Obstetric Violence Is Prevalent in Routine Maternity Care: A Cross-Sectional Study of Obstetric Violence and Its Associated Factors among Pregnant Women in Sri Lanka’s Colombo District
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Gayford, J.J. Wife battering: A preliminary survey of 100 cases. Brit. Med. J. 1975, 1, 194–197. [Google Scholar] [CrossRef]
- Gelles, R. Battered wives: Why do they stay? J. Marr. Fam. 1976, 38, 659–668. [Google Scholar] [CrossRef]
- Straus, M.A. Wife beating: How common and why? Victimology 1977, 2, 443–458. [Google Scholar]
- Rounsaville, B.; Weissman, M.M. Battered women: A medical problem requiring detection. Int. J. Psychiatry Med. 1977, 8, 191–202. [Google Scholar] [CrossRef]
- Krug, E.G.; Dahlberg, L.L.; Mercy, J.A.; Zwi, A.B.; Lozano, R. World Report on Violence and Health; World Health Organization: Geneva, Switzerland, 2002. [Google Scholar]
- Coyle, J.; Williams, B. An exploration of the epistemological intricacies of using qualitative data to develop a quantitative measure of user views of health care. J. Adv. Nurs. 2000, 31, 1235–1243. [Google Scholar] [CrossRef]
- Coyle, J.; Williams, B. Seeing the wood for the trees: Defining the forgotten concept of patient dissatisfaction in the light of patient satisfaction research. Leadersh. Health Serv. 1999, 12, 1–9. [Google Scholar] [CrossRef]
- World Health Organization. Statement on the Prevention and Elimination of Disrespect and Abuse during Facility-Based Childbirth; World Health Organization: Geneva, Switzerland, 2015. [Google Scholar]
- Vacaflor, C.H. Obstetric violence: A new framework for identifying challenges to maternal healthcare in Argentina. Reprod. Health Matters 2016, 24, 65–73. [Google Scholar] [CrossRef]
- Sadler, M.; Santos, M.J.; Ruiz-Berdun, D.; Rojas, G.L.; Skoko, E.; Gillen, P.; Clausen, J.A. Moving beyond disrespect and abuse: Addressing the structural dimensions of obstetric violence. Reprod. Health Matters 2016, 24, 47–55. [Google Scholar] [CrossRef]
- Diaz-Tello, F. Invisible wounds: Obstetric violence in the United States. Reprod. Health Matters 2016, 24, 56–64. [Google Scholar] [CrossRef]
- United Nations. Universal Declaration of Human Rights; UN General Assembly Resolution 217 A. 1948. Available online: https://www.un.org/sites/un2.un.org/files/2021/03/udhr.pdf (accessed on 11 August 2022).
- United Nations. International Covenant on Economic, Social and Cultural Rights; UN General Assembly Resolution 2200A (XXI), adopted 16 December 1966. Available online: https://www.ohchr.org/sites/default/files/cescr.pdf (accessed on 11 August 2022).
- United Nations. Declaration on the Elimination of Violence against Women; UN General Assembly (48th Session.: 1993–1994). Available online: https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.21_declaration%20elimination%20vaw.pdf (accessed on 11 August 2022).
- White Ribbon Alliance. Respectful Maternity Care: The Universal Rights of Childbearing Women; White Ribbon Alliance: Washington, DC, USA, 2011; Available online: https://www.whiteribbonalliance.org/wpcontent/uploads/2017/11/Final_RMC_Charter.pdf (accessed on 11 August 2022).
