Kasaye Habtamu, Scarf Vanessa, Sheehy Annabel, Baird Kathleen
Collective for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
Department of Midwifery, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia.
PLoS One. 2024 Dec 13;19(12):e0313217. doi: 10.1371/journal.pone.0313217. eCollection 2024.
The mistreatment of women during maternity care hinders quality care globally and deter women from seeking health services. To implement necessary actions, it is essential to explore instances of mistreatment, their factors and negative outcomes. This study explores the narratives of mistreatment experienced by women, its drivers, as well as the consequences of mistreatment.
We conducted a descriptive qualitative study among women who had received maternity care at East Wollega Zone, Ethiopia. Data were obtained through in-depth interviews with purposively selected participants in Afan Oromo, each lasting, on average, 30 to 60 minutes. Interviews were conducted within three months of childbirth and discontinued upon reaching data saturation at seventeen interviews. All interviews were audio recorded, transcribed, translated into English, coded using NVivo 12 and analysed through thematic and framework analysis.
Three main themes were identified in this study: experiences, drivers, and consequences of mistreatment of women during maternity care. The narratives of mistreatment fell into two sub-themes: interpersonal abuse and mistreatment in the process of care. Women described experiencing physical and verbal abuse, stigma, and discrimination, as well as neglect and abandonment, violations of privacy and confidentiality, and health facility failures related to resource limitations. These forms of mistreatment were perceived to arise from a complex interaction of factors at an individual, interpersonal, and facility level, as well as broader health system and societal norms, such as gender inequality. The identified consequences of mistreatment included fear of future childbirth, negative perceptions towards health facilities and healthcare providers, switching to home birth, and psychological stress.
This qualitative study presents women's first-hand experiences of mistreatment in health facilities, highlighting various forms stemming from interpersonal interactions and systemic deficiencies in care quality. These experiences lead to significant negative consequences and implications on service delivery. The findings underscore the importance of understanding the complex factors driving mistreatment, extending beyond individual healthcare providers' behaviours to macro-level health system issues and general violence against women in society. This emphasises the importance of applying a systems-thinking approach to address the abuse and suffering women experience during maternity care in health facilities.
孕产妇护理期间对妇女的虐待阻碍了全球优质护理的提供，并使妇女不愿寻求医疗服务。为了采取必要行动，探索虐待事件、其影响因素和负面结果至关重要。本研究探讨了妇女经历的虐待事件、其驱动因素以及虐待的后果。
我们在埃塞俄比亚东沃莱加区接受过孕产妇护理的妇女中开展了一项描述性定性研究。通过对有意挑选的奥罗莫语参与者进行深入访谈获取数据，每次访谈平均持续30至60分钟。访谈在分娩后三个月内进行，在进行了17次访谈达到数据饱和后停止。所有访谈均进行了录音、转录、翻译成英文，使用NVivo 12进行编码，并通过主题分析和框架分析进行分析。
本研究确定了三个主要主题：孕产妇护理期间妇女虐待的经历、驱动因素和后果。虐待事件的叙述分为两个子主题：人际虐待和护理过程中的虐待。妇女描述了遭受身体和言语虐待、耻辱和歧视，以及忽视和遗弃、侵犯隐私和保密权，以及与资源限制相关的医疗机构失误。这些形式的虐待被认为是由个人、人际和机构层面的因素以及更广泛的卫生系统和社会规范（如性别不平等）的复杂相互作用引起的。确定的虐待后果包括对未来分娩的恐惧、对医疗机构和医疗服务提供者的负面看法、转向在家分娩以及心理压力。
这项定性研究呈现了妇女在医疗机构中遭受虐待的第一手经历，突出了人际互动和护理质量系统缺陷所产生的各种形式。这些经历对服务提供产生了重大负面后果和影响。研究结果强调了理解驱动虐待的复杂因素的重要性，这些因素不仅包括个体医疗服务提供者的行为，还包括宏观层面的卫生系统问题以及社会中对妇女的普遍暴力。这强调了应用系统思维方法来解决妇女在医疗机构孕产妇护理期间所经历的虐待和痛苦的重要性。
