How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys
How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys
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DOI：
10.1016/s0140-6736(19)31992-0
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发表时间：
2019-11-09
期刊：
影响因子：
168.9
通讯作者：
Tuncalp, Ozge
中科院分区：
文献类型：
--
作者：
Bohren, Meghan A.;Mehrtash, Hedieh;Tuncalp, Ozge
背景世界各地的妇女在分娩期间受到虐待。我们的目标是开发和实施循证、有效的工具来衡量分娩期间的虐待，并报告来自四个低收入和中等收入国家的横断面研究的结果。方法我们前瞻性地招募了2016年9月19日至2018年1月18日期间加纳、几内亚、缅甸和尼日利亚12个卫生机构（每个国家3个）中至少15岁的女性。从入院到产后2小时，对分娩和分娩进行连续观察。调查由社区访谈员对产后8周的妇女进行。没有在缅甸进行劳工观察。数据收集的社会人口统计学，产科史，和经验的虐待。结果2016劳动观察和2672调查完成。在2016年观察的妇女中，有838人（41.6%）和2672名接受调查的妇女中有945人（35.4%）经历过身体或语言虐待，或耻辱或歧视。身体和言语虐待在出生前30分钟达到峰值，直到出生后15分钟（观察）。尽管接受了会阴切开术（观察组：253例中的190例[75.1%];调查组：526例中的295例[56.1%]）或剖腹产（观察组：261例中的35例[13.4%];调查组：483例中的52例[10.8%]），但许多妇女不同意这些手术。在2 672名妇女或其婴儿中，有133人（5.0%）因无力支付账单而被拘留在该设施中（调查）。年龄较小（15 - 19岁）和缺乏教育是虐待的主要决定因素（调查）。例如，没有受过教育的年轻女性（优势比[OR] 3.6，95%CI 1.6 - 8.0）和具有一定教育的年轻女性（OR 1.6，1.1 - 2.3）与老年妇女相比，（>= 30年），解释超过三分之一的妇女经历过虐待，并且在2010年前后特别脆弱。出生年轻和受教育程度较低的妇女面临的风险最大，这表明妇女在分娩期间受到的待遇不平等。了解虐待的驱动因素和结构性方面，包括性别和社会不平等，对于确保干预措施充分考虑到更广泛的背景至关重要。版权所有（C）2019这是一篇根据CC BY 3.0 IGO许可证发布的开放获取文章，该许可证允许在任何媒体上无限制地使用，分发和复制，前提是原始作品被正确引用。
Background Women across the world are mistreated during childbirth. We aimed to develop and implement evidence-informed, validated tools to measure mistreatment during childbirth, and report results from a cross-sectional study in four low-income and middle-income countries.Methods We prospectively recruited women aged at least 15 years in twelve health facilities (three per country) in Ghana, Guinea, Myanmar, and Nigeria between Sept 19, 2016, and Jan 18, 2018. Continuous observations of labour and childbirth were done from admission up to 2 h post partum. Surveys were administered by interviewers in the community to women up to 8 weeks post partum. Labour observations were not done in Myanmar. Data were collected on sociodemographics, obstetric history, and experiences of mistreatment.Findings 2016 labour observations and 2672 surveys were done. 838 (41.6%) of 2016 observed women and 945 (35.4%) of 2672 surveyed women experienced physical or verbal abuse, or stigma or discrimination. Physical and verbal abuse peaked 30 min before birth until 15 min after birth (observation). Many women did not consent for episiotomy (observation: 190 [75.1%] of 253; survey: 295 [56.1%] of 526) or caesarean section (observation: 35 [13.4%] of 261; survey: 52 [10.8%] of 483), despite receiving these procedures. 133 (5.0%) of 2672 women or their babies were detained in the facility because they were unable to pay the bill (survey). Younger age (15-19 years) and lack of education were the primary determinants of mistreatment (survey). For example, younger women with no education (odds ratio [OR] 3.6, 95% CI 1 .6-8.0) and younger women with some education (OR 1.6, 1.1-2.3) were more likely to experience verbal abuse, compared with older women (>= 30 years), adjusting for marital status and parity.Interpretation More than a third of women experienced mistreatment and were particularly vulnerable around the time of birth. Women who were younger and less educated were most at risk, suggesting inequalities in how women are treated during childbirth. Understanding drivers and structural dimensions of mistreatment, including gender and social inequalities, is essential to ensure that interventions adequately account for the broader context. Copyright (C) 2019 This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.