Table 2 Typology of the mistreatment of women during childbirth according to Bohren et al. based on presence/absence in our findings
Third Order Themes | Second Order Themes | First Order Themes | |||
|---|---|---|---|---|---|
Present | Absent | Present | Absent | Present | Absent |
Physical abuse | Use of force Sexual abuse | Women beaten, slapped, kicked, or pinched during delivery Women physically restrained to the bed or gagged during delivery | |||
Sexual abuse | Sexual abuse | Sexual abuse or rape | |||
Verbal abuse | Harsh language Threats and blaming | Harsh or rude language a Judgmental or accusatory comments | Threats of withholding treatment or poor outcomes Blaming for poor outcomes | ||
Stigma and discrimination | Discrimination based on socio-demographic characteristics Discrimination based on medical conditions | Discrimination based on ethnicity/race/ religion Discrimination based on age Discrimination based on socioeconomic status Discrimination based on HIV status | |||
Failure to meet professional standards of care | Lack of informed consent and confidentiality Physical examinations and procedures Neglect and abandonment | Refusal to provide pain relief Performance of unconsented surgical operations Neglect, abandonment, or long delays Skilled attendant absent at time of delivery a | Lack of informed consent process Breaches of confidentiality Painful vaginal exams | ||
Poor rapport between women and providers | Ineffective communication Lack of supportive care Loss of autonomy | Poor communication Lack of supportive care from health workers a Denial or lack of birth companions Denial of food, fluids, or mobility a Denial of safe traditional practices Lack of respect for women’s preferred birth positions | Dismissal of women’s concerns Poor staff attitudes Language and interpretation issues Women treated as passive participants during childbirth Objectification of women Detainment in facilities | ||
Health system conditions and constraints | Lack of resources Facility culture | Lack of policies | Physical condition of facilities Supply constraints Bribery and extortion Unclear fee structures | Staffing constraints Staffing shortages Lack of privacy a Lack of redress Unreasonable requests of women by health workers | |