Cellulle de Recherche en Sante de la Reproduction en Guinee (CERREGUI), Conakry, Guinea
Schulich School of Medicine and Dentistry, London, Ontario, Canada.
BMJ Glob Health. 2020 Nov;5(Suppl 2). doi: 10.1136/bmjgh-2020-003564.
Evidence has shown the benefits of labour companions during childbirth. Few studies have documented the relationship between the absence of labour companions and mistreatment of women during childbirth in low-income and middle-income countries using a standardised tool.
We conducted a secondary analysis of the WHO multi-country study on how women are treated during childbirth, where a cross-sectional community survey was conducted with women up to 8 weeks after childbirth in Ghana, Guinea, Nigeria and Myanmar. Descriptive analysis and multivariable logistic regression were used to examine whether labour companionship was associated with various types of mistreatment.
Of 2672 women, about half (50.4%) reported the presence of a labour companion. Approximately half (49.6%) of these women reported that the timing of support was during labour and after childbirth and most of the labour companions (47.0%) were their family members. Across Ghana, Guinea and Nigeria, women without a labour companion were more likely to report physical abuse, non-consented medical procedures and poor communication compared with women with a labour companion. However, there were country-level variations. In Guinea, the absence of labour companionship was associated with any physical abuse, verbal abuse, or stigma or discrimination (adjusted OR (AOR) 3.6, 1.9-6.9) and non-consented vaginal examinations (AOR 3.2, 1.6-6.4). In Ghana, it was associated with non-consented vaginal examinations (AOR 2.3, 1.7-3.1) and poor communication (AOR 2.0, 1.3-3.2). In Nigeria, it was associated with longer wait times (AOR 0.6, 0.3-0.9).
Labour companionship is associated with lower levels of some forms of mistreatment that women experience during childbirth, depending on the setting. Further work is needed to ascertain how best to implement context-specific labour companionship to ensure benefits while maintaining women's choices and autonomy.
已有证据表明，分娩时有陪产者会带来益处。但很少有研究使用标准化工具，记录在中低收入国家陪产者缺失与分娩期妇女遭虐待之间的关系。
我们利用世界卫生组织多国妇女分娩期待遇研究中的二次分析数据，对加纳、几内亚、尼日利亚和缅甸分娩后 8 周内的产妇进行了横断面社区调查。采用描述性分析和多变量逻辑回归，检验陪产与各种类型的虐待之间的关系。
在 2672 名产妇中，约有一半（50.4%）报告有陪产者。其中近一半（49.6%）报告陪产者在分娩中和分娩后提供支持，大多数陪产者（47.0%）是产妇的家庭成员。在加纳、几内亚和尼日利亚，与有陪产者的产妇相比，没有陪产者的产妇更有可能报告遭受身体虐待、未经同意的医疗程序和沟通不良。但也存在国家层面的差异。在几内亚，没有陪产者与遭受任何身体虐待、言语虐待或侮辱或歧视（调整后的比值比（AOR）3.6，1.9-6.9）和未经同意的阴道检查（AOR 3.2，1.6-6.4）相关。在加纳，没有陪产者与未经同意的阴道检查（AOR 2.3，1.7-3.1）和沟通不良（AOR 2.0，1.3-3.2）相关。在尼日利亚，没有陪产者与等待时间延长（AOR 0.6，0.3-0.9）相关。
陪产与分娩期部分形式的虐待程度降低有关，具体取决于环境。需要进一步研究如何最好地实施特定环境下的陪产，以确保陪产带来益处的同时，维护妇女的选择权和自主权。
