TY - JOUR
T1 - “By slapping their laps, the patient will know that you truly care for her”
T2 - A qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria
AU - Bohren, Meghan A.
AU - Vogel, Joshua P.
AU - Tunçalp, Özge
AU - Fawole, Bukola
AU - Titiloye, Musibau A.
AU - Olutayo, Akinpelu Olanrewaju
AU - Oyeniran, Agnes A.
AU - Ogunlade, Modupe
AU - Metiboba, Loveth
AU - Osunsan, Olubunmi R.
AU - Idris, Hadiza A.
AU - Alu, Francis E.
AU - Oladapo, Olufemi T.
AU - Gülmezoglu, A. Metin
AU - Hindin, Michelle J.
N1 - Funding Information:
Scientific and technical approval was obtained from the World Health Organization Human Reproduction Programme (HRP) Review Panel on Research Projects (RP2), and ethical approval was obtained from the World Health Organization Ethical Review Committee (protocol ID, A65880) and the Federal Capital Territory Health Research Ethics Committee in Nigeria (protocol ID, FHREC/2014/01/72/28-11-14). This paper is reported according to the consolidated criteria for reporting qualitative research (COREQ) guidance ( Tong, Sainsbury, & Craig, 2007 ). 3
Funding Information:
The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding for this project was received from The United States Agency for International Development (USAID) and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research , Development and Research Training in Human Reproduction (HRP) , Department of Reproductive Health and Research , World Health Organization .
Publisher Copyright:
© 2016 The Authors
PY - 2016/12/1
Y1 - 2016/12/1
N2 - 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.
AB - 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.
KW - Childbirth
KW - Maternal health
KW - Mistreatment
KW - Nigeria
KW - Qualitative research
KW - Quality of care
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U2 - 10.1016/j.ssmph.2016.07.003
DO - 10.1016/j.ssmph.2016.07.003
M3 - Article
C2 - 28345016
AN - SCOPUS:84986630291
SN - 2352-8273
VL - 2
SP - 640
EP - 655
JO - SSM - Population Health
JF - SSM - Population Health
ER -