Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Department of Statistics, University of Karachi, Karachi, Pakistan.
PLoS One. 2021 Apr 15;16(4):e0249874. doi: 10.1371/journal.pone.0249874. eCollection 2021.
Attainment of healthcare in respectful and dignified manner is a fundamental right for every woman regardless of the individual status. However, social exclusion, poor psychosocial support, and demeaning care during childbirth at health facilities are common worldwide, particularly in low- and middle-income countries. We concurrently examined how women with varying socio-demographic characteristics are treated during childbirth, the effect of women's empowerment on mistreatment, and health services factors that contribute to mistreatment in secondary-level public health facilities in Pakistan.
A cross-sectional survey was conducted during August-November 2016 among 783 women who gave birth in six secondary-care public health facilities across four contiguous districts of southern Sindh. Women were recruited in health facilities and later interviewed at home within 42 days of postpartum using a WHO's framework-guided 43-item structured questionnaire. Means, standard deviation, and average were used to describe characteristics of the participants. Multivariable linear regression was applied using Stata 15.1.
Women experiencing at least one violation of their right to care by hospital staff during intrapartum care included: ineffective communication (100%); lack of supportive care (99.7%); loss of autonomy (97.5%); failure of meeting professional clinical standards (84.4%); lack of resources (76.3%); verbal abuse (15.2%); physical abuse (14.8%); and discrimination (3.2%). Risk factors of all three dimensions showed significant association with mistreatment: socio-demographic: primigravida and poorer were more mistreated; health services: lesser-education on birth preparedness and postnatal care leads to higher mistreatment; and in terms of women's empowerment: women who were emotionally and physically abused by family, and those with lack of social support and lesser involvement in joint household decision making with husbands are more likely to be mistreated as compared to their counterparts. The magnitude of relationship between all significant risk factors and mistreatment, in the form of β coefficients, ranged from 0.2 to 5.5 with p-values less than 0.05.
There are glaring inequalities in terms of the way women are treated during childbirth in public health facilities. Measures of socio-demographic, health services, and women's empowerment showed a significant independent association with mistreatment during childbirth. At the health system level, there is a need for urgent solutions for more inclusive care to ensure that all women are treated with compassion and dignity, complemented by psychosocial support for those who are emotionally disturbed and lack social support.
无论个人地位如何，获得尊重和有尊严的医疗保健都是每个女性的基本权利。然而，在全球范围内，特别是在中低收入国家，社会排斥、不良的心理社会支持以及在医疗机构分娩时受到有辱人格的护理仍然很常见。我们同时研究了不同社会人口特征的妇女在分娩期间如何受到对待，妇女赋权对虐待的影响，以及在巴基斯坦二级公立卫生设施中导致虐待的卫生服务因素。
2016 年 8 月至 11 月，在信德省南部四个毗邻地区的六家二级保健公立卫生设施中分娩的 783 名妇女进行了横断面调查。在卫生设施中招募妇女，然后在产后 42 天内在家中使用世卫组织框架指导的 43 项结构式问卷对其进行访谈。使用均值、标准差和平均值来描述参与者的特征。使用 Stata 15.1 进行多变量线性回归。
在分娩期间至少经历过一次医护人员侵犯其护理权利的妇女包括：沟通无效（100%）；缺乏支持性护理（99.7%）；失去自主权（97.5%）；未能达到专业临床标准（84.4%）；资源匮乏（76.3%）；言语虐待（15.2%）；身体虐待（14.8%）；和歧视（3.2%）。所有三个维度的风险因素均与虐待有显著关联：社会人口统计学方面：初产妇和贫困者受到的虐待更多；卫生服务方面：较少接受生育准备和产后护理教育会导致更高的虐待；在妇女赋权方面：受到家庭情感和身体虐待、缺乏社会支持以及与丈夫在家庭决策方面参与较少的妇女，与其他妇女相比，更有可能受到虐待。所有显著风险因素与虐待之间的关系程度（以β系数表示）范围为 0.2 至 5.5，p 值均小于 0.05。
在公立卫生设施中，妇女在分娩期间受到的待遇存在明显的不平等。社会人口统计学、卫生服务和妇女赋权方面的措施与分娩期间的虐待有显著的独立关联。在卫生系统层面，需要紧急采取措施，提供更具包容性的护理，确保所有妇女都能得到同情和尊严的待遇，并为那些情绪困扰和缺乏社会支持的妇女提供心理社会支持。
