Women's experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan
Women's experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan
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DOI：
10.1371/journal.pone.0194601
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发表时间：
2018-03-16
期刊：
影响因子：
3.7
通讯作者：
Avan, Bilal Iqbal
中科院分区：
文献类型：
--
作者：
Hameed, Waqas;Avan, Bilal Iqbal
尊重和有尊严的医疗保健是每个妇女的基本权利。然而，许多寻求分娩服务的妇女，特别是巴基斯坦等低收入国家的妇女，受到助产士的虐待。这项流行病学研究的目的是估计巴基斯坦在设施和家庭环境中分娩的妇女遭受虐待的普遍程度和虐待类型，以解决这一问题缺乏经验证据的问题。该研究还探讨了人口统计学（社会人口，生育史和赋权状态）和虐待之间的关联，无论是在一般情况下，并根据出生环境（无论是家庭或设施为基础的）。材料和方法在第一阶段，我们确定了24个虐待指标，通过广泛的文献综述。然后，我们对这些指标进行了预测试，并将其分为七种行为类型。在第二阶段，调查在巴基斯坦14个地区进行（2013年4月至5月）。共有1，334名在过去12个月内在家或在医疗机构分娩的女性接受了采访。使用Stata 14.1版对全部数据集进行线性回归分析，并分别对设施和家庭分娩进行分析。结果设施和家庭分娩之间的虐待表现无显著差异。大约97%的妇女报告说至少经历过一次不尊重和虐待行为。按类型分列的虐待经历如下：未经同意的护理（81%）;知情权（72%）;非保密护理（69%）;言语虐待（35%）;放弃护理（32%）;歧视性护理（15%）;和身体虐待（15%）。在总体分析中，失业妇女遭受虐待的经历较少（β =-1.17，95%CI-1.81，-0.53）;在权力较低的妇女中更高（β = 0.11，95% CI 0.06，0.16）;由传统助产士而非全科医生协助的产妇（β = 0.94，95% CI 0.13，1.75）。对在家分娩的亚组分析发现，与虐待有同样的显著关联，包括种族。在设施分娩中，妇女的就业和赋权状况与虐待之间存在着重要关系。与以前的教育对生育准备的妇女不太可能经历虐待相比，那些谁没有收到以前的生育准备education.ConclusionIn以促进护理是以妇女为中心，并提供在尊重和文化上适当的方式，服务提供者应认识到目前的情况，并确保提供优质的产前保健。在社区一级，妇女应寻求产前护理，以改善生育准备，而在人际一级，应制定战略，利用妇女参与关键家庭决策的能力。
IntroductionRespectful and dignified healthcare is a fundamental right for every woman. However, many women seeking childbirth services, especially those in low-income countries such as Pakistan, are mistreated by their birth attendants. The aim of this epidemiological study was to estimate the prevalence of mistreatment and types of mistreatment among women giving birth in facility-and home-based settings in Pakistan in order to address the lack of empirical evidence on this topic. The study also examined the association between demographics (socio-demographic, reproductive history and empowerment status) and mistreatment, both in general and according to birth setting (whether home-or facility-based).Material and methodsIn phase one, we identified 24 mistreatment indicators through an extensive literature review. We then pre-tested these indicators and classified them into seven behavioural types. During phase two, the survey was conducted (April-May 2013) in 14 districts across Pakistan. A total of 1,334 women who had given birth at home or in a healthcare facility over the past 12 months were interviewed. Linear regression analysis was employed for the full data set, and for facility-and home-based births separately, using Stata version 14.1.ResultsThere were no significant differences in manifestations of mistreatment between facility- and home-based childbirths. Approximately 97% of women reported experiencing at least one disrespectful and abusive behaviour. Experiences of mistreatment by type were as follows: non-consented care (81%); right to information (72%); non-confidential care (69%); verbal abuse (35%); abandonment of care (32%); discriminatory care (15%); and physical abuse (15%). In overall analysis, experience of mistreatment was lower among women who were unemployed (beta = -1.17, 95% CI -1.81, -0.53); and higher among less empowered women (beta = 0.11, 95% CI 0.06, 0.16); and those assisted by a traditional birth attendant as opposed to a general physician (beta = 0.94, 95% CI 0.13, 1.75). Sub-group analyses for home-based births identified the same significant associations with mistreatment, with ethnicity included. In facility-based births, there was a significant relationship between women's employment and empowerment status and mistreatment. Women with prior education on birth preparedness were less likely to experience mistreatment compared to those who had received no previous birth preparedness education.ConclusionIn order to promote care that is woman-centred and provided in a respectful and culturally appropriate manner, service providers should be cognisant of the current situation and ensure provision of quality antenatal care. At the community level, women should seek antenatal care for improved birth preparedness, while at the interpersonal level strategies should be devised to leverage women's ability to participate in key household decisions.