Women’s Experience of Disrespect and Abuse during Institutional Delivery in Biratnagar, Nepal
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Setting
2.2. Study Population and Sample Size
2.3. Data Collection Tool
2.4. Data Collection Procedure
2.5. Outcome Measures
2.6. Data Analysis
2.7. Ethical Considerations
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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S N. | Categories and Items of D & A Scale | Yes | No |
---|---|---|---|
1 | Physical abuse | ||
1.1 | Used physical force | ||
1.2 | Bitten, slapped, or pinched | ||
1.3 | Touched roughly | ||
1.4 | Episiotomy given or sutured without anesthesia | ||
1.5 | Restrained or tied down during labor | ||
2 | Non-consented care | ||
2.1 | Provider did not introduce herself | ||
2.2 | Provider did not explain procedure and expectations | ||
2.3 | Provider did not give periodic updates on status and progress | ||
2.4 | Provider did not obtain consent prior to procedure | ||
3 | Non-confidential care | ||
3.1 | Curtains and physical barriers were not used | ||
3.2 | Drape or body covering was not used | ||
3.3 | The number of staff members around was not logical (more than required) | ||
3.4 | Provider disclosed my personal/medical history to third parties | ||
4 | Non-dignified care | ||
4.1 | Provider did not speak politely, truthfully, and promptly | ||
4.2 | Provider made insults, threats, etc. | ||
4.3 | Provider did not encourage me to ask questions | ||
4.4 | Provider used abusive language | ||
5 | Discriminatory care | ||
5.1 | Provider used language difficult to understand | ||
5.2 | Provider showed disrespect based on specific attribute (e.g., caste, religion) | ||
5.3 | Provider did not demonstrate in a culturally appropriate way | ||
6 | Abandonment of care | ||
6.1 | Provider did not encourage me to call if needed | ||
6.2 | Provider made me feel alone or unattended | ||
6.3 | Provider did not come quickly when needed | ||
6.4 | Baby was separated without medical indication | ||
6.5 | My husband was not allowed to sit with me during labor | ||
7 | Detention in facility | ||
7.1 | Provider did not allow me to move during delivery | ||
7.2 | Provider did not allow me to assume position of choice | ||
7.3 | Detained me/ my baby due to bill not paid |
Public Hospital (n = 218) n (%) | Private Hospital (n = 109) n (%) | p-Value | |
---|---|---|---|
Age (in years) | 0.03 | ||
<20 | 25 (11.5) | 14 (12.8) | |
20–25 | 131 (60.1) | 52 (47.7) | |
25–30 | 55 (25.2) | 32(29.4) | |
>30 | 7 (3.2) | 11 (10.1) | |
Mean ± S.D | 22.77 ± 3.37 | 23.84 ± 4.85 | < 0.001 |
Ethnicity | 0.003 | ||
Madhesi * | 138 (63.3) | 57 (52.3) | |
Aadibasi-Terai | 38 (17.4) | 14 (12.8) | |
Caste-Hill # | 22 (10.1) | 30 (27.5) | |
Muslim | 20 (9.2) | 8 (7.3) | |
Religion | 0.57 | ||
Hindu | 98 (90.8) | 101 (92.7) | |
Muslim | 20 (9.2) | 8 (7.3) | |
Education | 0.02 | ||
Non-formal | 60 (27.5) | 18 (16.5) | |
Primary level | 38 (17.4) | 15 (13.8) | |
Secondary level | 86 (39.4) | 48 (44.0) | |
Higher secondary level | 27 (12.4) | 17 (15.6) | |
Bachelor and above | 7 (3.2) | 11 (10.1) | |
Occupation | 0.28 | ||
Housewife | 182 (83.5) | 87 (79.8) | |
Business | 20 (9.2) | 16 (14.7) | |
Laborer | 16 (7.3) | 6 (5.5) | |
Parity | 0.81 | ||
Primi | 121 (55.5) | 59 (54.1) | |
Multi | 97 (44.5) | 50 (45.9) | |
Living children | 0.99 | ||
One | 126 (57.8) | 63 (57.8) | |
Two | 71 (32.6) | 35 (32.1) | |
Three or more | 21 (9.6) | 11 (10.1) |
Abusive Behavior Reported | Public Hospital (n = 218) n (%) | Private Hospital (n = 109) n (%) | p-Value |
---|---|---|---|
Physical Abuse | |||
Bitten, slapped, or pinched | 15 (6.9) | 17 (15.6) | 0. 01 |