- Pérez, R. Obstetric violence: A new legal term introduced in Venezuela. Int. J. Gynecol. Obstet. 2010, 111, 201–202. [Google Scholar] [CrossRef]
- Patrizia, Q. Obstetric violence observatory: Contributions of Argentina to the international debate. Med. Anthropol. 2019, 38, 762–776. [Google Scholar] [CrossRef]
- Jewkes, R.; Abrahams, N.; Cersa, Z.M. Why do nurses abuse patients? Reflections from South African obstetric services. Soc. Sc. Med. 1998, 47, 1781–1795. [Google Scholar] [CrossRef]
- Slade, P.; MacPherson, S.A.; Hume, A.; Maresh, A. Expectations, experiences and satisfaction with labour. Br. J. Clin. Psychol. 1993, 32, 469–483. [Google Scholar] [CrossRef]
- Coyle, J. Exploring the meaning of ‘dissatisfaction’ with health care: The importance of ‘personal identity threat’. Sociol Health Illn. 1999, 21, 95–123. [Google Scholar] [CrossRef]
- Brüggemann, J.; Swahnberg, K. Patients’ silence towards the healthcare system after ethical transgressions by staff: Associations with patient characteristics in a cross-sectional study among Swedish female patients. BMJ Open 2012, 2, e001562. [Google Scholar] [CrossRef] [PubMed]
- Brüggemann, J.; Wijma, B.; Swahnberg, K. Patients’ silence following health care staff’s ethical transgressions. Nurs. Ethics 2012, 19, 750–763. [Google Scholar] [CrossRef]
- Kruk, M.; Kujawski, S.; Mbaruku, G.; Ramsey, K.; Moyo, W.; Freedman, L.P. Disrespectful and abusive treatment during facility delivery in Tanzania: A facility and community survey. Health Policy Plan. 2014, 33, e26–e33. [Google Scholar] [CrossRef] [PubMed]
- Abuya, T.; Warren, C.E.; Miller, N.; Njuki, R.; Ndwiga, C.; Maranga, A.; Mbehero, F.; Njeru, A.; Bellows, B. Exploring the prevalence of disrespect and abuse during childbirth in Kenya. PLoS ONE 2015, 10, e0123606. [Google Scholar] [CrossRef]
- Asefa, A.; Bekele, D. Status of respectful and non-abusive care during facility-based childbirth in a hospital and health centers in Addis Ababa, Ethiopia. Reprod. Health 2015, 12, 1–9. [Google Scholar] [CrossRef]
- Brüggemann, J.; Swahnberg, K. What contributes to abuse in health care? A grounded theory of female patients’ stories. Int. J. Nurs. Stud. 2013, 50, 404–412. [Google Scholar] [CrossRef]
- Chadwick, R. Ambiguous subjects: Obstetric violence, assemblage and South African birth narratives. Fem. Psychol. 2017, 27, 489–509. [Google Scholar] [CrossRef]
- Virginia, S.; Arachu, C. Measuring mistreatment of women during childbirth: A review of terminology and methodological approaches. Reprod. Health 2017, 14, 138. [Google Scholar]
- Bohren, M.A.; Vogel, J.P.; Hunter, E.C.; Lutsiv, O.; Makh, S.K.; Souza, J.P.; Aguiar, C.; Coneglian, F.S.; Diniz, A.L.A.; Tunçalp, Ö.; et al. The mistreatment of women during childbirth in health facilities globally: A mixed-methods systematic review. PLoS Med. 2015, 12, e1001847. [Google Scholar] [CrossRef] [PubMed]
- Jungari, S.; Sharma, B.; Wagh, D. Beyond maternal mortality: A systematic review of evidences on mistreatment and disrespect during childbirth in health facilities in India. Trauma Violence Abus. 2019, 22, 739–751. [Google Scholar] [CrossRef] [PubMed]
- United Nations Children’s Fund. The State of the World’s Children; UNICEF: New York, NY, USA, 2008. [Google Scholar]
- Ministry of Health Sri Lanka. Annual Report 2018; Family Health Bureau, Ministry of Health: Colombo, Sri Lanka, 2018.
- United Nations. The Millennium Development Goals Report 2015; United Nations: New York, NY, USA, 2015. [Google Scholar]
- Ministry of Health Sri Lanka. Annual Health Statistics 2018; Medical Statistics Unit, Ministry of Health: Colombo, Sri Lanka, 2018.
