Department of Health Policy and Management, Columbia University Mailman School of Public Health, 600 West 168 Street, New York, NY 10032, USA.
Averting Maternal Death and Disability Program, Columbia University Mailman School of Public Health, 60 Haven Avenue, New York, NY 10032, USA.
Health Policy Plan. 2018 Jan 1;33(1):e26-e33. doi: 10.1093/heapol/czu079.
Although qualitative studies have raised attention to humiliating treatment of women during labour and delivery, there are no reliable estimates of the prevalence of disrespectful and abusive treatment in health facilities. We measured the frequency of reported abusive experiences during facility childbirth in eight health facilities in Tanzania and examined associated factors. The study was conducted in rural northeastern Tanzania. Using a structured questionnaire, we interviewed women who had delivered in health facilities upon discharge and re-interviewed a randomly selected subset 5-10 weeks later in the community. We calculated frequencies of 14 abusive experiences and the prevalence of any disrespect/abuse. We performed logistic regression to analyse associations between abusive treatment and individual and birth experience characteristics. A total of 1779 women participated in the exit survey (70.6% response rate) and 593 were re-interviewed at home (75.8% response rate). The frequency of any abusive or disrespectful treatment during childbirth was 343 (19.48%) in the exit sample and 167 (28.21%) in the follow-up sample; the difference may be due to courtesy bias in exit interviews. The most common events reported on follow-up were being ignored (N = 84, 14.24%), being shouted at (N = 78, 13.18%) and receiving negative or threatening comments (N = 68, 11.54%). Thirty women (5.1%) were slapped or pinched and 31 women (5.31%) delivered alone. In the follow-up sample women with secondary education were more likely to report abusive treatment (odds ratio (OR) 1.48, confidence interval (CI): 1.10-1.98), as were poor women (OR 1.80, CI: 1.31-2.47) and women with self-reported depression in the previous year (OR 1.62, CI: 1.23-2.14). Between 19% and 28% of women in eight facilities in northeastern Tanzania experienced disrespectful and/or abusive treatment from health providers during childbirth. This is a health system crisis that requires urgent solutions both to ensure women's right to dignity in health care and to improve effective utilization of facilities for childbirth in order to reduce maternal mortality.
虽然定性研究已经引起了人们对分娩过程中对妇女的羞辱性待遇的关注，但对于医疗机构中不尊重和虐待行为的普遍程度还没有可靠的估计。我们测量了坦桑尼亚八家医疗机构中报告的分娩过程中虐待行为的频率，并检查了相关因素。这项研究在坦桑尼亚东北部农村进行。我们使用结构化问卷，在出院时采访了在医疗机构分娩的妇女，并在社区中对随机选择的一部分妇女进行了 5-10 周后的随访采访。我们计算了 14 种虐待经历的频率和任何不尊重/虐待的发生率。我们进行了逻辑回归分析，以分析虐待治疗与个体和分娩经历特征之间的关系。共有 1779 名妇女参加了出院调查（70.6%的应答率），其中 593 名在出院后在家中接受了随访（75.8%的应答率）。分娩时任何不尊重或虐待行为的发生率在出院样本中为 343 例（19.48%），在随访样本中为 167 例（28.21%）；差异可能是由于出院访谈中的礼貌偏差。在随访中报告最多的事件是被忽视（N=84，14.24%）、被大声喊叫（N=78，13.18%）和收到负面或威胁性评论（N=68，11.54%）。30 名妇女（5.1%）被扇耳光或捏，31 名妇女（5.31%）独自分娩。在随访样本中，接受过中等教育的妇女更有可能报告虐待行为（优势比（OR）1.48，置信区间（CI）：1.10-1.98），贫穷妇女（OR 1.80，CI：1.31-2.47）和前一年报告有抑郁的妇女（OR 1.62，CI：1.23-2.14）也是如此。在坦桑尼亚东北部的八家医疗机构中，有 19%-28%的妇女在分娩过程中受到医疗服务提供者的不尊重和/或虐待。这是一个卫生系统危机，需要紧急解决，既要确保妇女在医疗保健中享有尊严的权利，又要改善设施的有效利用，以减少孕产妇死亡率。
