Women's narratives of experiences, drivers and consequences of mistreatment during maternity care in western Ethiopia.

Abstract

Background: The mistreatment of women during maternity care hinders quality care globally and deter women from seeking health services. To implement necessary actions, it is essential to explore instances of mistreatment, their factors and negative outcomes. This study explores the narratives of mistreatment experienced by women, its drivers, as well as the consequences of mistreatment.

Methods: We conducted a descriptive qualitative study among women who had received maternity care at East Wollega Zone, Ethiopia. Data were obtained through in-depth interviews with purposively selected participants in Afan Oromo, each lasting, on average, 30 to 60 minutes. Interviews were conducted within three months of childbirth and discontinued upon reaching data saturation at seventeen interviews. All interviews were audio recorded, transcribed, translated into English, coded using NVivo 12 and analysed through thematic and framework analysis.

Result: Three main themes were identified in this study: experiences, drivers, and consequences of mistreatment of women during maternity care. The narratives of mistreatment fell into two sub-themes: interpersonal abuse and mistreatment in the process of care. Women described experiencing physical and verbal abuse, stigma, and discrimination, as well as neglect and abandonment, violations of privacy and confidentiality, and health facility failures related to resource limitations. These forms of mistreatment were perceived to arise from a complex interaction of factors at an individual, interpersonal, and facility level, as well as broader health system and societal norms, such as gender inequality. The identified consequences of mistreatment included fear of future childbirth, negative perceptions towards health facilities and healthcare providers, switching to home birth, and psychological stress.

Conclusions: This qualitative study presents women's first-hand experiences of mistreatment in health facilities, highlighting various forms stemming from interpersonal interactions and systemic deficiencies in care quality. These experiences lead to significant negative consequences and implications on service delivery. The findings underscore the importance of understanding the complex factors driving mistreatment, extending beyond individual healthcare providers' behaviours to macro-level health system issues and general violence against women in society. This emphasises the importance of applying a systems-thinking approach to address the abuse and suffering women experience during maternity care in health facilities.