Data from: Women's experiences of mistreatment during childbirth: a comparative view of home- and facility-based births in Pakistan

Introduction: Respectful and dignified healthcare is a fundamental right for every woman. However, many women seeking childbirth services, especially those in low-income countries such as Pakistan, are mistreated by their birth attendants. The aim of this epidemiological study was to estimate the prevalence of mistreatment and types of mistreatment among women giving birth in facility- and home-based settings in Pakistan in order to address the lack of empirical evidence on this topic. The study also examined the association between demographics (socio-demographic, reproductive history and empowerment status) and mistreatment, both in general and according to birth setting (whether home- or facility-based). Material and methods: In phase one, we identified 24 mistreatment indicators through an extensive literature review. We then pre-tested these indicators and classified them into seven behavioural types. During phase two, the survey was conducted (April-May 2013) in 14 districts across Pakistan. A total of 1,334 women who had given birth at home or in a healthcare facility over the past 12 months were interviewed. Linear regression analysis was employed for the full data set, and for facility- and home-based births separately, using Stata version 14.1. Results: There were no significant differences in manifestations of mistreatment between facility- and home-based childbirths. Approximately 97% of women reported experiencing at least one disrespectful and abusive behaviour. Experiences of mistreatment by type were as follows: non-consented care (81%); right to information (72%); non-confidential care (69%); verbal abuse (35%); abandonment of care (32%); discriminatory care (15%); and physical abuse (15%). In overall analysis, experience of mistreatment was lower among women who were unemployed (β = -1.17, 95% CI -1.81, -0.53); and higher among less empowered women (β = 0.11, 95% CI 0.06, 0.16); and those assisted by a traditional birth attendant as opposed to a general physician (β = 0.94, 95% CI 0.13, 1.75). Sub-group analyses for home-based births identified the same significant associations with mistreatment, with ethnicity included. In facility-based births, there was a significant relationship between women's employment and empowerment status and mistreatment. Women with prior education on birth preparedness were less likely to experience mistreatment compared to those who had received no previous birth preparedness education. Conclusion: In order to promote care that is woman-centred and provided in a respectful and culturally appropriate manner, service providers should be cognisant of the current situation and ensure provision of quality antenatal care. At the community level, women should seek antenatal care for improved birth preparedness, while at the interpersonal level strategies should be devised to leverage women's ability to participate in key household decisions.引言：获得尊重且有尊严的医疗保健是每一位女性的基本权利。然而，诸多寻求分娩服务的女性，尤其是巴基斯坦等低收入国家的女性，常遭受分娩照护人员（birth attendants）的虐待。本项流行病学研究旨在评估巴基斯坦医疗机构及家庭分娩场景中女性遭受分娩照护虐待的现患率与虐待类型，以填补该领域实证证据的空白。同时，本研究从总体层面及分娩场景（家庭分娩或医疗机构分娩）分层，分析人口统计学特征（社会人口学特征、生育史与赋权状况）与分娩照护虐待之间的关联。 材料与方法：第一阶段，研究团队通过全面的文献综述确定了24项分娩照护虐待指标，随后对这些指标进行预测试，并将其划分为7类行为类型。第二阶段，研究于2013年4月至5月在巴基斯坦14个地区开展问卷调查。共访谈了1334名在过去12个月内于家中或医疗机构分娩的女性。研究采用Stata 14.1软件，对全部数据集以及医疗机构分娩、家庭分娩的亚组数据分别进行线性回归分析。 结果：医疗机构分娩与家庭分娩的分娩照护虐待表现无显著差异。约97%的女性报告曾遭受至少一种不尊重或虐待行为。各类虐待行为的发生情况如下：非知情同意照护（non-consented care，81%）、信息知晓权被侵犯（right to information，72%）、非保密照护（non-confidential care，69%）、言语虐待（verbal abuse，35%）、照护遗弃（abandonment of care，32%）、歧视性照护（discriminatory care，15%）以及身体虐待（physical abuse，15%）。总体分析显示，未就业女性的分娩照护虐待经历更少（β=-1.17，95%CI：-1.81~-0.53）；赋权程度较低的女性（β=0.11，95%CI：0.06~0.16）以及由传统助产士（traditional birth attendant）而非全科医师（general physician）照护的女性，其虐待经历更多。家庭分娩亚组分析显示，除种族因素外，其余与分娩照护虐待相关的关联均与总体分析一致。医疗机构分娩亚组中，女性就业状况与赋权程度均与虐待经历存在显著关联。此前接受过分娩准备教育的女性，相比未接受过相关教育的女性，遭受虐待的概率更低。 结论：为推广以女性为中心、尊重且符合文化习俗的分娩照护服务，医疗服务提供者应充分了解当前现状，并确保提供高质量的产前保健（antenatal care）。在社区层面，女性应主动寻求产前保健以提升分娩准备程度；在人际互动层面，应制定策略以强化女性参与家庭重大决策的能力。