- Infanti, J.J.; Lund, R.; Muzrif, M.M.; Schei, B.; Wijewardena, K. Addressing domestic violence through antenatal care in Sri Lanka’s plantation estates: Contributions of public health midwives. Soc. Sci. Med. 2015, 145, 35–43. [Google Scholar] [CrossRef]
- Perera, D.; Lund, R.; Swahnberg, K.; Schei, B.; Infanti, J.J. ‘When helpers hurt’: Women’s and midwives’ stories of obstetric violence in state health institutions, Colombo district, Sri Lanka. BMC Pregnancy Childbirth 2018, 18, 211. [Google Scholar] [CrossRef]
- Swahnberg, K.; Zbikowski, A.; Wijewardene, K.; Josephson, A.; Khadka, P.; Jeyakumaran, D.; Mambulage, U.; Infanti, J.J. Can Forum Play contribute to counteracting abuse in health care? A pilot intervention study in Sri Lanka. Int. J. Environ. Res. Public Health 2019, 16, 1616. [Google Scholar] [CrossRef]
- Curnow, S.A. The open window phase: Helpseeking and reality behaviors by battered women. Appl. Nurs. Res. 1997, 10, 128–135. [Google Scholar] [CrossRef]
- Swahnberg, K.; Thapar-Bjorkert, S.; Bertero, C. Nullified: Women’s perceptions of being abused in health care. J. Psychosom. Obstet. Gynecol. 2007, 28, 161–167. [Google Scholar] [CrossRef]
- Abrahams, N.; Jewkes, R.; Mvo, Z. Health care-seeking practices of pregnant women and the role of the midwife in Cape Town, South Africa. J. Midwifery Women’s Health 2001, 46, 240–247. [Google Scholar] [CrossRef]
- Pourhoseingholi, M.A.; Vahedi, M.; Rahimzadeh, M. Sample size calculation in medical studies. Gastroenterol. Hepatol. Bed Bench 2013, 6, 14–17. [Google Scholar] [PubMed]
- Lwanga, S.K.; Lemeshows, S. Sample Size Determination in Health Studies: A Practical Manual; World Health Organization: Geneva, Switzerland, 1991. [Google Scholar]
- Bennett, S.; Woods, T.; Liyanage, W.M.; Smith, D.L. A simplified general method for cluster-sample surveys of health in developing countries. World Health Stat. Q. 1991, 44, 98–106. [Google Scholar] [PubMed]
- Swahnberg, K.; Wijma, B. The NorVold Abuse Questionnaire (NorAQ): Validation of new measures of emotional, physical, and sexual abuse, and abuse in health care system among women. Eur. J. Public Health 2003, 13, 361–366. [Google Scholar] [CrossRef] [PubMed]
- Bruggemann, A.J.; Wijma, B.; Swahnberg, K. Abuse in health care: A concept analysis. Scand. J. Caring Sci. 2012, 26, 123–132. [Google Scholar] [CrossRef] [PubMed]
- Soeken, K.; McFarlane, J.; Parker, B.; Lominack, M.C. The Abuse Assessment Screen: A clinical instrument to measure frequency, severity, and perpetrator of abuse against women. In Empowering Survivors of Abuse: Health Care for Battered Women and Their Children; Campbell, J.C., Ed.; Sage: Thousand Oaks, CA, USA.
- Sasseville, N.; Maurice, P.; Montminy, L.; Hassan, G.; St-Pierre, É. Cumulative contexts of vulnerability to intimate partner violence among women with disabilities, elderly women, and immigrant women: Prevalence, risk factors, explanatory theories, and prevention. Trauma Violence Abus. 2022, 23, 88–100. [Google Scholar] [CrossRef] [PubMed]
- Irinyenikan, T.A.; Aderoba, A.K.; Fawole, O.; Adeyanju, O.; Mehrtash, H.; Adu-Bonsaffoh, K.; Maung, T.M.; Balde, M.D.; Vogel, J.P.; Plesons, M.; et al. Adolescent experiences of mistreatment during childbirth in health facilities: Secondary analysis of a community-based survey in four countries. BMJ Glob. Health 2022, 5, e007954. [Google Scholar] [CrossRef]
- Rice, J.G.; Bjargardóttir, H.B.; Sigurjónsdóttir, H.B. Child protection, disability and obstetric violence: Three case studies from Iceland. Int. J. Environ. Res. Public Health 2020, 18, 158. [Google Scholar] [CrossRef]
