Re-examining Norms of Disrespect and Abuse in the Second Stage of Labor in Tanzanian Maternity Care

ABSTRACT

Globally, the widespread occurrence of disrespect and abuse (D&A) on maternity wards is well-documented. Using ethnography and cultural consensus analysis we explore how the practice of midwives hitting women who are in the second stage of labor (pushing) has become a locally accepted form of care in Tanzania if a baby’s life appears to be at risk. This analysis interrogates the deep uncertainty of birth outcomes in this setting that may motivate abuse during this time. Seriously engaging with local discourses on abuse and care sheds light on hegemonic norms and power dynamics and is critical for improving maternity services.

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KEYWORDS:

• Tanzania
• United Republic of
• respectful maternity care
• disrespect and abuse
• care
• cultural consensus analysis
• obstetric violence

Acknowledgments

We thank Sarah Charles for her work as research assistant in Kigoma, and Dr. Paul Chaote for support of the fieldwork in Kigoma region. The Tanzanian National Institute for Medical Research, the Tanzanian Commission on Science and Technology, Columbia University’s, and the University of Florida’s Institutional Review Boards in the United States granted ethical approval. Many thanks to the anonymous reviewers for their helpful suggestions.

Notes

1. Though not all nurses in Tanzania are women, all but one of those interviewed at Mawingu were; as such, we use “she” to refer to nurses and their clients. Nurses on maternity wards are nurse-midwives and conduct all normal deliveries. Physicians only conducted or assisted complicated vaginal deliveries and performed C-sections. In Swahili there are no gendered pronouns but, for ease of reading, we have included them here.

Additional information

Funding

The research was made possible by funding from a National Science Foundation Postdoctoral Research Fellowship, grant no. 1714358.

Notes on contributors

Adrienne E. Strong

Adrienne E. Strong, PhD, is an Assistant Professor of Anthropology at the University of Florida. Her research focuses on maternal health and mortality in health facilities in Tanzania. Address correspondence to Dr. Adrienne Strong, Turlington Hall, Room 1112, P.O. Box 117305, Gainesville, FL 32611-7305, USA. Telephone: [phone], Email: [email protected]

Tara L. White

Tara L. White, MSc, is a 2^nd year medical student at the Vrije Universiteit Amsterdam. During her Master’s in Global Health her research focused on support and care during pregnancy and childbirth in Tanzania.