Abstract
Objectives This study assesses associations between mistreatment by a provider during childbirth and maternal complications in Uttar Pradesh, India. Methods Cross-sectional survey data were collected from women (N = 2639) who had delivered at 68 public health facilities in Uttar Pradesh, participating in a quality of care study. Participants were recruited from April to July 2015 and surveyed on demographics, mistreatment during childbirth (measure developed for this study, Cronbach’s alpha = 0.70), and maternal health complications. Regression models assessed associations between mistreatment during childbirth and maternal complications, at delivery and postpartum, adjusting for demographics and pregnancy complications. Results Participants were aged 17–48 years, and 30.3% were scheduled caste/scheduled tribe. One in five (20.9%) reported mistreatment by their provider during childbirth, including discrimination and abuse; complications during delivery (e.g., obstructed labor) and postpartum (e.g., excessive bleeding) were reported by 45.8 and 41.5% of women, respectively. Health providers at delivery included staff nurses (81.8%), midwives (14.0%), and physicians (2.2%); Chi square analyses indicate that women were significantly more likely to report mistreatment when their provider was a nurse rather than a physician or midwife. Women reporting mistreatment by a provider during childbirth had higher odds of complications at delivery (AOR = 1.32; 95% CI 1.05–1.67) and postpartum (AOR = 2.12; 95% CI 1.67–2.68). Conclusions for Practice Mistreatment of women by their provider during childbirth is a pervasive health and human rights violation, and is associated with increased risk for maternal health complications in Uttar Pradesh. Efforts to improve quality of maternal care should include greater training and monitoring of providers to ensure respectful treatment of patients.
Similar content being viewed by others
References
Abuya, T., Warren, C., Miller, N., Njuki, R., Ndwiga, C., Maranga, A., … Bellows, B. (2015). Exploring the prevalence of disrespect and abuse during childbirth in Kenya. PLoS ONE, 10(4), e0123606. doi:10.1371/journal.pone.0123606.
Acharya, S. S. (2010). Access to health care and patterns of discrimination: a study of dalit children in select villages of Gujarat and Rajastan. Retrieved from http://www.dalitstudies.org.in/uploads/publication/1473145022.pdf.
Afsana, K., & Rashid, S. F. (2001). The challenges of meeting rural Bangladeshi women’s needs in delivery care. Reproductive Health Matters, 9(18), 79–89.
Arora, K. S., Shields, L. E., Grobman, W. A., D’Alton, M. E., Lappen, J. R., & Mercer, B. M. (2015). Triggers, bundles, protocols, and checklists: What every maternal care provider needs to know. American Journal of Obstetrics and Gynecology. doi:10.1016/j.ajog.2015.10.011.
Blanc, A. K., Warren, C., McCarthy, K. J., Kimani, J., Ndwiga, C., & RamaRao, S. (2016). Assessing the validity of indicators of the quality of maternal and newborn health care in Kenya. Journal of Global Health, 6(1), 010405. doi:10.7189/jogh.06.010405.
Bohren, M. A., Vogel, J. P., Hunter, E. C., Lutsiv, O., Makh, S. K., Souza, J. P., … Gulmezoglu, A. M. (2015). The Mistreatment of women during childbirth in health facilities globally: A mixed-methods systematic review. PLoS Medicine, 12(6), e1001847–e1001847. doi:10.1371/journal.pmed.1001847.
Bowser, D., & Hill, K. (2010). Exploring evidence for disrespect and abuse in facility-based childbirth: Report of a landscape analysis. Boston: USAID-TRAction Project, Harvard School of Public Health
Chaturvedi, S., De Costa, A., & Raven, J. (2015). Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh. Global Health Action, 8, 27427–27427.
Freedman, L., & Kruk, M. (2014). Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas. Lancet, 384(9948), e42–e44. doi:10.1016/S0140-6736(14)60859-X.
Freedman, L., Ramsey, K., Abuya, T., Bellows, B., Ndwiga, C., Warren, C., … Mbaruku, G. (2014). Defining disrespect and abuse of women in childbirth: A research, policy and rights agenda. Bulletin of the World Health Organization, 92, 915–917. doi:10.2471/BLT.14.137869.
Government of India. (2013). Indicators from Annual Health Survey 2012–2013. Geneva: World Health Organization. Retrieved from https://data.gov.in/catalog/indicators-annual-health-survey#web_catalog_tabs_block_10.
Greenland, S., & Pearce, N. (2015). Statistical foundations for model-based adjustments. Annual review of public health, 36, 89–108. doi:10.1146/annurev-publhealth-031914-122559.
Hulton, L. A., Matthews, Z., & Stones, R. W. (2007). Applying a framework for assessing the quality of maternal health services in urban India. Social Science & Medicine, 64(10), 2083–2095. doi:10.1016/j.socscimed.2007.01.019.
International Institute for Population Sciences and Macro International. (2007). National Family Health Survey (NFHS-3), 2005–06: India.
Jewkes, R., Abrahams, N., & Mvo, Z. (1998). Why do nurses abuse patients? Reflections from South African obstetric services. Social Science & Medicine, 47(11), 1781–1795.
Kruk, M. E., Kujawski, S., Mbaruku, G., Ramsey, K., Moyo, W., & Freedman, L. P. (2014). Disrespectful and abusive treatment during facility delivery in Tanzania: A facility and community survey. Health Policy and Planning. doi:10.1093/heapol/czu079.
