Three out of 10 women surveyed in a study on childbirth experience claimed to have been victims of abuse, disrespect and discrimination, with non-consensual interventions being the most recurrent form of such violence.

Promoted by the Portuguese Association for Women’s Rights in Pregnancy and Childbirth (APDMGP), the second edition of the survey “Childbirth Experiences in Portugal”, analysed the period 2015-2019, says a report published by Portugal News.

The objective was “to know the experiences of women in terms of the characteristics of childbirth and personal satisfaction with it, as well as any situations of abuse or disrespect that may have been experienced in its course”.

The questionnaire obtained 7,555 valid answers and testimonies from women who had one or more babies during this period. More than half of the sample is between 30 and 39 years old, followed by the 20/29 age group.

Of the 7,555 births, 69 percent were vaginal and 31 percent by caesarean section, according to the APDMGP.

Only 52.8 percent of respondents who had a vaginal birth said they had freedom of movement during labour.

“Respondents with an intrapartum caesarean section were the least satisfied with their experience and felt more conditioned in expressing their opinion, less involved in decision-making, less supported by the team, less confident,” the association said in a statement.

According to the survey, “around 50.30 percent of women who said they had experienced childbirth had a vaginal birth without the use of forceps or suction cups, while 28.50 percent” said they had used these mechanisms.

About 2,820 women said their pregnancy was at risk (37 percent), but only 2,746 identified the factors that assessed this risk.

Some 78 percent said that the right to follow-up during childbirth was mostly respected. The partner (81.80 percent), the specialist nurse (76.20 percent) and the obstetrician (62.54 percent) were the most frequent attendances.

The association points out that “currently, in Portugal, this is not a reality” due to the pandemic.

The vast majority of respondents agree that they were able to observe their baby after birth and that this moment corresponded to their expectations.

About 62 percent say that their birth was not induced, against 37.6 percent who say it was, but “an important number” say they are not sure if their birth was induced or not.

For most respondents, the ideal birth is vaginal, pain-free, spontaneously initiated and assisted by professionals of their choice.

“Alongside the advancement of the pandemic, we are experiencing a real pandemic of abuse, disrespect and violence against women, with an exponential increase in violations of women’s rights throughout the world,” the association warns.

For the APDMGP, “more than ever it is important to ensure that women’s rights and the recommendations of the World Health Organisation are respected”, stressing that “violence against women is the most widespread violation of human rights around the world”.

Why Abuse?

Disrespect and abuse during childbirth are a violation of women’s human rights. Women deserve care that maintains their dignity, ensures their privacy and confidentiality and is free from mistreatment and discrimination.

Most research has, quite rightly, focused on the perspectives of women, said another report published by The Conversation on April 7, 2020. However, it’s also essential to get a better understanding of what drives providers toward this behaviour. To better understand the dynamics, we conducted research with providers in 18 facilities in rural Kenya.

Most providers we spoke to reported that women were mostly treated with respect. But some acknowledged instances of verbal and physical abuse and lack of privacy and confidentiality. We identified several drivers of this behaviour.

The most common reason given for abuse was that they “had to do it” to save the baby when the woman was uncooperative or difficult. Examples of what made women “difficult” included not following instructions, refusing exams or aspects of care, screaming too much, wanting to deliver on the floor or being disrespectful to providers.

Providers said they sometimes felt overwhelmed when they felt the baby might die because of a woman’s lack of cooperation. They then reacted by being verbally or physically abusive.

Another major contributor cited by the providers was stressful work conditions and burnout. Issues raised included high workloads due to staff shortage, a lack of essential supplies and medicines, women presenting for labour without the recommended items and language barriers.

Another factor was the culture within a facility, and if providers were held accountable. For example, providers thought disrespect and abuse were more likely at night when providers were often alone and would not be held accountable. Unfortunately, when providers were punished for abuse they would often just transfer to another facility.

Providers also cited poor infrastructure and lack of supplies and medications. It was sometimes difficult to maintain women’s privacy and confidentiality because of small labour wards and a lack of privacy screens. Women had to bring their own supplies like sanitary pads and detergents, and those who didn’t bring their own sheets were sometimes left uncovered.

Community expectations of “free maternity care” under Kenya’s maternal health policy sometimes created tensions between providers and women and their families because they did not think they should have to bring their own supplies.

Few providers admitted that abuse was their own responsibility. However, a few acknowledged that disrespect and abuse were sometimes due to provider attitudes and temperament. Provider attitudes were attributed to stress, lack of motivation, ignorance, lack of training or just being human.

They also acknowledged that treatment differed based on a range of factors such as personal connections, wealth, social status, education, empowerment, age and ethnic affiliation.