Mistreatment during Childbirth: Impact on Maternal Outcomes and Importance of Provider Perspectives

Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, maternal mortality rates have doubled in the United States in the last twenty years. This commentary examines the various contributing factors to this trend. Methods: A literature review was performed using the keywords: maternal mortality, United States, disrespectful maternity care, obstetric violence, provider perspectives, and disparities. Maternal mortality statistics were obtained from the World Health Organization website. Results: Medical factors associated with maternal mortality include increased maternal age and cardiovascular conditions. Social factors include barriers to healthcare access, delays in receiving medical care, reduction in reproductive health services in some states, and non-obstetrical deaths such as accidents, domestic violence, and suicide. Racial inequities and disparities of care are reflected in higher maternal mortality rates for minorities and people of color. Disrespectful maternity care or obstetric violence has been reported worldwide as a factor in delay of lifesaving obstetrical care and reluctance by a pregnant person to access the healthcare system. About one in five US women has reported experiencing mistreatment, varying from verbal abuse to lack of privacy, from coerced procedures to neglect during childbirth. Conclusion: This commentary highlights the importance of inclusion of providers in research on respectful maternity care. Provider burnout, moral distress, limited time, and burden of clinical responsibilities are known challenges to respectful and comprehensive medical care. The association of disrespectful care with poor maternal outcomes needs to be studied. Exploring root causes of disrespectful childbirth care can empower nurses, midwives, and physicians to improve their environment and find solutions to reduce a potential cause of maternal mortality.

Patient and Provider Perspectives of Disrespect and Abuse during Childbirth in Tanzania: A Literature Review

Objective: Disrespectful and abusive (D&A) maternity care is a deterrent to facility childbirth and can thus contribute to child and maternal mortality. This study will review existing literature on D&A in Tanzania to better understand and contextualize the issue. Methods: A comprehensive literature search was conducted to find relevant publications on D&A during childbirth in Tanzania. The search was conducted on the National Center for Biotechnology Information (NCBI) and PubMed (U.S. National Library of Medicine at the National Institutes of Health). The inclusion criteria were as follows: qualitative, quantitative, and ethnographic studies conducted in Tanzania on obstetrical violence;published in English;focused on prevalence, incidence, root causes, historical trends, interventions, and policy recommendations for obstetrical violence in Tanzania. Results: Twenty-one studies were selected for this literature review. Up to 73.1% of women reported experiencing at least one form of D&A during labor. Commonly reported D&A events include non-dignified care, non-confidential care, and physical abuse. Other forms of D&A, including detention in facilities and asking for unofficial payments, are also reported. Ninety-six percent of nurses, midwives, and nursing assistants in Tanzania self-reported engaging in at least one form of D&A. Lack of training and provider support, long work hours, fear of blame, and limited infrastructure were reported as factors leading to D&A by providers. Conclusions: In Tanzania, D&A during childbirth is prevalent in healthcare systems. The direct relationship between D&A and poor maternal and fetal health is well-documented. Individual and systemic factors influence both provider and patient perspectives of D&A, providing a window into a complex and sensitive phenomenon. It is important that D&A in Tanzania be viewed holistically, and that interventions target the multifaceted nature of the issue.