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Table 2 Manifestations of mistreatment of women during childbirth in Kenya

From: Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions

Third order themes Second order themes Illustrative manifestations of experiences and reports of first order themes from Kenya
Women Men Health providers (HPs)/managers
Intentional mistreatment: use of violence, physical, verbal, negligent withholding of care
Physical abuse Use of force Slapping/pinching Beaten by HPs Slap to save a woman’s life
Physical restraint Pushing my thighs Helped to make the woman cooperate or obey To make room for baby to come out if mother is closing legs. Fear of being reprimand for poor out pregnancy comes
Sexual abuse Sexual abuse Not recorded in any data from this study
Verbal abuse Harsh language
Threats and blaming
Insulting language; Threatening and insulting relatives/caretaker
Women blamed for negative outcomes
Reprimanding client if she calls for help
Insults from health providers to women and caregivers Harsh words ‘helps’ women and relatives cooperate; You must appear tough to gain cooperation
Personal attitude
Stigma and discrimination Discrimination based on ethnicity, socioeconomic status Women ‘blamed’ for high parity, age and socioeconomic status
Tribalism/ethnicity
Devalues my partner/wife and I or my community Women take too long to understand. HPs overworked, stereo typing, negative attitude and values ‘that tribe behavior/react like that
HIV positive women avoided or abandoned Men forced to take HIV test Fear, stigma lack of knowledge
Failure to meet professional standards of care Lack of informed consent for physical exam and procedures HPs discuss the examination results with others Devalues my wife and I Rooms do not offer audio privacy
Student allowed to do episiotomy ‘badly’
Frequent vaginal examinations/multiple tests by HPs and students
Student must learn on clients: too many students must achieve skills in a short time. Lack of HPs skills and confidence.
Lack of confidentiality and privacy Examination, delivery and treatment required to undress without curtains or partitions Bed sharing Lack of curtains
Too many clients
Limited space
Women have to give personal information in public (within hearing distance of others) Over crowding
Neglect and abandonment Older/higher parity women report left to deliver on their own as HPs abandon them due to their previous birth experience HPs refuse to help women in labor if not come with drugs, supplies, money. Men rush to buy them. Too busy, overworked, uncooperative mother. Poor staff attitude, “have done my shift for the day”, lack of team work. Inadequate supervision, Demotivated.
Ignoring clients’ calls for help HPs not available or at night
Doctor not available to conduct cesarean section No doctor available Absenteeism; report late on duty, no housing for doctors; lack of transport.
HPs not responding to client when in pain Some women too afraid of pain Poor staff attitude; Lack of professional ethics;
Poor leadership
Poor rapport between women and health providers Lack of autonomy Not involved in decision making in my care
Used language that I could not understand
Lack of food/drink. No bathing facilities
  Poor staff attitude.
Too busy to explain, they do not get even if you explained,
Ineffective counseling/communication.
Detainment Lack of money makes mothers avoid going to hospital Women are detained Clients are abandoned by their relatives in hospital.
Ineffective communication Not given information about my care
Do not understand the need for frequent vaginal examinations
Not consulted or informed about my wife’s progress or babies condition HPs have no time to discuss procedures due to high workload
Clients do not understand
Structural disrespect deviations
Health system conditions an constraints Lack of resources Lack of equipment. bed sharing,
Lack of curtains/clean linen
Facility request money to buy drugs Inadequate supplies, lack of funds, misuse of funds, lack of maintenance, poor planning and forecasting
No water for bathing, dirty bathrooms
No food
No support staff
Staff shortage/no supervision/poor leadership. Made to clean up
Have to buy the drugs and supplies Shortages
Staff and equipment and supplies
Facility culture Too few staff Staff not supervised Staff shortages
Ineffective supervision
Corruption/bribery You must stretch your hand
Some behave in a way that they want to be bribed
Pay bribe to get own bed Poor and delayed pay.
Accepted norm- everyone is doing it anyway
  1. The illustrative manifestations (first-order themes describing specific events or instances of mistreatment) presented in this table are drawn from the study findings in Kenya. We have adapted these to the framework developed by Bohren et al [2] using a global evidence-based typology (third, second and first order themes) of mistreatment of women during childbirth. The second- and third-order themes classify first-order themes into meaningful groups based on common attributes. The third-order themes are ordered from the level of interpersonal relations through the level of the health system
  2. HP health provider