- Davis, D.-A. Obstetric racism: The racial politics of pregnancy, labor, and birthing. Med. Anthropol. 2019, 38, 560–573. [Google Scholar] [CrossRef]
- Aakvaag, H.F.; Thoresen, S.; Wentzel-Larsen, T.; Dyb, G. Adult victimization in female survivors of childhood violence and abuse: The contribution of multiple types of violence. Violence Against Women 2017, 23, 1601–1619. [Google Scholar] [CrossRef]
- Shields, M.; Tonmyr, L.; Hovdestad, W.E.; Gonzalez, A.; MacMillan, H. Exposure to family violence from childhood to adulthood. BMC Public Health 2020, 20, 1673. [Google Scholar] [CrossRef]
- Guruge, S. Nurses’ role in caring for women experiencing intimate partner violence in the Sri Lankan context. ISRN Nurs. 2012, 2012, 485273. [Google Scholar] [CrossRef] [PubMed]
Event | N | % (95% CI) |
---|---|---|
Experienced violence involving health care providers during immediate past pregnancy care (obstetric violence) | 238 | 18.1 (16.02–20.18) |
Experienced emotional type of obstetric violence (neglected, insulted, verbally abused, etc.) | 235 | 17.8 (15.73–19.87) |
Experienced physical obstetric violence (hitting, slapping, pushing, etc.) | 11 | 0.8 (0.32–1.28) |
Experienced sexual obstetric violence | 2 | 0.2 (−0.04–0.44) |
Total (N = 1314) | Obstetric Violence * | p-Value | ||
---|---|---|---|---|
Yes: n (%) | No: n (%) | |||
Age | ||||
16–21 | 32 | 13 (40.62) | 19 (59.38) | χ2 = 11.22 |
22–35 | 999 | 176 (17.62) | 823 (82.38) | df = 2 |
36–44 | 283 | 49 (17.31) | 234 (82.69) | p = 0.004 |
Education level | ||||
Grades 0–5 | 144 | 35 (24.31) | 109 (75.69) | χ2 = 7.21 |
Grades 6–11 | 766 | 122 (15.93) | 644 (84.07) | Df = 2 |
>Grade 12 | 404 | 81 (20.05) | 323 (79.95) | p = 0.027 |
Ethnicity | ||||
Sinhala | 967 | 160 (16.55) | 807 (83.45) | χ2 = 15.13 |
Tamil | 166 | 27 (16.27) | 139 (83.73) | df = 3 |
Muslim | 170 | 49 (28.82) | 121 (71.18) | p = 0.001 |
Living children | ||||
0–1 child | 829 | 155 (18.70) | 674 (81.30) | χ2 = 0.519 |
2 children | 379 | 65 (17.15) | 314 (82.85) | df = 2 |
≥3 children | 106 | 18 (16.98) | 88 (83.02) | p = 0.771 |
Employment status | χ2 = 1.57 | |||
Employed | 271 | 42 (15.50) | 229 (84.50) | df = 1 |
Housewife | 1043 | 196 (18.79) | 847 (81.21) | p = 0.21 |
Family income/month | ||||
Up to LKR 30,000 | 60 | 17 (28.33) | 43 (71.67) | χ2 = 6.28 |
LKR 30,001–60,000 | 1014 | 186 (18.34) | 828 (81.66) | df = 2 |
LKR 60,001 and above | 240 | 35 (14.58) | 205 (85.42) | p = 0.043 |
Living area | χ2 = 5.93 | |||
Rural | 521 | 111 (21.31) | 410 (78.69) | df = 1 |
Urban | 793 | 127 (16.02) | 666 (83.98) | p = 0.015 |
Prenatal care | χ2 = 9.07 | |||
Government sector | 1184 | 227 (19.17) | 957 (80.83) | df = 1 |
Private sector only | 126 | 10 (7.94) | 116 (92.06) | p = 0.002 |
Place of delivery | χ2 = 8.04 | |||
Government hospital | 1190 | 227 (19.08) | 963 (78.66) | df = 1 |
Private hospital | 110 | 9 (8.18) | 101 (91.82) | p = 0.005 |
Mode of delivery | χ2 = 7.13 | |||
Vaginal delivery | 1043 | 204 (19.56) | 839 (80.44) | df = 1 |
Cesarean section | 271 | 34 (12.55) | 237 (22.0) | p = 0.008 |
Partner’s education | χ2 = 0.34 | |||
Up to grade 11 | 890 | 160 (18.0) | 730 (82.0) | df = 1 |
12 and above | 424 | 78 (18.4) | 346 (81.6) | p = 0.854 |
Partner’s job category | ||||
Professional | 172 | 24 (14.5) | 147 (85.5) | χ2 = 1.76 |
Non-professional | 1103 | 202 (18.3) | 901 (81.7) | df = 1 |
Unemployed | 16 | 2 (12.5) | 14 (87.5) | p = 0.415 |
Total (N = 1314) | Obstetric Violence * | p-Value | ||
---|---|---|---|---|
Yes: n (%) | No: n (%) | |||
Ever experience DV during pregnancy? | χ2 = 49.89 | |||
