable: They are caused by problems that can be treated, like bleeding, infection and high blood pressure. Often, to save the woman’s life, the care must be quick and expert.

Health officials say the key to reducing maternal mortality is to increase the proportion of women who give birth in hospitals rather than at home. But women will avoid hospitals if they fear being abused when they are most vulnerable.

"To imagine that women are mistreated during this very special time is truly devastating," said Meghan A. Bohren, a research consultant at the World Health Organization and the first author of the new report.

The WHO had already expressed concern about the issue in a 2014 statement that mentioned many forms of abuse, such as women’s being forced into medical procedures, including sterilization, and mothers’ and infants’ being held in detention in medical facilities for inability to pay.

A commentary in The Lancet in 2014 by researchers from Columbia University said the problem of abusive treatment "runs wide and deep within the maternity services of many countries."

Bohren said she had worked on women’s health issues in Ghana, Sudan, Uganda, Guinea and Nigeria, and had heard shocking accounts of mistreatment from women, as well as encountering such reports in studies by other researchers.

She said that although many of the abuses occurred on a personal, one-to-one level between health workers and patients, some of the fault also lay with hospitals and health systems. Insufficient staffing, poor training and lack of supervision can all contribute, as can the lack of supplies, water and electricity. A more fundamental problem is the low status of and lack of respect for women in many cultures.

The PLOS article compiles information from 65 studies but does not provide new data or give global measurements of how commonly abuses occur. It cites several studies that do provide estimates based on groups of several hundred to nearly 2,000 women. For instance, a study in Nigeria found that 98 percent of 446 women reported some form of mistreatment. In another study, based on 593 women in Tanzania, the figure was 28 percent.

One goal of the article, Bohren said, was to categorize the types of problems that women encounter, to aid further studies and to develop ways to stop the abuse. There were seven categories of abuse: physical, sexual, verbal, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers, and problems with health systems.

The research was paid for by the U.S. Agency for International Development.

Bohren said researchers wanted to know, "What do people mean when they say they’re mistreated by health workers?"

Nearly all of the 300,000 women a year who die from complications of pregnancy or birth live in low- and middle-income countries. In poorer countries, about a third of women give birth without what experts call a skilled birth attendant, meaning someone with medical training like a professional midwife, doctor or nurse.

The maternal death rate has dropped in recent years, but not as much as the United Nations hoped in 2000 when it set a millennium development goal of a 75 percent reduction from the 1990 rate by 2015. In 1990, there were 380 maternal deaths per 100,000 births, so a 75 percent reduction would have lowered it to 95 per 100,000. But in 2013, the figure was still 210 per 100,000.

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