Background
Methods
Study design, setting and sampling
Study tool and data collection
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Physical abuse: slapping, pinching, beating or tying the women; invasive procedures done without any pain relief (episiotomies and caesarean sections); repetitive use of excessive force during vaginal examinations/labour/delivery)
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Non-dignified care: shouting/ scolding; threatening to withhold treatment; threatening or negative comments (in the form of rude remarks about the woman’s sexual behavior that led to pregnancy)
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Neglect and abandonment: ignoring or abandoning the women when in need and/or delivering alone
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Non-confidential care: lack of physical privacy (that is, body seen by non-health personnel); disclosing private health information to others without consent and doing procedures like tubal ligation, caesarean sections and hysterectomy without consent
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Non-consented care: doing tubal ligation; caesarean sections and hysterectomy without consent of the woman or her family members
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Inappropriate demands for money: demands for bribe for better care and detaining mother or the baby or both in facilities due to failure to pay
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Other types of disrespect and abuse: an open ended category was kept to capture any other kind of disrespect and abuse that women experienced during their delivery
Statistical analysis
Results
Socio-demographic and delivery characteristics
Variables | N = 410 (%) |
---|---|
Age - Mean (in years) ± SD | 24.7 (3.18) |
Educational status | |
No education | 77 (18.8) |
< = Secondary (till class X or less) | 197 (48.0) |
> =Higher secondary and above (class XII or above) | 136 (33.2) |
Occupational status | |
Remunerated Work | 54 (13.2) |
Non-remunerated work | 356 (86.8) |
Place of delivery | |
a) Government facilities | |
Primary Health Center | 86 (21.0) |
Community Health Center | 53 (12.9) |
District Hospital/ Tertiary Hospital | 9 (2.2) |
Health Sub-Centre | 135 (32.9) |
Other government facilities | 19 (4.6) |
b) Private facilities | 108 (26.3) |
Previous use of facility before the current delivery | |
Yes | 215 (52.4) |
No | 195 (47.6) |
Companion3 present during delivery | |
Yes | 251 (61.2) |
No | 159 (38.8) |
Main provider conducting delivery | |
Doctor | 135 (32.9) |
Nurse | 231 (56.3) |
Informal worker4 | 40 (9.8) |
None | 4 (1) |
Type of delivery | |
Normal/ episiotomies | 354 (86.3) |
C-section/ Vacuum extraction/ forceps delivery | 56 (13.7) |
Complications post-delivery | |
Yes | 65 (15.8) |
No | 345 (84.1) |
Overall quality of care during delivery | |
Very good | 45 (10.9) |
Good | 242 (59.0) |
Fair/ Poor | 123 (30.0) |
Choice of facility for next delivery | |
Same facility | 183 (88.8) |
Another facility | 23 (11.2) |
Disrespect and abuse
Variables | N = 118 (%) | |
---|---|---|
Frequency of abuse |
Any abuse
a
|
Any abuse
b
|
Never abused | 30 (7.3) | 292 (71.2) |
Experienced only 1 type of abuse | 266 (64.9) | 57 (13.9) |
Experienced 2 types of abuse | 56 (13.7) | 39 (9.5) |
Experienced 3 types of abuse | 37 (9.0) | 13 (3.2) |
Experienced = > 4 types of abuse | 21 (5.12%) | 9 (2.2%) |
Any disrespect and abuse | 380 (92.7) | 118 (28.8) |
Specific experiences of disrespect and abuse excluding inappropriate demands of money (overlapping categories) | ||
Physical abuse | ||
Overall | 55 (13.4) | |
Physical abuse (slapping/ pinching etc.) | 11 (2.7) | |
Use of excessive force during delivery | 49 (12) | |
Delivery without any pain relief | 6 (1.5) | |
Non-dignified care | ||
Overall | 79 (19.3) | |
Shouting/scolding | 71 (17.3) | |
Threat of withholding treatment | 17 (4.1) | |
Threatening or negative comments | 26 (6.3) | |
Non-confidential care | ||
Overall | 23 (5.6) | |
