title: Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers.
abstract: BACKGROUND
  Global efforts have increased facility-based childbirth, but substantial barriers remain in some settings. In Nigeria, women report that poor provider attitudes influence their use of maternal health services. Evidence also suggests that women in Nigeria may experience mistreatment during childbirth; however, there is limited understanding of how and why mistreatment this occurs. This study uses qualitative methods to explore women and providers' experiences and perceptions of mistreatment during childbirth in two health facilities and catchment areas in Abuja, Nigeria.
  
  
  METHODS
  In-depth interviews (IDIs) and focus group discussions (FGDs) were used with a purposive sample of women of reproductive age, midwives, doctors and facility administrators. Instruments were semi-structured discussion guides. Participants were asked about their experiences and perceptions of, and perceived factors influencing mistreatment during childbirth. Thematic analysis was used to synthesize findings into meaningful sub-themes, narrative text and illustrative quotations, which were interpreted within the context of this study and an existing typology of mistreatment during childbirth.
  
  
  RESULTS
  Women and 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. Participants identified three main factors contributing to mistreatment: poor provider attitudes, women's behavior, and health systems constraints.
  
  
  CONCLUSIONS
  Moving forward, findings from this study must be communicated to key stakeholders at the study facilities. Measurement tools to assess how often mistreatment occurs and in what manner must be developed for monitoring and evaluation. Any intervention to prevent mistreatment will need to be multifaceted, and implementers should consider lessons learned from related interventions, such as increasing audit and feedback including from women, promoting labor companionship and encouraging stress-coping training for providers.
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA. mbohren1@jhu.edu.|UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. mbohren1@jhu.edu.
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Bohren
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Vogel
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Özge
authors.initials: Ö
authors.lastname: Tunçalp
authors.affiliation: Department of Obstetrics & Gynaecology, National Institute of Maternal & Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Bukola
authors.initials: B
authors.lastname: Fawole
authors.affiliation: Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Musibau A
authors.initials: MA
authors.lastname: Titiloye
authors.affiliation: Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria.
authors.forename: Akinpelu Olanrewaju
authors.initials: AO
authors.lastname: Olutayo
authors.affiliation: Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Modupe
authors.initials: M
authors.lastname: Ogunlade
authors.affiliation: Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Agnes A
authors.initials: AA
authors.lastname: Oyeniran
authors.affiliation: Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Olubunmi R
authors.initials: OR
authors.lastname: Osunsan
authors.affiliation: Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Loveth
authors.initials: L
authors.lastname: Metiboba
authors.affiliation: Nyanya General Hospital, Abuja, Federal Capital Territory, Nigeria.
authors.forename: Hadiza A
authors.initials: HA
authors.lastname: Idris
authors.affiliation: Maitama District Hospital, Abuja, Federal Capital Territory, Nigeria.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Alu
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Olufemi T
authors.initials: OT
authors.lastname: Oladapo
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: A Metin
authors.initials: AM
authors.lastname: Gülmezoglu
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA.|UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Hindin
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D036861:Delivery, Obstetric; D005260:Female; D006268:Health Facilities / Q000592:standards*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D036801:Parturition / Q000523:psychology*; D010465:Perception; D011247:Pregnancy; D036301:Qualitative Research; D011787:Quality of Health Care; D012938:Social Perception; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D014930:Women / Q000523:psychology*; D055815:Young Adult
keywords: Abuse; Childbirth; Disrespect; Maternal health; Mistreatment; Nigeria; Obstetric delivery; Qualitative research; Quality of care