Touched roughly | 22 (10.1) | 18 (16.5) | 0. 09 |
Episiotomy given without adequate anesthesia | 146 (67.0) | 31 (28.4) | <0.001 |
Sutured without adequate anesthesia | 165 (75.7) | 41 (37.6) | <0.001 |
Non-consented care | |||
Provider did not introduce herself | 218 (100) | 109 (100) | - |
Did not explain about procedure | 218 (100) | 109 (100)- | - |
Did not explain expectations | 218 (100) | 109 (100) | - |
Did not give periodic updates | 218 (100) | 109 (100) | - |
Did not obtain consent prior to procedure | 218 (100) | 109 (100) | - |
Non-confidential care | |||
Curtains and physical barriers not used | 218 (100) | 0 (0.0) | - |
Drape or body covering was not used | 218 (100) | 0 (0.0) | - |
The numbers of staff around was not logical | 0 (0.0) | 109 (100) | - |
Non-dignified care | |||
Did not speak politely | 157 (72.0) | 79 (72.5) | 0.93 |
Made insults, threats, etc. | 10 (4.6) | 13 (11.9) | 0.01 |
Did not encourage patient to ask questions | 215 (98.6) | 105 (96.3) | 0.17 |
Used abusive language | 16 (7.3) | 5 (4.6) | 0.33 |
Discriminatory care | |||
Used language difficult to understand | 134 (61.5) | 58 (53.2) | 0.15 |
Showed disrespect based on specific attribute | 26 (11.9) | 55 (50.5) | <0.001 |
Did not demonstrate in culturally appropriate way | 26 (11.9) | 20 (18.3) | 0.11 |
Abandonment of care | |||
Did not encourage patient to call if needed | 217 (95.0) | 107 (98.2) | 0.16 |
Made patient feel alone or unattended | 8 (3.7) | 108 (99.1) | <0.001 |
Husband was not allowed to sit with patient during labor | 218 (100) | 109(100) | - |
Provider did not come quickly when needed | 216 (99.1) | 109 (100) | - |
Detention in health facility | 0 | 0 | - |
Independent Variables | N | Median Score | p-Value |
---|---|---|---|
Ethnicity | <0.001 # | ||
Madhesi | 195 | 15 | |
Aadibasi-Terai | 52 | 14 | |
Caste-Hill | 52 | 13 | |
Muslim | 28 | 16 | |
Religion | 0.012 * | ||
Hindu | 299 | 15 | |
Muslim | 28 | 16 | |
Education level | 0.045 # | ||
Non-formal and primary | 131 | 15 | |
Secondary | 134 | 15 | |
Higher secondary and above | 62 | 14 | |
Number of living children | 0.012 * | ||
One | 189 | 15 | |
Two or more | 138 | 14 | |
Place of delivery | <0.001 * | ||
Public hospital | 218 | 14 | |
Private hospital | 109 | 16 |
Coefficient | 95% CI | |
---|---|---|
Ethnicity | ||
Madhesi | 1 | |
Aadibasi-Terai | 2.45 | 1.82, 3.09 |
Caste-Hill | 1. 59 | 0.79, 2.38 |
Muslim | 3.27 | 2.32, 4.22 |
Religion | ||
Hindu | 1 | |
Muslim | 1.09 | 1.06, 2.02 |
Education level | ||
Non-formal and primary | 1 | |
Secondary | 0.50 | −0.14, 1.14 |
Higher secondary and above | 0.30 | −0.18, 0.79 |
Number of living children | ||
One | 1 | |
Two or more | 0.90 | 0.45, 1.35 |
Place of delivery | ||
Public hospital | 1 | |
Private hospital | 2.28 | 1.80, 2.76 |
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Ghimire, N.P.; Joshi, S.K.; Dahal, P.; Swahnberg, K. Women’s Experience of Disrespect and Abuse during Institutional Delivery in Biratnagar, Nepal. Int. J. Environ. Res. Public Health 2021, 18, 9612. https://doi.org/10.3390/ijerph18189612
Ghimire NP, Joshi SK, Dahal P, Swahnberg K. Women’s Experience of Disrespect and Abuse during Institutional Delivery in Biratnagar, Nepal. International Journal of Environmental Research and Public Health. 2021; 18(18):9612. https://doi.org/10.3390/ijerph18189612
Chicago/Turabian StyleGhimire, Narayani Paudel, Sunil Kumar Joshi, Pranab Dahal, and Katarina Swahnberg. 2021. "Women’s Experience of Disrespect and Abuse during Institutional Delivery in Biratnagar, Nepal" International Journal of Environmental Research and Public Health 18, no. 18: 9612. https://doi.org/10.3390/ijerph18189612