Disclosing private health information to others | 0 (0) | |
Delivery without any physical barriers | 23 (5.6) | |
Neglect | ||
Overall | 35 8.5) | |
Ignored when needed help | 35 (8.5) | |
Delivery without attendant | 2 (0.5) | |
Inappropriate demands for money | ||
Overall | 371 (90.5) | |
Detention in facility for failure to pay | 54 (13.2) | |
Request for bribe | 371 (90.5) | |
Other forms of abuse | 20 (4.9) |
Physical abuse
‘They were inserting their fingers inside me in every 10 min (….) it was so painful. Then they would beat me up on the thighs. They did that several times (….) during delivery I would cry (….) I do not how many they were, but almost everybody had pressed me down to the bed, I could not move (….) The moment I drew my breath, everybody became so mad at me. They started beating me more, pushing on my abdomen. It was so painful that it got torn down there. While giving the stitches, they did not give me anything for pain. It was my first delivery and now I am really scared for my second child’ -
Primi mother from a lower caste
Non-dignified care
‘
When you were sleeping with your husband, then you did not scream, and now you are? (….) If you do not want babies but want to have fun then do ligation’ -
Mother of three from a lower caste
Neglect and abandonment
‘They gave me a bed but nobody came to look after me (…) they were so busy with some other woman that my mother took the curtains from the windows as we did not have any plastic sheet with us (…) she (nurse) started pushing on my abdomen (…) by the grace of God, I delivered and it was a daughter’ -
Mother of three from a lower caste
Non-confidential care
‘I was lying on the bed naked drenched in my own blood after delivery for around half an hour in the presence of everybody (…) I somehow found my clothes and covered myself’ -
Mother of two from a lower caste
Inappropriate demands of payment
‘The nurse told everybody has to pay, and then only you will get the money from the government. Also, all the medicines were bought with my money, so that has to be covered as well. Give 2000 rupees, else I will not give your baby’-
Mother of two from a higher caste
Other types of abuse (lack of cleanliness)
‘It was like a dump. I could see blood and stuff of other women on the bed sheets. There were plastic bags, used sanitary napkins, urine, blood, vomit, food; everything on the floor (…) the toilets were overflowing with faeces with no water facility inside (…) finally I had to go to the fields’ -
Mother of five from a lower caste
|
Factors associated with disrespect and abuse
Predictor variable | % of pregnant women abused | p-value |
---|---|---|
Age | ||
< 25 years | 29.1 | 0.87 |
= > 25 years | 28.4 | |
Education | ||
= <Secondary education (till class X) | 27.4 | 0.69 |
> Secondary education (more than class X) | 29.4 | |
Occupation | ||
Non-remunerated work | 27.5 | 0.15 |
Remunerated work | 37.0 | |
Caste | ||
General | 29.6 | 0.15 |
OBCa | 27.6 | |
SC/STb | 29.2 | |
Economic status | ||
Non-poor | 29.4 | 0.96 |
Poor | 29.1 | |
Total number of children | ||
One child | 29.9 | 0.94 |
2–3 children | 28.4 | |
= > 4 children | 27.7 | |
Type of facility | ||
Government | 30.1 | 0.31 |
Private | 25.0 | |
Nature of government facility | ||
PHCc and HSCd | 24.9 | 0.00* |
CHCe | 47.2 | |
DH/ THf | 55.6 | |
Referred from first facility approached | ||
Yes | 36.4 | 0.18 |
No | 27.6 | |
Respondent was escorted for current delivery to the facility | ||
Yes | 29.1 | 0.20 |
No | 0 | |
Companion present during delivery | ||
Yes | 30.3 | 0.40 |
No | 26.4 | |
Type of provider conducting delivery | ||
Doctor | 36.3 | 0.04* |
Nurse/ ANMg | 23.8 | |
ASHAh/ Dais | 27.5 | |
Presence of complications | ||
Yes | 44.6 | 0.00* |
No | 25.8 |
Predictor variable | Adjusted Odds Ratio (95% CI) |
---|---|
Presence of complications | |
Yes | 4.18 (1.78–9.83) |
No | Ref |
Type of provider | |
Doctors | 2.56 (0.89–7.36) |
Nurses | 0.75 (0.32–1.76) |
ASHAh/ Dais | Ref |
Type of facility | |
PHCc and HSCd | Ref |
CHCe | 1.00 (0.19–5.30) |
DH/ THf | 2.52 (0.45–14.07) |