Table 1 Typology of mistreatment [3]
First-order themes | Second-order themes | Third-order themes |
|---|---|---|
Physical abuse | Use of force Physical restraint | 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 language | Harsh or rude language Judgmental or accusatory comments Threats of withholding treatment or poor outcomes Blaming for poor outcomes Harsh or rude language |
Stigma and discrimination | Discrimination based on sociodemographic 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 | Lack of informed consent Breeches of confidentiality Painful vaginal exams Refusal to provide pain relief Performance of unconsented surgical operations Neglect, abandonment or long delays Skilled attendant absent at time of delivery |
Poor rapport between women and providers | Ineffective communication Lack of supportive care Lack of autonomy | Poor communication Dismissal of women’s concerns Language and interpretation issues Poor staff attitudes Lack of supportive care from health workers Denial or lack of birth companions Women treated as passive participants during childbirth Denial of food, fluids or mobility Lack of respect for women’s preferred birth positions Denial of safe traditional practices Objectification of women Detainment in facilities |
Health system conditions and constraints | Lack of resources Lack of policies Facility culture | Physical conditions of facilities Staffing constraints Staffing shortages Supply constraints Lack of privacy Lack of redress Bribery and extortion Unclear fee structures Unreasonable requests of women by health workers |