Raj Anita, Dey Arnab, Boyce Sabrina, Seth Aparna, Bora Siddhartha, Chandurkar Dharmendra, Hay Katherine, Singh Kultar, Das Arup Kumar, Chakraverty Amit, Ramakrishnan Aparajita, Shetye Mrunal, Saggurti Niranjan, Silverman Jay G
Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
Sambodhi Research and Communications Pvt. Ltd., Noida, Uttar Pradesh, India.
Matern Child Health J. 2017 Sep;21(9):1821-1833. doi: 10.1007/s10995-017-2298-8.
Objectives This study assesses associations between mistreatment by a provider during childbirth and maternal complications in Uttar Pradesh, India. Methods Cross-sectional survey data were collected from women (N = 2639) who had delivered at 68 public health facilities in Uttar Pradesh, participating in a quality of care study. Participants were recruited from April to July 2015 and surveyed on demographics, mistreatment during childbirth (measure developed for this study, Cronbach's alpha = 0.70), and maternal health complications. Regression models assessed associations between mistreatment during childbirth and maternal complications, at delivery and postpartum, adjusting for demographics and pregnancy complications. Results Participants were aged 17-48 years, and 30.3% were scheduled caste/scheduled tribe. One in five (20.9%) reported mistreatment by their provider during childbirth, including discrimination and abuse; complications during delivery (e.g., obstructed labor) and postpartum (e.g., excessive bleeding) were reported by 45.8 and 41.5% of women, respectively. Health providers at delivery included staff nurses (81.8%), midwives (14.0%), and physicians (2.2%); Chi square analyses indicate that women were significantly more likely to report mistreatment when their provider was a nurse rather than a physician or midwife. Women reporting mistreatment by a provider during childbirth had higher odds of complications at delivery (AOR = 1.32; 95% CI 1.05-1.67) and postpartum (AOR = 2.12; 95% CI 1.67-2.68). Conclusions for Practice Mistreatment of women by their provider during childbirth is a pervasive health and human rights violation, and is associated with increased risk for maternal health complications in Uttar Pradesh. Efforts to improve quality of maternal care should include greater training and monitoring of providers to ensure respectful treatment of patients.
目的 本研究评估印度北方邦分娩期间医护人员虐待行为与孕产妇并发症之间的关联。方法 收集了参与一项医疗质量研究的北方邦68家公共卫生机构中分娩妇女（N = 2639）的横断面调查数据。参与者于2015年4月至7月招募，接受了人口统计学、分娩期间虐待行为（为本研究开发的测量方法，克朗巴哈系数α = 0.70）以及孕产妇健康并发症方面的调查。回归模型评估了分娩期间虐待行为与分娩时及产后孕产妇并发症之间的关联，并对人口统计学和妊娠并发症进行了调整。结果 参与者年龄在17至48岁之间，30.3%为在册种姓/在册部落。五分之一（20.9%）的人报告在分娩期间受到医护人员的虐待，包括歧视和虐待；分别有45.8%和41.5%的妇女报告了分娩期间（如难产）和产后（如大出血）的并发症。分娩时的医护人员包括护士（81.8%）、助产士（14.0%）和医生（2.2%）；卡方分析表明，当医护人员是护士而非医生或助产士时，妇女报告受到虐待的可能性显著更高。报告在分娩期间受到医护人员虐待的妇女在分娩时（调整后比值比AOR = 1.32；95%置信区间CI 1.05 - 1.67）和产后（AOR = 2.12；95% CI 1.67 - 2.68）出现并发症的几率更高。实践结论 在北方邦，医护人员在分娩期间虐待妇女是一种普遍存在的侵犯健康和人权行为，且与孕产妇健康并发症风险增加相关。改善孕产妇护理质量的努力应包括对医护人员进行更多培训和监督，以确保尊重患者。
