Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth Report of a Landscape Analysis

Executive Summary This report is a review of the evidence on the topic of disrespect and abuse in facility-based childbirth. The primary purpose of the report is to review the evidence in published and gray literature with regard to the definition, scope, contributors, and impact of disrespect and abuse in childbirth, to review promising intervention approaches, and to identify gaps in the evidence. Despite the agreed importance among maternal health and human rights stakeholders of achieving respectful, non-abusive birth care for all women, there has been a relative lack of formal research around this topic. Lack of respectful and non-abusive care at birth may encompass many points along a continuum that spans dignified, patient centered care, non-dignified care, and overtly abusive maternal care. Examples of disrespect and abuse include subtle humiliation of women, discrimination against certain subgroups of women, overt humiliation, abandonment of care and physical and verbal abuse during childbirth. While it is likely that disrespect and abuse are often multi-factorial and may be perceived differently and sometimes normalized depending on the specific setting, many stakeholders and maternal health experts agree that disrespect and abuse in facility-based childbirth represent important causes of suffering for women, an important barrier to skilled care utilization (a key MGD-5 indicator), important quality of care problems, and often a violation of women's human rights. This document reviews reports of disrespect and abuse in facility-based childbirth across a range of birth care settings in low, middle and high income countries. The report intentionally focuses on care provided at the time of birth given the intense vulnerability of women during childbirth. Building on the results of an extensive review of the published and gray literature as well as results from a structured group discussion and individual interviews with expert informants, seven categories of disrespect are identified: physical abuse, non-consented clinical care, non-confidential care, non-dignified care (including verbal abuse), discrimination based on specific patient attributes, abandonment of care, and detention in facilities. Categories of disrespect and abuse draw on human rights and ethics principles and are intended to help synthesize a complex body of evidence. It is understood, however, that manifestations of disrespect and abuse often fall into more than one category. Categories are not intended to be mutually exclusive but rather to be overlapping along a continuum. After a review of categories of disrespect and abuse in childbirth, the report explores evidence for potential contributors to …