Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America.
Department of Public Health and Community Medicine, Tufts University, Boston, Massachusetts, United States of America.
PLoS One. 2023 Aug 24;18(8):e0290434. doi: 10.1371/journal.pone.0290434. eCollection 2023.
Peripartum mistreatment of women contributes to maternal mortality across the globe and disproportionately affects vulnerable populations. While traditionally recognized in low/low-middle-income countries, the extent of research on respectful maternity care and the types of mistreatment occurring in high-income countries is not well understood. We conducted a scoping review to 1) map existing respectful maternity care research by location, country income level, and approach, 2) determine if high-income countries have been studied equally when compared to low/low-middle-income countries, and 3) analyze the types of disrespectful care found in high-income countries.
A systematic search for published literature up to April 2021 using PubMed/MEDLINE, EMBASE, CINAHL Complete, and the Maternity & Infant Care Database was performed. Studies were included if they were full-length journal articles, published in any language, reporting original data on disrespectful maternal care received from healthcare providers during childbirth. Study location, country income level, types of mistreatment reported, and treatment interventions were extracted. This study was registered on PROSPERO, number CRD42021255337.
A total of 346 included studies were categorized by research approach, including direct labor observation, surveys, interviews, and focus groups. Interviews and surveys were the most common research approaches utilized (47% and 29% of all articles, respectively). Only 61 (17.6%) of these studies were conducted in high-income countries. The most common forms of mistreatment reported in high-income countries were lack of informed consent, emotional mistreatment, and stigma/discrimination.
Mapping existing research on respectful maternity care by location and country income level reveals limited research in high-income countries and identifies a need for a more global approach. Furthermore, studies of respectful maternity care in high-income countries identify the occurrence of all forms of mistreatment, clashing with biases that suggest respectful maternity care is only an issue in low-income countries and calling for additional research to identify interventions that embrace an equitable, patient-centric empowerment model of maternity care.
在全球范围内，围产期虐待女性会导致孕产妇死亡，而且这种情况在弱势群体中更为严重。虽然在中低收入国家传统上已经认识到这种问题，但对于高收入国家尊重产妇护理的程度以及发生的虐待类型的研究还不是很清楚。我们进行了一项范围界定审查，以 1）按地点、国家收入水平和方法绘制现有的尊重产妇护理研究，2）确定与中低收入国家相比，高收入国家是否得到了同等研究，3）分析高收入国家发现的不尊重护理类型。
使用 PubMed/MEDLINE、EMBASE、CINAHL Complete 和母婴护理数据库对截至 2021 年 4 月的已发表文献进行了系统搜索。如果研究是全长期刊文章，以任何语言发表，并报告了在分娩期间从医疗保健提供者那里获得的不尊重产妇护理的原始数据，则将其纳入研究。提取研究地点、国家收入水平、报告的虐待类型和治疗干预措施。本研究已在 PROSPERO 上注册，编号为 CRD42021255337。
共有 346 项纳入的研究按研究方法进行分类，包括直接分娩观察、调查、访谈和焦点小组。访谈和调查是最常用的研究方法（分别占所有文章的 47%和 29%）。只有 61 项（17.6%）研究在高收入国家进行。在高收入国家报告的最常见的虐待形式是缺乏知情同意、情感虐待和污名/歧视。
通过位置和国家收入水平绘制现有的尊重产妇护理研究，发现高收入国家的研究有限，并确定需要采取更全面的方法。此外，高收入国家尊重产妇护理的研究确定了所有形式的虐待的发生，这与认为尊重产妇护理只是低收入国家的问题的偏见相矛盾，并呼吁进行更多的研究，以确定干预措施，这些干预措施应采用公平、以患者为中心的产妇护理授权模式。
