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Disrespect and Abuse in Obstetric Care in Mexico: An Observational Study of Deliveries in Four Hospitals

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Abstract

Introduction

To identify and describe the frequency and characteristics of disrespect and abuse practices towards women during facility-based delivery in four hospitals in two Mexican states in 2017, using a mixed method of direct observation and women’s reports of health care experiences.

Methods

A cross-sectional study was performed to describe disrespect and abuse practices in obstetric care (interactions or conditions that are experienced as or intended to be humiliating or undignified) committed by healthcare providers. We included all pregnant women admitted for childbirth (vaginal and cesarean). Semi-structured interviews were also conducted with women, prior to discharge, regarding their experience at delivery.

Results

867 deliveries were observed. 18.8% of women (n = 163) experienced at least one disrespect and abuse event, especially at secondary care facilities. There were a total of 493 disrespect and abuse events, which, on average, represents three events per woman (39.4% were verbal abuse, 32% were physical abuse, and 28.6% were discrimination). In the majority of cases (> 50%), women did not give consent to not recommended invasive procedures and were not provided with adequate information to those procedures.

Conclusions for Practice

Direct observation and interviews was a useful tool to identify disrespectful and abusive practices during delivery care. Our findings provide new evidence of the frequency and characteristics of disrespect and abuse during delivery care in Mexico, which can be used to inform maternal health programs. Additionally, these results encourage the creation of surveillance policies and committees in order to guarantee violence-free and dignified treatment of women during delivery care.

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References

  • Afulani, P. A., Kelly, A. M., Buback, L., Asunka, J., Kirumbi, L., & Lyndon, A. (2020). Providers’ perceptions of disrespect and abuse during childbirth: A mixed-methods study in Kenya. Health Policy and Planning, 35, 577–586.

    Article  Google Scholar 

  • Amy Manning & Martaf Schaaf. (2018). Falta de respeto y abuso durante el parto y cuidado materno respetuoso. Retrieved from https://www.whiteribbonalliance.org/wp-content/uploads/2018/01/6422_RMC-DA-Brief-PPG-V2_Spanish_Final.pdf

  • Ayers, S., Eagle, A., & Waring, H. (2006). The effects of childbirth-related post-traumatic stress disorder on women and their relationships: A qualitative study. Psychology, Health and Medicine, 11(4), 389–398.

    Article  Google Scholar 

  • Bohren, M. A., Mehrtash, H., Fawole, B., Maung, T. M., Balde, M. D., Maya, E., et al. (2019). How women are treated during facility-based childbirth in four countries: A cross-sectional study with labour observations and community-based surveys. The Lancet, 394(10210), 1750–1763.

    Article  Google Scholar 

  • Bowser, D., & Hill, K. (2010). Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth Report of a Landscape Analysis USAID-TRAction Project.

  • Calvo-Aguilar, O., Torres-Falcón, M., & Valdez-Santiago, R. (2019). Obstetric violence criminalised in Mexico: A comparative analysis of hospital complaints filed with the medical arbitrating commision. BMJ Sexual and Reproductive Health. https://doi.org/10.1136/bmjsrh-2018-200224.

    Article  PubMed  Google Scholar 

  • Castro R, Frias S. (2016). Violencia obstétrica en México resultados de la ENDIREH 2016. In Primer congreso sobre violencias de género contra las mujeres. (pp. 1–13). https://doi.org/https://doi.org/10.22201/crim.UNAM000001c.2017.c55

  • Catchpole, K., Neyens, D. M., Abernathy, J., Allison, D., Joseph, A., & Reeves, S. T. (2017). Framework for direct observation of performance and safety in healthcare. BMJ Quality & Safety, 26(12), 1015–1021.

    Article  Google Scholar 

  • D’Oliveira, A. F., Diniz, S. G., & Schraiber, L. B. (2002). Violence against women in health-care institutions: An emerging problem. Lancet, 359(9318), 1681–1685.

    Article  Google Scholar 

  • Downe, S., Lawrie, T. A., Finlayson, K., et al. (2018). Effectiveness of respectful care policies for women using routine intrapartum services: A systematic review. Reproductive Health, 15(1), 23. https://doi.org/10.1186/s12978-018-0466-y.

    Article  PubMed  PubMed Central  Google Scholar 

  • Elmir, R., Schimied, V., Wilkes, L., & Jackson, D. (2010). Women’s perceptions and experiences of a traumatic birth: A meta-ethnography. Journal of Advanced Nutritions, 66(10), 2142–2153. https://doi.org/10.1111/j.1365-2648.2010.05391.x.

