Date Published: March 21, 2017
Publisher: Public Library of Science
Author(s): Foluso Ishola, Onikepe Owolabi, Veronique Filippi, Delmiro Fernandez-Reyes.
Promoting respectful care at childbirth is important to improve quality of care and encourage women to utilize skilled delivery services. However, there has been a relative lack of public health research on this topic in Nigeria. A systematic review was conducted to synthesize current evidence on disrespect and abuse of women during childbirth in Nigeria in order to understand its nature and extent, contributing factors and consequences, and propose solutions.
Five electronic databases were searched for relevant published studies, and five data sources for additional grey literature. A qualitative synthesis was conducted using the Bowser and Hill landscape analytical framework on disrespect and abuse of women during childbirth.
Fourteen studies were included in this review. Of these studies, eleven were cross sectional studies, one was a qualitative study and two used a mixed method approach. The type of abuse most frequently reported was non-dignified care in form of negative, poor and unfriendly provider attitude and the least frequent were physical abuse and detention in facilities. These behaviors were influenced by low socioeconomic status, lack of education and empowerment of women, poor provider training and supervision, weak health systems, lack of accountability and legal redress mechanisms. Overall, disrespectful and abusive behavior undermined the utilization of health facilities for delivery and created psychological distance between women and health providers.
This systematic review documented a broad range of disrespectful and abusive behavior experienced by women during childbirth in Nigeria, their contributing factors and consequences. The nature of the factors influencing disrespectful and abusive behavior suggests that educating women on their rights, strengthening health systems to respond to specific needs of women at childbirth, improving providers training to encompass interpersonal aspects of care, and implementing and enforcing policies on respectful maternity care are important. This review has also shown that more robust research is needed to explore disrespect and abuse of women during childbirth in Nigeria and propose compelling interventions.
Out of an estimated 303,000 maternal deaths that occurred worldwide in 2015, 99% occurred in low-and middle income countries [1, 2]. Nigeria with its large population and high fertility rate contributed 19% of global maternal deaths, with an estimated 58,000 deaths occurring in 2015. It also has a high maternal mortality ratio (MMR) estimated at 814 maternal deaths per 100,000 live births and lags behind many countries in the region. A factor contributing to this high MMR is the low rate of skilled birth attendance with 45% of births in Nigeria attended by skilled health personnel in 2015.
A systematic review of published quantitative and qualitative literature between January 2004 and July 2014 was initially conducted to capture studies published in the last ten years. However, this period was extended till October 2015 to update our literature search before the final analysis and writing up was done. The Bowser and Hill classification informed the synthesis of this review as it provided a framework for the classification, contributing factors and consequences of disrespect and abuse during childbirth that fit the aim of this review.
The initial search yielded 2115 citations and the updated search yielded an additional 355 making a total of 2470, of which 68 duplicates were removed, After title and abstract screening, 36 potentially relevant articles were identified for full text review. One additional eligible article was identified through manual searches of reference lists. This left a total of 37 studies to be screened at full text level. 14 studies met the inclusion criteria and 23 studies were excluded (Fig 1).
Our systematic review suggests that disrespect and abuse of women during childbirth occurs frequently in Nigeria, and can take the many forms described in the literature for other settings. The type of abuse most repeatedly reported was non-dignified care and the least commonly reported were physical abuse and detention in facilities, mentioned only in one study .This might be unsurprising as they are both extreme forms of abuse. Nevertheless, underreporting is possible as this behavior may be accepted as normal and not considered as abuse or disrespect by some women . Thus such incidents may not have been spontaneously reported if specific questions about these situations were not asked by the researchers (27). Our findings should therefore not be interpreted as though such acts rarely exist.
This systematic review documented a broad range of disrespectful and abusive behavior experienced by women during childbirth in Nigeria, their contributing factors and consequences. Findings from this review contribute to the overall knowledge on barriers to the utilization of health facilities for delivery in Nigeria.