BLOG: Recognizing and Tackling Disrespect and Abuse of Women in Childbirth

This posting is from Mary Ellen Stanton, Senior Maternal Health Advisor at USAID.  She chronicles instances of disrespect and abuse during maternity care that she has witnessed over time, and discusses the challenges and opportunities for changing disrespectful and abusive behaviors in the maternity care system.

Photo Courtesy of UNFPA

When I started midwifery training decades ago in the United States, in the hospital where I worked, I first saw evidence of disrespect and abuse of women in labor. Women were separated from families and visitors from admission to discharge four days later and, in the second and third stages of labor, their legs were secured by stirrups and their wrists put in leather restraints.  Soon after, I worked in West Africa in a government maternity and witnessed women being verbally abused -- "if you don't push and your baby is born dead, it will be your fault" – and physically abused by slapping and massive fundal pressure to force delivery. Women were ridiculed for making too much noise in labor -- and then were chastised if they were silent and delivered alone.

Fast forward decades later.  As I visit maternity services in a number of countries, I don't need to look far to see and hear evidence of disrespect and abuse of women in childbirth.  A convulsing woman in labor on the steps of an urban referral hospital turned away from because she cannot pay.  A doctor who derides poor women for not using family planning to control their fertility.  A nurse who tells me that postpartum mothers "sneak in" to see their hospitalized newborns at night, while the families seek to find funds to pay the bills in order to get their newborns discharged.  Unclothed women laboring and giving birth as visitors walk by. A researcher who tells of a postpartum mother being detained for months because she could not pay her bill. The human rights worker who tells me that refugee women are discriminated against in childbirth and that one refugee was forced to keep her stillborn in her bed with her for 24 hours against her will.

I do not cease to be saddened and angered by the number of ways women giving birth are being degraded, abused, and humiliated by healthcare workers, often women themselves.  Abuses continue to occur in all corners of the world, including my own. They are not behaviors that are easy to change.  Some are reinforced by financial incentives and subtle or overt discrimination. For many, the behaviors are learned and reinforced in home, school and society -- wherever there are unequal power relationships. 

Despite the problems, many of the frontline caregivers at birth – midwives, doctors, nurses and auxiliaries – work diligently, treat women with compassion, and even use their own resources to assist women in referrals in the case of life-threatening emergencies. Their selfless work needs to be recognized, even while the problems of abuse are uncovered.

I am now very encouraged that the issue of abuse is resonating with so many who care for and about childbearing women.  I see there is growing attention to this problem through documentation of the abuses; identification, dissemination and the implementation of the new Universal Rights of Childbearing Women; and implementation research to expand the evidence base on what it takes to tackle this problem effectively.  Many people and organizations are working on this and I am delighted that the United States Agency for International Development is supporting this work in country settings, in partnership with many others, to ensure that all women are treated with the respect and compassion during childbirth that they deserve.