Moms giving birth in Abuja get tough love
It is official. New research has documented evidence of mistreatment of women during childbirth in Abuja’s hospitals.
The research, published in the journal Reproductive Health, says women and health care providers reported experiencing or witnessing “physical abuse including slapping, physical restraint to a delivery bed, and detainment in the hospital and verbal abuse, such as shouting and threatening women with physical abuse.
“Women sometimes overcame tremendous barriers to reach a hospital, only to give birth on the floor, unattended by a provider,” the research said.
Some 15 experts behind the study drew results from 84 in-depth interviews and focus group discussions with women, health care providers and hospital administrators in select urban and peri-urban hospitals in Abuja.
The urban hospital took 2417 deliveries in 2013, compared with 3231 in the periurban one. Ninety-four women died in the periurban hospital, and 73 in the urban one.
The names of women and providers who took part in the study have been removed from the report, which Daily Trust obtained, simply identified by sex and job description. Good or bad is a matter of context
Some women noted positive birth experiences in which they were “well care for” by health care providers, but they spontaneously bring up mistreatment to illustrate negative experiences.
Health care providers admitted to scenarios where they had “perpetrated mistreatment and where they witnessed a colleague mistreat a woman.”
But both women and their providers are quick to justify the situations as the result of “an overstretched health system, rather than isolated events of intentional abuse.”
A male doctor, 41, working in an urban facility told researchers: “If a midwife is already delivering a baby and another patient is calling for her attention you know she will not be able to attend [to her] at that particular time. But...that patient might feel that she has been treated wrongly. We know it is far from that.”
Workers on labour ward describe “disobedient,” “uncooperative” and “unruly” women who make it difficult to provide supportive care or papper them.
A doctor likened the labour room to a war zone. “On the war front, you don’t pamper; when you are at war, you are at war,” said the doctor, 40, working in a peri-urban hospital.
One incident had a woman lash out at a health worker in retaliation for the poor treatment she received, according to a 41-year-old woman in a focus group discussion.
The woman felt intense labour pain as she was brought to hospital, “so she was shouting and crying,” said the 41-year-old.
“That nurse, immediately, when she reached there, she gave the woman “baa!” (slap). Hey! The woman was just looking at her like ‘please you don’t know what is wrong with me and you slapped me, okay thank you.’
When the patient gave birth, the nurse told her everything done to her was for her own good.
When the patient was to leave hospital, she called the nurse aside, the woman narrated.
“Please, I want to see you”. She gave the nurse “fiam!” (slap). She said ‘the thing you did to me, that is what I did back to you.’” At risk
Health workers themselves suggest adolescents, first-time mothers and women of lower socioeconomic status may be more vulnerable to mistreatment.
Workers “may judge them for being pregnant too young, or they are unaware of what to expect during childbirth and appeared ill-prepared to engage with the health system,” the research reports.
“Furthermore, women who have not arranged to give birth in that facility (e.g.: unbooked for delivery) may be mistreated more often, as the lack of records contributes to a stressful environment for healthcare providers.
“These women were blamed for their lack of preparedness, even though providers were aware that they were more likely to be from disadvantaged backgrounds compared to women who had booked at that hospital for delivery.” Physical abuse
Many are reluctant to agree physical abuse happens in their facility, others provide detailed scenarios where women are “slapped or beaten” during childbirth to ensure positive outcome.
A woman doctor, 36, said told researchers during in-depth interviews: “If the woman is not cooperating. Like, you have your legs apart, the baby’s head is out, and you are now trying to pull your legs back together. The, the nurse that could be taking delivery at that time could be so agitated. Thereby, just palm the woman on the thigh [slap the woman on the thigh] to ‘open up’ so that she can actually deliver the baby. It is not really mistreatment. It is helping the woman indirectly.”
Healthworkers used slapping to get a woman to comply or cooperate, and it wasn’t often considered a mistreatment provided it wasn’t done out of malice.
A 35-year-mother said she felt bad when slapped, once her baby was born, she knew the nurses had been helping her and never held a grudge against them.
“If that baby dies, I lose; if I myself die, we all lose, so at least I prefer that slap than [losing] the baby,” she justified.
A 52-year-old doctor justifies slapping even more. “If she is slapped during labour, it depends. A woman is going, the head is out, she’s closing her leg. If you were in my shoes, what would you do? Will you leave her to kill the baby? No answer me. Will you leave her to kill the baby?”
But not all women welcome extra physical or psychological pain during labour. “Let them stop that shouting that they do. they shouldn’t even beat women during labour,” a 29-year-old woman fumed at a focus group discussion.
A 30-year-old woman said five finger marks stayed on her face till she left hospital after delivery. “I don’t even want to remember that past…she was supposed to pet me as far as it’s my first experience.”
Another woman, aged 36, said nurses beat her so hard, she found out, “If I don’t push, I may end up dying or the baby may end up dying.”
Another 31-year-old woman who gave birth in an urban Abuja hospital remembers pleading to no avail.
“I was telling them, ‘I beg, nurse, take it easy, it is not my fault, you see it is painful. I was just pleading with them because I know them; they were also fed up with me. I know they did their best. I know at that point in them, they were trying their best to save me, but because of the beating, I didn’t have strength.”
