Balde Mamadou Diouldé, Bangoura Abou, Diallo Boubacar Alpha, Sall Oumar, Balde Habibata, Niakate Aïssatou Sona, Vogel Joshua P, Bohren Meghan A
Cellule de recherche en santé de la reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea.
Faculté de médecine, pharmacie et odontostomatologie, Université G.A. Nasser de Conakry, Conakry, Guinea.
Reprod Health. 2017 Jan 13;14(1):4. doi: 10.1186/s12978-016-0262-5.
Reducing maternal morbidity and mortality remains a key health challenge in Guinea. Anecdotal evidence suggests that women in Guinea are subjected to mistreatment during childbirth in health facilities, but limited research exists on this topic. This study was conducted to better understand the social norms and the acceptability of four scenarios of mistreatment during childbirth, from the perspectives of women and service providers.
This study used qualitative methods including in-depth interviews (IDIs) and focus group discussions (FGDs) with women of reproductive age, midwives, nurses and doctors. This study was conducted in one urban area (Mamou) and one peri-urban area (Pita) in Guinea. Participants were presented with four scenarios of mistreatment during childbirth, including a provider: (1) slapping a woman; (2) verbally abusing a woman; (3) refusing to help a woman; and (4) forcing a woman to give birth on the floor. Data were collected in local languages (Pular and Malinké) and French, and transcribed and analyzed in French. We used a thematic analysis approach and manually coded the data using a codebook developed for the project.
A total of 40 IDIs and eight FGDs were conducted with women of reproductive age, 5 IDIs with doctors, and 13 IDIs with midwives. Most women were not accepting of any of the scenarios, unless the action was perceived to be used to save the life of the mother or child. However, they perceived a woman's disobedience and uncooperativeness to contribute to her poor treatment. Women reacted to this mistreatment by accepting poor treatment, refusal to use the same hospital, revenge against the provider or complaints to hospital management. Service providers were accepting of mistreatment when women were disobedient, uncooperative, or to save the life of the baby.
This is the first known study on mistreatment of women during childbirth to be conducted in Guinea. Both women and service providers were accepting of mistreatment during childbirth under certain conditions. Any approach to preventing and eliminating mistreatment during childbirth must consider these important contextual and social norms and develop a comprehensive intervention that addresses root causes. Further research is needed on how to measure mistreatment during childbirth in Guinea.
降低孕产妇发病率和死亡率仍是几内亚面临的一项关键卫生挑战。有传闻证据表明，几内亚的妇女在医疗机构分娩期间遭受虐待，但关于这一主题的研究有限。本研究旨在从妇女和服务提供者的角度，更好地了解分娩期间四种虐待情况的社会规范及可接受性。
本研究采用定性方法，包括对育龄妇女、助产士、护士和医生进行深入访谈（IDI）和焦点小组讨论（FGD）。本研究在几内亚的一个城市地区（马穆）和一个城郊地区（皮塔）开展。向参与者展示了四种分娩期间的虐待情况，包括医护人员：（1）扇妇女耳光；（2）辱骂妇女；（3）拒绝帮助妇女；（4）强迫妇女在地板上分娩。数据以当地语言（富拉语和马林凯语）及法语收集，并用法语进行转录和分析。我们采用主题分析法，并使用为该项目开发的编码手册对数据进行人工编码。
共对育龄妇女进行了40次深入访谈和8次焦点小组讨论，并对医生进行了5次深入访谈，对助产士进行了13次深入访谈。大多数妇女不接受任何一种情况，除非该行为被认为是为了挽救母婴生命。然而，她们认为妇女的不服从和不合作导致了其受到恶劣对待。妇女对这种虐待的反应是接受恶劣对待、拒绝再次使用同一家医院、报复医护人员或向医院管理层投诉。当妇女不服从、不合作或为了挽救婴儿生命时，服务提供者会接受虐待行为。
这是几内亚开展的第一项关于分娩期间妇女受虐待情况的已知研究。妇女和服务提供者在某些情况下都接受分娩期间的虐待行为。任何预防和消除分娩期间虐待行为的方法都必须考虑这些重要的背景和社会规范，并制定一项解决根本原因的综合干预措施。需要进一步研究如何衡量几内亚分娩期间的虐待行为。
