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： 享有尊重且有尊严的医疗照护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，会遭到分娩照护人员（birth attendants）的虐待。本项流行病学研究（epidemiological study）旨在评估巴基斯坦医疗机构及家庭分娩场景中女性遭受虐待的发生率与虐待类型，以填补该领域实证证据的空白。本研究同时分析了人口统计学特征（社会人口学特征、生育史与赋权状况）与虐待行为之间的整体关联，以及按分娩场景（家庭分娩或医疗机构分娩）划分的关联差异。 材料与方法： 第一阶段，我们通过全面的文献综述确定了24项虐待行为指标。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，我们于2013年4月至5月在巴基斯坦14个地区开展了调查。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。我们使用Stata 14.1版（Stata version 14.1）软件，对全部数据集以及分别针对医疗机构分娩、家庭分娩的子数据集进行了线性回归分析（linear regression analysis）。 结果： 医疗机构分娩与家庭分娩的虐待表现并无显著差异。约97%的女性报告曾遭遇至少一种不尊重与虐待行为。按类型划分的虐待经历如下：未获得知情同意的照护（81%）、知情权被侵犯（72%）、非保密照护（69%）、言语虐待（35%）、弃置照护（32%）、歧视性照护（15%）以及身体虐待（15%）。整体分析显示，失业女性的虐待经历更少（β=-1.17，95%置信区间（95% CI）[-1.81, -0.53]）；赋权程度较低的女性（β=0.11，95%置信区间（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（β=0.94，95%置信区间（95% CI）[0.13, 1.75]）。家庭分娩亚组分析得出了与虐待行为相同的显著关联，且纳入了种族因素。在医疗机构分娩的亚组中，女性就业状况与赋权程度与虐待行为存在显著关联。曾接受分娩准备教育的女性，相较于未接受过相关教育的女性，遭受虐待的可能性更低。 结论： 为推广以女性为中心、尊重且符合文化适宜性的照护服务，服务提供者应了解当前现状，并确保提供高质量的产前保健（antenatal care）服务。在社区层面，女性应寻求产前保健以提升分娩准备程度；在人际层面，应制定策略以增强女性参与家庭关键决策的能力。