In an urban Abuja hospital, a 36-yearold woman doctor, thinks women being uncooperative in labour could be treated better. “We are not supposed to use our hand ... to beat the woman. They way I am taught, there are better ways to communicate to her. But sometimes, you see midwives beating patients-‘you want to kill the baby? Pow! Pow! Pow!”
A female nurse, 39, working in an Abuja hospital describes another method of controlling a woman during childbirth. She was the lone midwife on night duty when her patient, a first-time mother, came in.
“She was fully dilated, but no way, she would rather get up and stand. When she started having contractions, she would climb the couch and remain there.
She had to call the woman’s relations, and after managing to get the woman down, “put still ropes to hold her legs.”
The most telling thing women think about healthworkers is they are rude, don’t care about human life, insult people as if they aren’t human and mistreat you like a slave.
One 29-year-old woman who gave birth in a peri-urban hospital in Abuja said the nurses addressed as a “goat”, telling her go outside and not disturb them with labour because it wasn’t her time when she arrived the hospital.
Shouting, criticism, harsh words and insults were pervasive during childbirth. And women are yelled at for not bringing all supplies needed for childbirth.
“It is very, very common with general hospitals, some can be very, very rude,” said a patient in the study. “The way they talk to you sometimes as if they are not being sensitive to your situation.”
In some situations, health workers shamed women for having enjoyed having sex while they have to deal with the resulting pregnancy and childbirth.
A 25-year-old woman described the insult from a nurse. “‘Am I your husband? When your husband was doing it, it was sweet. Now you are disturbing us with your noise’. When you hear that kind of insult, even when they come to attend to you, you will be feeling shy to even open your legs.”
Verbally abused women felt vulnerable and unable to communicate with their carer or complain about poor services.
The typical response is: “I don’t have anything to say, is only God that will help me in this condition now because I don’t have the power,” said a woman, 27, about disrespect during childbirth.
Stigma and discrimination
Ismaila Garba, who runs Amana, a community-based group helping people living wih HIV access drugs in Niger state, say women living with the virus are most discriminated against.
Such women may not visit hospitals at all, or refrain from disclosing their status to health workers for fear of discrimination.
“This may put health workers and their babies at risk of contracting HIV if appropriate protection is not used,” the researchers note.
“Women also felt discriminated against when they were of different religions, ethnicities or from low socioeconomic status.”
In indepth interview, a 36-year-old woman doctor admits to some health workers having a bias and not being very nice to women.
“Most people don’t look at their patients with the human face; you look at people and you are already judging them,” she says.
“I think that if a woman comes, for example, she’s coming from a squalid background, she’s dirty, you can actually give her a bath and make her feel nice and then you bring her back in and continue what you’re doing.”
Education and socioeconomy also put health workers at odds with women and their husbands or other caregivers.
With an “educated person, you don’t have to clash with them because they reason very well,” says a male doctor, 42, in a periurban hospital in Abuja.
“These uneducated people, they’re poor, stupid, ignorant, nothing. They anger you. You’re trying to save his wife; he doesn’t understand what you’re talking about.”
The research found common neglect during labour, leaving women feeling abandoned and unable to summon health workers when needed. Many were not monitored during labour.
Health workers speak of being overworked, with women expecting them to drop everything else and attend to them.
“You feel so irritated and you talk to them any how or you will even send them away that you are not going to attend to them,” a nurse, 40, admitted in interview with researchers.
“I have done it before too. Like four years ago we used to have more than 13 deliveries in a night and it will just be two nurses on duty. By the time you are handing over in the morning, you will see that your legs are shaking, and they will bring one unbooked patient for you to leave what you are doing to come and attend. Your head will be banging and you won’t even know when you will tell them to go to hell, anywhere they want to go let them go.”
Respondents speak about women just “laying on the floor and delivering” because hospitals never had enough bed spaces. One of the hospitals had at least eight women at every time in its maternity area, but had only four beds.
The urban hospitals in the study tupically had 28 medical officers, midwives and obstetrician/gynaecologists combined, compared with 26 in the peri-urban hospitals. The urban hospital had eight bed on its delivery ward, compared with six in periurban one.
Design of labour wards was considered inadequate, causing violation of privacy.
Delivery rooms contained several beds with no partition between them, and if curtains were available, they were tattered or not closed properly. Windows were broken and lacked curtains to shield women from passersby, the researchers report.
A 31-year-old woman mentioned at the outset recalls her baby struggling to get out while people passed by and looked at her in the labour room.
“It’s supposed to be enclosed but they did not repair everything that they suppose, like windows. I mean according to our religion, it is not allowed, everybody were seeing our naked [bodies, watching] how the baby will come out. I was annoyed,” she said.
The research notes mistreatment of women could be destabilising.
“If they treat you well, encourage you, it will give you that confidence but if they are rude and harsh, it will destabilize you and add to your problem,” a woman, 29, said in inedepth interview with the researchers.
“Women, they are dying at home because of they are fearing to go to hospital because of the way nurses and doctors are treating them,” a 30-year-old mother said.