    Article  Google Scholar 

  • Fajardo-Dolci, G. E., Hernández-Torres, F., Santacruz-Varela, J., Hernández-Ávila, M., Kuri-Morales, P., et al. (2008). Perfil epidemiológico general de las quejas médicas atendidas en la Comisión Nacional de Arbitraje Médico. 1996-2007. Salud Pública de México, 51(2), 119–125.

    Article  Google Scholar 

  • Freedman, L. P., Ramsey, K., Abuya, T., Bellows, B., Ndwiga, C., et al. (2014). Defining disrespect and abuse of women in childbirth: A research, Policy and rights agenda. Bulletin of the World Health Organization., 92(12), 915–917.

    Article  Google Scholar 

  • Freedman, L. P., & Kruk, M. E. (2014). Disrespect and abuse of women in childbirth: Challenging the global quality and accountability agendas. The Lancet., 384(9948), 42–44. https://doi.org/10.1016/S0140-6736(14)60859-X.

    Article  Google Scholar 

  • Freitas-Silveira, M., Arndt-Mesenburg, M., Damaso-Bertoldi, A., Loret De Mola, C., et al. (2019). The association between disrespect and abuse of women during childbirth and postpartum depression: Findings from the 2015 Pelotas birth cohort study. Journal of Affective Disorders, 256, 441–447.

    Article  Google Scholar 

  • Freyermuth-Enciso MG. (2010). Desiguales en la vida desiguales para morir. La mortalidad materna en Chiapas. Un análisis desde la inequidad. PNUD. Informe Sobre Desarrollo Humano En Chiapas.

  • Frías S. (2017). Violence against Women in Mexico: 25 Years of Qualitative and Quantitative Research. Revista Internacional de Estadística y Geografía, 8(2)

  • Grilo Diniz, C. S., Rattner, D., Lucas d’Oliveira, A. F. P., et al. (2018). Disrespect and abuse in childbirth in Brazil: Social activism, public policies and providers´training. Reproductive Health Matters, 26(53), 1–17.

    Article  Google Scholar 

  • Gobierno de México. (2019). Consejo Nacional de Población.

  • Gómez-Dantes, O., Sesma, S., Becerril, V. M., Knaul, F. M., et al. (2011). Sistema de salud de México. Salud Pública de México, 53(2), 13.

    Google Scholar 

  • Hernández Ávila, M., Rivera Dommarco, J., Shamah Levy, T., Cuevas Nasu, L., et. al.(2016). Encuesta Nacional de Salud y Nutrición de Medio Camino. Cuernavaca. Retrieved from https://www.insp.mx/produccion-editorial/publicaciones-anteriores-2010/4669-encuesta-nacional-salud.html

  • Instituto Mexicano del Seguro Social. (2019). Informe al ejecutivo federal y al congreso de la unión sobre la situación financiera y los riesgos del Instituto Mexicano del Seguro Social 2018–2019.

  • Instituto Nacional de Estadística y geografía INEGI. (2016). Resultados de la encuesta nacional sobre dinámica de las relaciones en los hogares (ENDIREH) 2016. México. Retrieved from http://www.beta.inegi.org.mx/proyectos/enchogares/especiales/endireh/2016/

  • Lansky, S., Ventura de Souza, K., de Morais Peixoto, E. R., et al. (2019). Obstetric violence: Influences of the senses of birth exhibition in pregnant women childbirth experience. Ciencia e Saude Coletiva, 24(8), 2811–2824. https://doi.org/10.1590/1413-81232018248.30102017.

    Article  PubMed  Google Scholar 

  • Madula, P., Kalembo, W., Yu, H., Kaminga, , et al. (2018). Healthcare provider-patient communication: A qualitative study of women’s perceptions during childbirth. Reproductive Health, 15(135), 2–10. https://doi.org/10.1186/s12978-018-0580-x.

    Article  Google Scholar 

  • Montesinos-Segura, R., Urrunaga-Pastor, D., Mendoza-Chuctaya, G., Taype-Rondan, A., Helguero-Santin, L. M., Martinez-Ninanqui, F. W., et al. (2018). Disrespect and abuse during childbirth in fourteen hospitals in nine cities of Peru. International Journal of Gynecology and Obstetrics, 140(2), 184–190. https://doi.org/10.1002/ijgo.12353.

    Article  PubMed  Google Scholar 

  • Morton, C. H., Henley, M. M., Seacrist, M., & Roth, L. M. (2018). Bearing witness: United States and Canadian maternity support workers’ observations of disrespectful care in childbirth. Birth, 45(3), 263–274. https://doi.org/10.1111/birt.12373.

    Article  PubMed  Google Scholar 

  • Nieto-González, L. A., Romero-Quiroz, M. A., Córdova-Ávila, M. A., et al. (2011). Percepción del trato digno por la mujer embarazada en la atención obstétrica de enfermería. Rev CONAMED, 16(1), 5–11.

