Implementation of the United Nations Sustainable Development Goals has increased emphasis in the global community on the social determinants of health. One growing concern worldwide is disrespectful and abusive care given to women while giving birth in healthcare facilities (Stanton, 2014). Bohren et al. (2015) synthesized qualitative and quantitative published works on this topic, including 65 studies conducted in 34 countries. The data revealed these categories of inappropriate care: (1) physical, sexual, and verbal abuse; (2) stigma and discrimination; (3) failure of providers to meet standards of healthcare; (4) ineffective communication between women and their providers; and (5) conditions and constraints of healthcare systems. Physical and sexual abuse described use of force including rape. Verbal abuse included harsh, critical, or judgmental language and threats. Stigma and discrimination were based on sociocultural factors such as ethnicity, race, or religion, as well as medical conditions such as HIV/AIDS.
Failure to meet standards of care included lack of informed consent and confidentiality, procedures performed in an inappropriate manner, denial of pain medication, and performing unconsented surgical procedures. Neglect and abandonment were also noted. Communication issues included dismissing women's concerns, lack of supportive care, and being insensitive to culturally diverse women's desire for culturally appropriate care (Bohren et al., 2015).
Health system issues included shortage of staff and supplies, lack of safe facilities, and lack of privacy (Bohren et al., 2015). For example, in an Ecuadorian maternity hospital with 32,400 births per year where mostly mestizo (mixed Indian and Spanish) women receive care, there is one row of stretchers for 22 women in active labor, the physicians going from woman to woman to assess them briefly with a single fetal monitor, not personalizing their care, receiving no pain medication, no labor support, and being left without family presence. Another row of women is waiting for a cesarean birth and a third row for women experiencing a perinatal loss awaiting care (Callister, Corbett, Reed, Tomao, & Thornton, 2010).
According to the International Federation of Gynecology and Obstetrics (FIGO) (2015, p. 95), "Every woman has the right to a positive birth experience and to compassionate care from knowledgeable, skilled providers who recognize that each woman, family and newborn is unique and deserving of individualized dignified care." Such rights have been outlined in the World Health Organization (WHO) Prevention and Elimination of Disrespect and Abuse During Childbirth statement (http://www.who.int/reproductivehealth/topics/maternal_perinatal/statement-childb). The WHO Safe Childbirth Checklist is a 29-item checklist that was piloted in South India, demonstrating improvement in healthcare workers' delivery of safe childbirth practices (Spector et al., 2013). Working with global partners including WHO, the International Confederation of Midwives, and the White Ribbon Alliance, FIGO is conducting a criterion-based audit of healthcare facilities designed to facilitate change from an environment of abuse and disrespect to one of quality, safety, and support for childbearing women and their families.
DeLellis (2000, p. xxii) beautifully described the importance of respecting birthing women through administration of supportive care, "The perinatal experience-an act of procreation, rite of passage, sacrifice of love, obligation of conscience, choice of fulfillment, or whatever it represents in the minds and hearts of birth-giving women and their communities-is a life-transforming object of respect." Women deserve better care.
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