title: The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review.
abstract: BACKGROUND
  Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence on the mistreatment of women during childbirth in health facilities to inform the development of an evidence-based typology of the phenomenon.
  
  
  RESULTS
  We searched PubMed, CINAHL, and Embase databases and grey literature using a predetermined search strategy to identify qualitative, quantitative, and mixed-methods studies on the mistreatment of women during childbirth across all geographical and income-level settings. We used a thematic synthesis approach to synthesize the qualitative evidence and assessed the confidence in the qualitative review findings using the CERQual approach. In total, 65 studies were included from 34 countries. Qualitative findings were organized under seven domains: (1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. Due to high heterogeneity of the quantitative data, we were unable to conduct a meta-analysis; instead, we present descriptions of study characteristics, outcome measures, and results. Additional themes identified in the quantitative studies are integrated into the typology.
  
  
  CONCLUSIONS
  This systematic review presents a comprehensive, evidence-based typology of the mistreatment of women during childbirth in health facilities, and demonstrates that mistreatment can occur at the level of interaction between the woman and provider, as well as through systemic failures at the health facility and health system levels. We propose this typology be adopted to describe the phenomenon and be used to develop measurement tools and inform future research, programs, and interventions.
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America; Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Bohren
authors.affiliation: Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Vogel
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Erin C
authors.initials: EC
authors.lastname: Hunter
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Olha
authors.initials: O
authors.lastname: Lutsiv
authors.affiliation: Population Services International, Washington, D. C., United States of America.
authors.forename: Suprita K
authors.initials: SK
authors.lastname: Makh
authors.affiliation: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: João Paulo
authors.initials: JP
authors.lastname: Souza
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Carolina
authors.initials: C
authors.lastname: Aguiar
authors.affiliation: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Saraiva Coneglian
authors.affiliation: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Alex Luíz Araújo
authors.initials: AL
authors.lastname: Diniz
authors.affiliation: Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
authors.forename: Özge
authors.initials: Ö
authors.lastname: Tunçalp
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Dena
authors.initials: D
authors.lastname: Javadi
authors.affiliation: Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
authors.forename: Olufemi T
authors.initials: OT
authors.lastname: Oladapo
authors.affiliation: Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
authors.forename: Rajat
authors.initials: R
authors.lastname: Khosla
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America; Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Hindin
authors.affiliation: Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
authors.forename: A Metin
authors.initials: AM
authors.lastname: Gülmezoglu
mesh_terms: D036861:Delivery, Obstetric / Q000523:psychology*; D005260:Female; D014943:Global Health; D006801:Humans; D036801:Parturition / Q000523:psychology*; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D014754:Violence