Yes | 53 | 29 (54.70) | 24 (45.30) | df = 1 |
No | 1261 | 209 (16.60) | 1052 (83.40) | p < 0.001 |
Lifetime DV (AAS)? a | χ2 = 20.01 | |||
Yes | 414 | 104 (25.10) | 310 (74.90) | df = 1 |
No | 900 | 134 (14.90) | 766 (85.10) | p < 0.001 |
Current DV (AAS)? b | χ2 = 14.70 | |||
Yes | 132 | 40 (30.30) | 92 (69.70) | df = 1 |
No | 1182 | 198 (16.80) | 984 (83.20) | p < 0.001 |
Ever asked by health care provider about DV? | χ2 = 8.72 | |||
Yes | 726 | 152 (20.90) | 574 (79.10) | df = 1 |
No | 588 | 86 (14.60) | 502 (85.40) | p = 0.003 |
Ever disclose DV c to a health care provider? | χ2 = 0.004 | |||
Yes | 55 | 14 (25.50) | 41 (74.50) | df = 1 |
No | 359 | 90 (25.1) | 269 (74.90) | p = 0.951 |
ORCrude | CI (95%) | ORAdjusted | CI (95%) | ||
---|---|---|---|---|---|
Participant Characteristics | |||||
Age | 16–21 years | 3.27 | 1.51–7.06 | 3.29 | 1.28–4.46 |
22–35 years | 1.02 | 0.72–1.45 | 0.96 | 0.69–1.39 | |
36–44 years | 1 | 1 | |||
Education a | Low | 1.70 | 1.11–2.60 | 1.26 | 0.76–2.08 |
High | 1.32 | 0.97–1.81 | 1.85 | 1.29–2.65 | |
Middle | 1 | 1 | |||
Ethnicity | Tamil | 0.98 | 0.63–1.53 | 1.01 | 0.60–1.68 |
Muslim | 2.04 | 1.41–2.97 | 3.10 | 2.00–4.81 | |
Sinhalese | 1 | 1 | |||
Income b | Low | 2.33 | 1.19–4.51 | 3.68 | 1.61–8.40 |
Middle | 1.32 | 0.89–1.95 | 1.21 | 0.78–1.88 | |
High | 1 | 1 | |||
Living area | Rural | 1.42 | 1.07–1.89 | 1.95 | 1.40–2.72 |
Urban | 1 | 1 | |||
Prenatal care | Government institutions | 2.75 | 1.41–5.33 | 3.27 | 1.53–7.02 |
Private only | 1 | 1 | |||
Mode of delivery | Vaginal delivery | 1.70 | 1.15–2.51 | 1.60 | 1.05–2.45 |
Cesarean section | 1 | 1 | |||
Place of delivery | Government hospital | 2.65 | 1.32–5.31 | 2.51 | 1.18–5.34 |
Private hospital | 1 | 1 | |||
Experiencing DV during pregnancy | Yes | 6.08 | 3.47–10.66 | 7.45 | 3.87–14.32 |
No | 1 | 1 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Perera, D.; Munas, M.; Swahnberg, K.; Wijewardene, K.; Infanti, J.J.; on behalf of the ADVANCE Study Group. Obstetric Violence Is Prevalent in Routine Maternity Care: A Cross-Sectional Study of Obstetric Violence and Its Associated Factors among Pregnant Women in Sri Lanka’s Colombo District. Int. J. Environ. Res. Public Health 2022, 19, 9997. https://doi.org/10.3390/ijerph19169997
Perera D, Munas M, Swahnberg K, Wijewardene K, Infanti JJ, on behalf of the ADVANCE Study Group. Obstetric Violence Is Prevalent in Routine Maternity Care: A Cross-Sectional Study of Obstetric Violence and Its Associated Factors among Pregnant Women in Sri Lanka’s Colombo District. International Journal of Environmental Research and Public Health. 2022; 19(16):9997. https://doi.org/10.3390/ijerph19169997
Chicago/Turabian StylePerera, Dinusha, Muzrif Munas, Katarina Swahnberg, Kumudu Wijewardene, Jennifer J. Infanti, and on behalf of the ADVANCE Study Group. 2022. "Obstetric Violence Is Prevalent in Routine Maternity Care: A Cross-Sectional Study of Obstetric Violence and Its Associated Factors among Pregnant Women in Sri Lanka’s Colombo District" International Journal of Environmental Research and Public Health 19, no. 16: 9997. https://doi.org/10.3390/ijerph19169997
APA StylePerera, D., Munas, M., Swahnberg, K., Wijewardene, K., Infanti, J. J., & on behalf of the ADVANCE Study Group. (2022). Obstetric Violence Is Prevalent in Routine Maternity Care: A Cross-Sectional Study of Obstetric Violence and Its Associated Factors among Pregnant Women in Sri Lanka’s Colombo District. International Journal of Environmental Research and Public Health, 19(16), 9997. https://doi.org/10.3390/ijerph19169997