Silent voices: institutional disrespect and abuse during delivery among women of Varanasi district, northern India
Silent voices: institutional disrespect and abuse during delivery among women of Varanasi district, northern India
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DOI：
10.1186/s12884-018-1970-3
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发表时间：
2018-08-20
影响因子：
3.1
通讯作者：
Ravindran, T. K. Sundari
中科院分区：
文献类型：
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作者：
Bhattacharya, Shreeporna;Ravindran, T. K. Sundari
背景：有相当数量的定性证据报告保健提供者在分娩期间虐待妇女。然而，缺乏关于这种虐待的实际流行程度和性质的信息，这是本研究的目的。方法：我们对410名2014年6月至2015年8月在印度北部瓦拉纳西地区任何卫生机构分娩的农村妇女进行了一项基于社区的横断面研究，使用Staha（斯瓦希里语中“尊重”的意思）项目调查问卷。我们通过多阶段整群随机抽样从瓦拉纳西的两个农村街区选择了妇女，这两个街区在2014-15年记录了最高的机构分娩次数。结果：家庭暴力行为发生率为28.8%（不包括不恰当的金钱要求，其发生率为90.5%）。报告的虐待是无尊严的照顾，包括与妇女性行为有关的言语虐待和贬损性侮辱（19.3%）；身体虐待（13.4%）；忽视或遗弃（8.5%）；非保密护理（5.6%）；由于缺乏清洁而感到羞耻（4.9%）。无论妇女的社会人口背景如何，她们在分娩或分娩期间都受到虐待。使用卡方检验的双变量分析显示，滥用与提供者类型、设施类型和分娩期间出现并发症之间存在统计学上显著的关联。二元逻辑回归表明，那些在分娩过程中出现并发症的妇女被虐待的几率要高出四倍。虽然统计数字微不足道，而且与预期相反，妇女似乎也在私人机构中受到虐待；但频率较低，严重程度较轻。结论：无论其社会人口背景或在政府和私人卫生机构的分娩条件如何，妇女在分娩或分娩期间受到不尊重和虐待的发生率很高。如果不解决不尊重和虐待的问题，可以假设，这种严酷的做法可能会促进家庭分娩，尽管更不安全，但它提供了一个同情的环境，而不是安全的基于设施的分娩选择。
Background: A considerable amount of qualitative evidence reporting abusive treatment of women during delivery by health providers is available. However, there is a dearth of information regarding the actual prevalence and nature of such abuse, which this study aimed to explore.Methods: We conducted a community based cross-sectional study using a contextually adapted version of the Staha (meaning 'respect' in Swahili) project questionnaire among 410 rural women who delivered between June, 2014 to August 2015 at any health facility of Varanasi district, northern India. We selected the women through multi-stage cluster random sampling from two rural blocks of Varanasi, which recorded the highest number of institutional deliveries in 2014-15.Results: The frequency of any abusive behavior (excluding inappropriate demands of money due to its high prevalence-90.5%) was 28.8%. The reported abuses were non-dignified care including verbal abuse and derogatory insults related to the woman's sexual behavior (19.3%); physical abuse (13.4%); neglect or abandonment (8.5%); non-confidential care (5.6%); and feeling humiliation due to lack of cleanliness bordering on filth (4.9%). Women were abused during labor or delivery irrespective of their socio-demographic background. Bivariate analysis using Chi-square tests showed statistically significant associations between abuse and provider type, facility type, and presence of complications during delivery. Binary logistic regression indicated that the odds of being abused was four times higher in those women who experienced complications during delivery. Though statistically insignificant, and contrary to expectations, women also seemed to be abused in private institutions; but with a lower frequency and of lesser severity.Conclusions: The prevalence of disrespect and abuse during labor or delivery was high among women irrespective of their socio-demographic background or delivery conditions in government as well as private health facilities. If the problem of disrespect and abuse is not addressed, it can be assumed that such harsh practices might promote home deliveries, which despite being more unsafe provide an empathetic environment in lieu of safe facility-based birthing options.