In 2014, the World Health Organization issued a statement on prevention and elimination of disrespectful behavior and ill-treatment of women in medical facilities. This document calls for action and research to ensure women’s freedom from abuse and violence within perinatal care [1]. The current guidelines, published in February 2018, underline the importance of respectful care for mothers and children, recognizing the positive experience of women as a priority [2].
Several terms and expressions are found in the literature to describe negative experiences during labor and birth: disrespect, misconduct, disrespectful or arrogant care, offensive behavior, abuse or neglect [3,4,5]. In addition, he concept of disrespectful and abusive obstetric care is now being used (DACF - disrespectful/abusive care during childbirth in facilities) [6, 7]. In recent years, inappropriate behavior towards women in childbirth began to be described and classified as violence, abuse and discrimination [8, 9]. Moreover, human rights are believed to be violated - when there is a maternal perinatal death associated with the possibility of avoiding complications [10].
Bowser and Hill described seven categories of inappropriate behaviors - physical abuse, non-consented clinical care, non-confidential care, non-dignified care, discrimination, abandonment, and detention in health facilities [6]. However, Bowser and Hill’s work has been critiqued. Freedmann et al. point to the fact that the 7-categories described by Bowser and Hill approach has certain limitations, due to the fact that it concentrates on describing the types of abuse that take place in maternity facilities, but does not take into account the wider context [11]. Freedmann et al. propose a definition that considers both the individual experience of degrading or violent behavior towards women and the importance of structural determinants. This approach reflects the complexity of violence in maternity care. It enables opening to perspectives of very different, often antagonized, groups of stakeholders - women, service providers, politicians and a joint debate on how to improve the quality of care.
A systematic review in the area of negligence and violations of childbirth led by Bohren et al. allowed a widening to the typology of these abuses [8]. The review presented a detailed typology that was evidence based and comprehensively illustrated how women in perinatal care facilities can be mistreated on multiple levels: interactions between women and healthcare providers as well as system and organizational failures. The literature describes respectful maternity care (RMC), which is opposed to abusive care during childbirth in facilities. A recent qualitative evidence synthesis performed by Shakibazadeh et al. elaborates further and mentions how respectful care is concerned with being free from harm and mistreatment [12].
There are many studies of violence and abuse in obstetrics in parts of Africa (Tanzania, Ghana, Kenya, Nigeria) [13,14,15,16], Latin America and the Caribbean [17], Pakistan [18]. Yet, there is a paucity of studies related to violence and abuse within European perinatal care. Data from several studies, that included 25% European women, inferred that the occurrence of certain forms of violence during labor may be associated with traumatic deliveries [19].
The scale and type of abuse and violence varies depending on the region of the world, culture or social position [20]. Abuses against birthing women start with subtle forms of discrimination and can turn into overt violence [21]. Research shows that minors, unmarried women, migrants or women from minority groups, as well as those with low socio-economic status, are the most exposed to degrading and inappropriate treatment, and women with HIV are particularly vulnerable to unequal treatment [22]. These abuses and acts of violence towards women during perinatal care have consequences. For example, abusive perinatal care is associated with the risk of complications in the mother and child such as uterine rapture, perineal laceration, neonatal mortality [7, 23].
In Poland, there are legal acts pertaining to a woman’s rights when receiving perinatal care provided by gynecological and obstetric hospitals, for example, The Patient Rights and Patient Rights Law [24] and the Regulation of the Minister of Health of August 16, 2018 on the standard of perinatal care [25] - in short called Perinatal Care Standards (PCS). These legal documents focus on protection of human rights and are evidence based, but they do not define instruments for monitoring the degree of compliance with these principles by specific institutions. These standards refer to patient’s rights [in this case women’s rights receiving perinatal care] and actions that guarantee care consistent with these rights. However, they do not refer to the issue of violence and abuse or the definition of these phenomena in the context of perinatal care exercised in Polish healthcare institutions. Unfortunately, Poland neither employs scientific research nor social activities to lessen and mitigate perinatal abuse and violence within its institutions and that this issue be addressed directly as soon as possible. Using the definitions described in the cited literature this study sought to uncover what is the disrespectful and abusive practices in Polish perinatal care through the experiences of women.
Aim
The aim of the study was to analyze perinatal care related experiences of women, especially focusing on those that have characteristics that indicate disrespectful/abusive care during childbirth in health facilities.
