“By slapping their laps, the patient will know that you truly care for her”: A qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria

Meghan A. Bohren, Joshua P. Vogel, Özge Tunçalp, Bukola Fawole, Musibau A. Titiloye, Akinpelu Olanrewaju Olutayo, Agnes A. Oyeniran, Modupe Ogunlade, Loveth Metiboba, Olubunmi R. Osunsan, Hadiza A. Idris, Francis E. Alu, Olufemi T. Oladapo, A. Metin Gülmezoglu, Michelle J. Hindin

Research output: Contribution to journalArticle

Abstract

Background Many women experience mistreatment during childbirth in health facilities across the world. However, limited evidence exists on how social norms and attitudes of both women and providers influence mistreatment during childbirth. Contextually-specific evidence is needed to understand how normative factors affect how women are treated. This paper explores the acceptability of four scenarios of mistreatment during childbirth. Methods Two facilities were identified in Abuja, Nigeria. Qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) were used with a purposive sample of women, midwives, doctors and administrators. Participants were presented with four scenarios of mistreatment during childbirth: slapping, verbal abuse, refusing to help the woman and physical restraint. Thematic analysis was used to synthesize findings, which were interpreted within the study context and an existing typology of mistreatment during childbirth. Results Eighty-four IDIs and 4 FGDs are included in this analysis. Participants reported witnessing and experiencing mistreatment during childbirth, including slapping, physical restraint to a delivery bed, shouting, intimidation, and threats of physical abuse or poor health outcomes. Some women and providers considered each of the four scenarios as mistreatment. Others viewed these scenarios as appropriate and acceptable measures to gain compliance from the woman and ensure a good outcome for the baby. Women and providers blamed a woman's “disobedience” and “uncooperativeness” during labor for her experience of mistreatment. Conclusions Blaming women for mistreatment parallels the intimate partner violence literature, demonstrating how traditional practices and low status of women potentiate gender inequality. These findings can be used to facilitate dialogue in Nigeria by engaging stakeholders to discuss how to challenge these norms and hold providers accountable for their actions. Until women and their families are able to freely condemn poor quality care in facilities and providers are held accountable for their actions, there will be little incentive to foster change.

Original languageEnglish (US)
Pages (from-to)640-655
Number of pages16
JournalSSM - Population Health
Volume2
DOIs
StatePublished - Dec 1 2016

Fingerprint

Social Norms
Nigeria
Parturition
Physical Restraint
scenario
Focus Groups
group discussion
abuse
Interviews
Women's Rights
Quality of Health Care
Health Facilities
Midwifery
midwife
Administrative Personnel
interview
health
Compliance
baby
Motivation

Keywords

  • Childbirth
  • Maternal health
  • Mistreatment
  • Nigeria
  • Qualitative research
  • Quality of care

ASJC Scopus subject areas

  • Health(social science)
  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

“By slapping their laps, the patient will know that you truly care for her” : A qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria. / Bohren, Meghan A.; Vogel, Joshua P.; Tunçalp, Özge; Fawole, Bukola; Titiloye, Musibau A.; Olutayo, Akinpelu Olanrewaju; Oyeniran, Agnes A.; Ogunlade, Modupe; Metiboba, Loveth; Osunsan, Olubunmi R.; Idris, Hadiza A.; Alu, Francis E.; Oladapo, Olufemi T.; Gülmezoglu, A. Metin; Hindin, Michelle J.

In: SSM - Population Health, Vol. 2, 01.12.2016, p. 640-655.

Research output: Contribution to journalArticle

Bohren, MA, Vogel, JP, Tunçalp, Ö, Fawole, B, Titiloye, MA, Olutayo, AO, Oyeniran, AA, Ogunlade, M, Metiboba, L, Osunsan, OR, Idris, HA, Alu, FE, Oladapo, OT, Gülmezoglu, AM & Hindin, MJ 2016, '“By slapping their laps, the patient will know that you truly care for her”: A qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria', SSM - Population Health, vol. 2, pp. 640-655. https://doi.org/10.1016/j.ssmph.2016.07.003
Bohren, Meghan A. ; Vogel, Joshua P. ; Tunçalp, Özge ; Fawole, Bukola ; Titiloye, Musibau A. ; Olutayo, Akinpelu Olanrewaju ; Oyeniran, Agnes A. ; Ogunlade, Modupe ; Metiboba, Loveth ; Osunsan, Olubunmi R. ; Idris, Hadiza A. ; Alu, Francis E. ; Oladapo, Olufemi T. ; Gülmezoglu, A. Metin ; Hindin, Michelle J. / “By slapping their laps, the patient will know that you truly care for her” : A qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria. In: SSM - Population Health. 2016 ; Vol. 2. pp. 640-655.
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abstract = "Background Many women experience mistreatment during childbirth in health facilities across the world. However, limited evidence exists on how social norms and attitudes of both women and providers influence mistreatment during childbirth. Contextually-specific evidence is needed to understand how normative factors affect how women are treated. This paper explores the acceptability of four scenarios of mistreatment during childbirth. Methods Two facilities were identified in Abuja, Nigeria. Qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) were used with a purposive sample of women, midwives, doctors and administrators. Participants were presented with four scenarios of mistreatment during childbirth: slapping, verbal abuse, refusing to help the woman and physical restraint. Thematic analysis was used to synthesize findings, which were interpreted within the study context and an existing typology of mistreatment during childbirth. Results Eighty-four IDIs and 4 FGDs are included in this analysis. Participants reported witnessing and experiencing mistreatment during childbirth, including slapping, physical restraint to a delivery bed, shouting, intimidation, and threats of physical abuse or poor health outcomes. Some women and providers considered each of the four scenarios as mistreatment. Others viewed these scenarios as appropriate and acceptable measures to gain compliance from the woman and ensure a good outcome for the baby. Women and providers blamed a woman's “disobedience” and “uncooperativeness” during labor for her experience of mistreatment. Conclusions Blaming women for mistreatment parallels the intimate partner violence literature, demonstrating how traditional practices and low status of women potentiate gender inequality. These findings can be used to facilitate dialogue in Nigeria by engaging stakeholders to discuss how to challenge these norms and hold providers accountable for their actions. Until women and their families are able to freely condemn poor quality care in facilities and providers are held accountable for their actions, there will be little incentive to foster change.",
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AU - Tunçalp, Özge

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AU - Olutayo, Akinpelu Olanrewaju

AU - Oyeniran, Agnes A.

AU - Ogunlade, Modupe

AU - Metiboba, Loveth

AU - Osunsan, Olubunmi R.

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