Bohren Meghan A, Vogel Joshua P, Tunçalp Özge, Fawole Bukola, Titiloye Musibau A, Olutayo Akinpelu Olanrewaju, Oyeniran Agnes A, Ogunlade Modupe, Metiboba Loveth, Osunsan Olubunmi R, Idris Hadiza A, Alu Francis E, Oladapo Olufemi T, Gülmezoglu A Metin, Hindin Michelle J
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe St, Baltimore, MD, USA; UNDP/UNFPA/UNICEF/WHO/WorldBank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
UNDP/UNFPA/UNICEF/WHO/WorldBank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
SSM Popul Health. 2016 Dec;2:640-655. doi: 10.1016/j.ssmph.2016.07.003.
Many women experience mistreatment during childbirth in health facilities across the world. However, limited evidence exists on how social norms and attitudes of both women and providers influence mistreatment during childbirth. Contextually-specific evidence is needed to understand how normative factors affect how women are treated. This paper explores the acceptability of four scenarios of mistreatment during childbirth.
Two facilities were identified in Abuja, Nigeria. Qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) were used with a purposive sample of women, midwives, doctors and administrators. Participants were presented with four scenarios of mistreatment during childbirth: slapping, verbal abuse, refusing to help the woman and physical restraint. Thematic analysis was used to synthesize findings, which were interpreted within the study context and an existing typology of mistreatment during childbirth.
Eighty-four IDIs and 4 FGDs are included in this analysis. Participants reported witnessing and experiencing mistreatment during childbirth, including slapping, physical restraint to a delivery bed, shouting, intimidation, and threats of physical abuse or poor health outcomes. Some women and providers considered each of the four scenarios as mistreatment. Others viewed these scenarios as appropriate and acceptable measures to gain compliance from the woman and ensure a good outcome for the baby. Women and providers blamed a woman's "disobedience" and "uncooperativeness" during labor for her experience of mistreatment.
Blaming women for mistreatment parallels the intimate partner violence literature, demonstrating how traditional practices and low status of women potentiate gender inequality. These findings can be used to facilitate dialogue in Nigeria by engaging stakeholders to discuss how to challenge these norms and hold providers accountable for their actions. Until women and their families are able to freely condemn poor quality care in facilities and providers are held accountable for their actions, there will be little incentive to foster change.
世界各地许多妇女在医疗机构分娩期间遭受虐待。然而，关于社会规范以及妇女和医护人员的态度如何影响分娩期间的虐待，现有证据有限。需要结合具体情况的证据来了解规范性因素如何影响妇女的待遇。本文探讨了分娩期间四种虐待情形的可接受性。
在尼日利亚阿布贾确定了两家医疗机构。采用定性方法（深入访谈和焦点小组讨论），对妇女、助产士、医生和管理人员进行了有目的抽样。向参与者展示了分娩期间的四种虐待情形：扇耳光、言语辱骂、拒绝帮助产妇和身体约束。采用主题分析来综合研究结果，并在研究背景和现有的分娩期间虐待类型中对结果进行解释。
本次分析纳入了84次深入访谈和4次焦点小组讨论。参与者报告称目睹并经历过分娩期间的虐待，包括扇耳光、将产妇约束在产床上、大喊大叫、恐吓以及身体虐待或不良健康后果的威胁。一些妇女和医护人员认为这四种情形均属于虐待。其他人则认为这些情形是促使产妇服从并确保婴儿有良好结局的适当且可接受的措施。妇女和医护人员将分娩期间妇女遭受虐待归咎于其“不听话”和“不配合”。
将虐待归咎于妇女与亲密伴侣暴力文献一致，表明传统习俗和妇女的低地位如何加剧性别不平等。这些研究结果可用于促进尼日利亚的对话，让利益相关者参与讨论如何挑战这些规范并让医护人员为其行为负责。除非妇女及其家人能够自由谴责医疗机构的劣质护理，并且医护人员要为其行为负责，否则几乎没有促进变革的动力。