Kruk, M. E., Paczkowski, M., Mbaruku, G., de Pinho, H., & Galea, S. (2009). Women’s preferences for place of delivery in rural Tanzania: A population-based discrete choice experiment. American Journal of Public Health, 99(9), 1666–1672. doi:10.2105/ajph.2008.146209.
Kujawski, S., Mbaruku, G., Freedman, L. P., Ramsey, K., Moyo, W., & Kruk, M. E. (2015). Association between disrespect and abuse during childbirth and women’s confidence in health facilities in Tanzania. Maternal and Child Health Journal, 19(10), 2243–2250. doi:10.1007/s10995-015-1743-9.
Lim, S. S., Dandona, L., Hoisington, J. A., James, S. L., Hogan, M. C., & Gakidou, E. (2010). India’s Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: An impact evaluation. Lancet, 375(9730), 2009–2023. doi:10.1016/S0140-6736(10)60744-1.
Mannava, P., Durrant, K., Fisher, J., Chersich, M., & Luchters, S. (2015). Attitudes and behaviours of maternal health care providers in interactions with clients: A systematic review. Globalization and Health, 11(1), 36–36. doi:10.1186/s12992-015-0117-9.
McCarthy, K. J., Blanc, A. K., Warren, C. E., Kimani, J., Mdawida, B., & Ndwidga, C. (2016). Can surveys of women accurately track indicators of maternal and newborn care? A validity and reliability study in Kenya. Journal of Global Health, 6(2), 020502. doi:10.7189/jogh.06.020502.
Miller, S., & Lalonde, A. (2015). The global epidemic of abuse and disrespect during childbirth: History, evidence, interventions, and FIGO’s mother-baby friendly birthing facilities initiative. International Journal of Gynaecology and Obstetrics, 131, S49–52. doi:10.1016/j.ijgo.2015.02.005.
Moyer, C. A., Adongo, P. B., Aborigo, R. A., Hodgson, A., & Engmann, C. M. (2014). ‘They treat you like you are not a human being’: maltreatment during labour and delivery in rural northern Ghana. Midwifery, 30(2), 262–268. doi:10.1016/j.midw.2013.05.006.
Mselle, L. T., Moland, K. M., Mvungi, A., Evjen-Olsen, B., & Kohi, T. W. (2013). Why give birth in health facility? Users’ and providers’ accounts of poor quality of birth care in Tanzania. BMC Health Services Research, 13, 174. doi:10.1186/1472-6963-13-174.
Nandan, D. (2010). National rural health mission: Turning into reality. Indian Journal of Community Medicine, 35(4), 453–454. doi:10.4103/0970-0218.74338.
Ratcliffe, H. L., Sando, D., Lyatuu, G. W., Emil, F., Mwanyika-Sando, M., Chalamilla, G., ... McDonald, & K, P. (2016). Mitigating disrespect and abuse during childbirth in Tanzania: An exploratory study of the effects of two facility-based interventions in a large public hospital. Reprod Health, 13(1), 79. doi:10.1186/s12978-016-0187-z.
Rothman, K., Lash, T., & Greenland, S. (2012). Modern Epidemiology third, mid-cycle revision edition. Philadelphia: Lippincott, Williams and Wilkins.
Silan, V., Kant, S., Archana, S., Misra, P., & Rizwan, S. (2014). Determinants of underutilisation of free delivery services in an area with high institutional delivery rate: A qualitative study. North American Journal of Medical Sciences, 6(7), 315–320. doi:10.4103/1947-2714.136906.
United Nations. (2015). Transforming our world: The 2030 Agenda for Sustainable Development. Retrieved from https://sustainabledevelopment.un.org/post2015/transformingourworld.
Vogel, J. P., Bohren, M. A., Tuncalp, O., Oladapo, O. T., Adanu, R. M., Balde, M. D., … Gulmezoglu, M. A. (2015). How women are treated during facility-based childbirth: Development and validation of measurement tools in four countries—phase 1 formative research study protocol. Reproductive Health, 12, 60. doi:10.1186/s12978-015-0047-2.
Vyas, S., & Kumaranayake, L. (2006). Constructing socio-economic status indices: how to use principal components analysis. Health Policy and Planning, 21(6), 459–468.
WHO, LSHTM, and SARC. (2013). Global and regional estimates of violence against women. Prevalence and health effects of intimate partner violence and non-partner sexual violence. Retrieved from http://www.who.int/reproductivehealth/publications/violence/9789241564625/en/index.html.
World Health Organization. (2015a). The prevention and elimination of disrespect and abuse during facility-based childbirth. Geneva: WHO. Retrieved from http://www.who.int/reproductivehealth/topics/maternal_perinatal/statement-childbirth/en/.
World Health Organization. (2015b). Trends in Maternal Mortality: 1990 to 2015. Geneva: WHO. Retrieved from http://apps.who.int/iris/bitstream/10665/193994/1/WHO_RHR_15.23_eng.pdf?ua=1.
World Health Organization. (2016). Maternal mortality. Retrieved from http://www.who.int/mediacentre/factsheets/fs348/en/.
Acknowledgements
This study was funded by the Bill and Melinda Gates Foundation Grant No. OPP1083531.
Author information
Authors and Affiliations
Corresponding author
Additional information
Clinical Trial Registry: CTRI/2015/09/006219.
Rights and permissions
About this article
Cite this article
Raj, A., Dey, A., Boyce, S. et al. Associations Between Mistreatment by a Provider during Childbirth and Maternal Health Complications in Uttar Pradesh, India. Matern Child Health J 21, 1821–1833 (2017). https://doi.org/10.1007/s10995-017-2298-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-017-2298-8