    Google Scholar 

  • Ortega-Fernández, G. (2018). Boletín CONAMED-OPS. La violencia obstétrica como generadora de prácticas invasivas, 3. https://doi.org/https://doi.org/10.18597/rcog.3032

  • Sacks, E. (2017). Defining disrespect and abuse of newborns: A review of the evidence and an expanded typology of respectful maternity care. Reproductive Health, 14, 66. https://doi.org/10.1186/s12978-017-0326-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sadler, M., Santos, M. J., Ruiz-Berdún, D., Rojas, G. L., Skoko, E., Gillen, P., & Clausen, J. A. (2016). Moving beyond disrespect and abuse: Addressing the structural dimensions of obstetric violence. Reproductive Health Matters, 24(47), 47–55. https://doi.org/10.1016/j.rhm.2016.04.002.

    Article  PubMed  Google Scholar 

  • Terán, P., Castellanos, C., & González-Blanco, M. R. D. (2013). Violencia obstétrica: Percepción de las usuarias. Rev Obstet Ginecol Venez, 73(3), 171–180.

    Google Scholar 

  • Tobasía-Hege, C., Pinart, M., Madeira, S., Guedes, A., Reveiz, L., Valdez-Santiago, R., et al. (2019). Disrespect and abuse during childbirth and abortion in Latin America: Systematic review and meta-analysis. Revista Panamericana de Salud Publica/Pan American Journal of Public Health. https://doi.org/10.26633/RPSP.2019.36.

    Article  PubMed  Google Scholar 

  • Valdez-Santiago, R., Arenas, L., Rojas, A., del Rio, A., et al. (2018). The strategy for promotion of good care in mexican maternity wards:the response of ministry of heath against abuse and disrespectin childbirth. Injury Prevention, 24(A), 106–107.

    Google Scholar 

  • Valdez-Santiago, R., Hidalgo-Solórzano, E., Mojarro-Iñiguez, M., & Arenas-Monreal, L. M. (2013). Nueva evidencia a un viejo problema:el abuso de las mujeres en las salas de parto. Revista CONAMED, 18(1), 14–20.

    Google Scholar 

  • Villanueva-Egan, L. A. (2010). El maltrato en las salas de parto: Reflexiones de un gineco-obstetra. Rev CONAMED, 15(3), 147–151.

    Google Scholar 

  • World Health Organization. (2003). Economic estimation of country-specific hospital costs. World Health Organization. Retrieved from https://www.who.int/choice/publications/p_2003_generalised_cea.pdf?ua=1

  • World Health Organization (WHO). The prevention and elimination of disrespect and abuse during facility-based childbirth (2015). World Health Organization. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/134588/WHO_RHR_14.23_eng.pdf?ua=1

  • World Health Organization (WHO). (2018a). WHO recommendation on companionship during labour and childbirth. Retrieved from https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-during-childbirth/who-recommendation-companionship-during-labour-and-childbirth

  • World Health Organization (WHO). (2018b). WHO recommendations: Intrapartum care for a positive childbirth experience. Geneve. Retrieved from https://extranet.who.int/rhl/guidelines/who-recommendations-intrapartum-care-positive-childbirth-experience

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Funding

This study was funded by the Fondo Sectorial de Investigación en Salud y Seguridad Social (FOSISS), and the Comisión Nacional de Ciencia y Tecnología (CONACYT), under grant numbrer: S0008-2015-3-262075 "Design and implementation of a comprehensive model of care and epidemiological surveillance system to improve maternal and neonatal care services". The collaboration was exclusively economic, since all the technical and methodological part was conducted by the Instituto Nacional de Salud Pública.

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Authors and Affiliations

  1. Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico

    Alexander Brenes Monge, María Fernández Elorriaga, Ofelia Poblano Verástegui, Manuel A. Martínez Nolasco, Iraís Yáñez Álvarez & Pedro J. Saturno Hernández

  2. Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico

    Rosario Valdez Santiago

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  1. Alexander Brenes Monge
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  2. María Fernández Elorriaga
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  3. Ofelia Poblano Verástegui
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  5. Manuel A. Martínez Nolasco
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  6. Iraís Yáñez Álvarez
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  7. Pedro J. Saturno Hernández
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Correspondence to María Fernández Elorriaga.

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Brenes Monge, A., Fernández Elorriaga, M., Poblano Verástegui, O. et al. Disrespect and Abuse in Obstetric Care in Mexico: An Observational Study of Deliveries in Four Hospitals. Matern Child Health J 25, 565–573 (2021). https://doi.org/10.1007/s10995-020-03052-9

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