Maya Ernest T, Adu-Bonsaffoh Kwame, Dako-Gyeke Phyllis, Badzi Caroline, Vogel Joshua P, Bohren Meghan A, Adanu Richard
a Lecturer, School of Public Health , University of Ghana , Accra , Ghana.
b Lecturer, Department of Obstetrics and Gynaecology, School of Medicine and Dentistry , University of Ghana , Accra , Ghana .
Reprod Health Matters. 2018;26(53):70-87. doi: 10.1080/09688080.2018.1502020. Epub 2018 Aug 28.
Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women's perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to "correct" disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman's experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth.
医疗机构在分娩过程中对妇女的虐待侵犯了她们的人权和自主权，可能与可预防的孕产妇和新生儿死亡及发病有关。在本文中，作为世界卫生组织（WHO）一项更大规模多国研究的一部分，我们探讨了妇女对医疗机构分娩期间虐待行为的看法，该研究旨在制定共识定义，并验证衡量这一现象负担的指标和工具。我们采用焦点小组讨论（FGD）和深入访谈（IDI）来探究曾在加纳科福里杜阿和恩萨瓦姆的医疗机构分娩的妇女的虐待经历。访谈进行了录音、转录并开展了主题分析。总共进行了39次深入访谈和10次焦点小组讨论，共有110名妇女参与。确定的主要虐待类型包括：言语虐待（大喊大叫、侮辱和贬损性言论）、身体虐待（掐、打耳光）以及遗弃和缺乏支持。虐待行为在分娩第二阶段较为常见，尤其是在青少年中。在第二阶段无法顺利用力、不听从接生人员的指示以及未携带分娩所需的规定物品（产妇包）往往是遭受虐待的前奏。大多数妇女表示，打耳光和掐是“纠正”不听话行为和鼓励用力的可接受手段。由于自身的虐待经历，或者听闻其他妇女的虐待经历，妇女未来可能会避免在医疗机构分娩。需要有衡量虐待行为的共识定义、经过验证的指标和工具，以衡量其发生率，并确定驱动因素和潜在切入点，从而尽量减少这一现象，并改善分娩期间的尊重性照护。
