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Disrespect and abuse in facility-based childbirth

The United States Agency for International Development (USAID) has published a report on disrespect and abuse in facility-based childbirth around the world.

From the Executive Summary:

Lack of respectful and non-abusive care at birth may encompass many points along a
continuum that spans dignified, patient centered care, non-dignified care, and overtly abusive
maternal care. Examples of disrespect and abuse include subtle humiliation of women,
discrimination against certain sub-groups of women, overt humiliation, abandonment of care and
physical and verbal abuse during childbirth…

Building on the results of an extensive review of the published and gray literature as well
as results from a structured group discussion and individual interviews with expert informants,
seven categories of disrespect are identified: physical abuse, non-consented clinical care, non-
confidential care, non-dignified care (including verbal abuse), discrimination based on specific
patient attributes, abandonment of care, and detention in facilities. Categories of disrespect and
abuse draw on human rights and ethics principles and are intended to help synthesize a complex
body of evidence. It is understood, however, that manifestations of disrespect and abuse often
fall into more than one category. Categories are not intended to be mutually exclusive but rather
to be overlapping along a continuum.

Coerced cesareans are one example of non-consented care cited in the report (emphasis added):

There is evidence of a widespread absence of patient information processes or informed
consent for common procedures around the time of childbirth in many settings (e.g. cesarean
sections, episiotomies, hysterectomies, blood transfusions, sterilization, or augmentation of
labor).  Interviewees from LAC, sub-Saharan Africa and Eastern Europe regions all confirmed
the lack of routine patient information communication and consent protocols for obstetric
procedures in their respective settings, including the widespread practice of episiotomy without
patient notification or consent.  Escalating and excessive rates of unnecessary cesareans have
been documented by many in the LAC, Asia, North American and other regions.  Reports from
Kenya, the United States, Dominican Republic, and Peru document women‘s stories of feeling
coerced into a cesarean section
(Center for Reproductive Rights & Federation of Women
Lawyers–Kenya (FIDA), 2007; S. Miller et al., 2003; Physicians for Human Rights, 2007;
Amnesty International, 2010).

Click here to download the full report.