The nature of obstetric violence and the organisational context of its manifestation in India: a systematic review

Figures & data

Figure 1. Process of article selection

Table 1. Studies included in the review

Authors	Methodology	Subject area	Topics
Sudhinaraset et al.^Citation8	Mixed-method (Cross-sectional)	Slum Area (Uttar Pradesh)	Factors associated with women’s report of mistreatment, how it is perpetrated, its drivers and consequences
Diamond-Smith et al.^Citation15	Quantitative method (Cross-sectional)	Slums of Lucknow (Uttar Pradesh)	Association between women’s empowerment and mistreatment during the time of childbirth
Chattopadhyay et al.^Citation1	Qualitative method (Cross-sectional)	Community (Assam)	Women’s experience of obstetric violence during childbirth and associated factors
Raj et al.^Citation7	Quantitative method (Cross-sectional)	Community (Women who delivered in Public Health Facilities) (Uttar Pradesh)	Associations between mistreatment during childbirth and maternal complications
Bhattacharya and Ravindran^Citation16	Mixed-method (Cross-sectional)	Community (Uttar Pradesh)	Frequency and nature of disrespect and abuse experienced in healthcare facilities by women, and possible associations
Madhiwalla et al.^Citation17	Qualitative method (Cross-sectional)	Government Hospitals (Mumbai)	Examined organisational context in order to understand disrespect and abuse
Morgan et al.^Citation18	Qualitative method (Cross-sectional)	Government Hospitals (Bihar)	Barriers and facilitators to optimal obstetric care
Goli et al.^Citation19	Quantitative method (Longitudinal study)	Community (Uttar Pradesh)	Investigates the prevalence of labour room violence and association between prevalence of obstetric violence and socioeconomic characteristics of the respondents
Sharma et al.^Citation20	Mixed-method (Cross-sectional)	Government & Private Hospitals (Uttar Pradesh)	Investigates the nature and context of mistreatment during labour and childbirth at public and private maternity facilities
Shrivastava and Sivakami^Citation12	Integrative literature review	India	Collates and analyses the existing literature on obstetric violence in India

Table 2. Nature of obstetric violence in the Indian context

Type of abuse	Characteristics	Studies
Physical abuse	–	[7,8,17]
	Slapping, punching, beating or tying the women	[16,20]
Sexual abuse	–	-
Verbal abuse	–	[7,8,20]
	Shouting, scolding, yelling	[1,16,17]
Stigma and discrimination	Discriminatory behaviours because of caste and class	[7,15,17,19]
	Discriminatory behaviours because of religion	[19]
	Treated differently because of particular community or class	[7]
Failure to meet professional standards of care	Request for bribe	[8,18,20]
	Abandoned or ignored	[7,8,16]
	Unnecessary separation from baby	[8]
	Forcefully pushed abdomen during delivery	[7,17]
	Applied force to pull the baby	[7]
	Did not take consent prior to the treatment	[7,16]
	Lack of physical privacy	[16]
	Post-partum contraception	[17]
	Use of pain relief medication	[17]
	Episiotomy	[1,17,20]
	Fundal Pressure	[20]
Poor rapport between women and providers	Lack of information	[7,8,16]
	Threats to withhold treatment	[8,16]
	Choice of positions denied	[8]
	Companion not allowed	[8]
	Support from providers during the stay in a facility	[7]
Health system conditions and constraints	High workload	[17]
	Adverse working conditions	[17]
	Shortages and misallocation of resources	[17,18]
	Staffing shortage	[17]
	Unqualified birth attendants	[20]
	Hygiene in Health facilities	[20]

Sudhinaraset M, Treleaven E, Melo J, et al. Women’s status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory. BMC Pregnancy Childbirth. 2016;16, https://doi.org/10.1186/s12884-016-1124-4.

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Diamond-Smith N, Treleaven E, Murthy N, et al. Women’s empowerment and experiences of mistreatment during childbirth in facilities in Lucknow, India: results from a cross-sectional study. BMC Pregnancy Childbirth. 2017;17:130–158. https://doi.org/10.1186/s12884-017-1501-7.

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Chattopadhyay S, Mishra A, Jacob S. ‘Safe’, yet violent? Women's experiences with obstetric violence during hospital births in rural Northeast India. Cult Heal Sex. 2017, https://doi.org/10.1080/13691058.2017.1384572.

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Raj A, Dey A, Boyce S, et al. Associations between mistreatment by a provider during childbirth and maternal health complications in Uttar Pradesh, India. Matern Child Health J. 2017;21:1821–1833. https://doi.org/10.1007/s10995-017-2298-8.

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Bhattacharya S, Sundari Ravindran TK. Silent voices: institutional disrespect and abuse during delivery among women of Varanasi district, Northern India. BMC Pregnancy Childbirth. 2018;18, https://doi.org/10.1186/s12884-018-1970-3.

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Madhiwalla N, Ghoshal R, Mavani P, et al. Identifying disrespect and abuse in organizational culture: a study of two hospitals in Mumbai, India. Reprod Health Matters. 2018;26:36–47. https://doi.org/10.1080/09688080.2018.1502021.

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Morgan MC, Dyer J, Abril A, et al. Barriers and facilitators to the provision of optimal obstetric and neonatal emergency care and to the implementation of simulation-enhanced mentorship in primary care facilities in Bihar, India: a qualitative study. BMC Pregnancy Childbirth. 2018;18, https://doi.org/10.1186/s12884-018-2059-8.

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Goli S, Ganguly D, Chakravorty S, et al. Labour room violence in Uttar Pradesh, India: evidence from a longitudinal study of pregnancy and childbirth. BMJ Open. 2019;9:e028688, https://doi.org/10.1136/bmjopen-2018-028688.

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Sharma G, Penn-Kekana L, Halder K, et al. An investigation into mistreatment of women during labour and childbirth in maternity care facilities in Uttar Pradesh, India: A mixed methods study. Reprod. Health. 2019;16, https://doi.org/10.1186/s12978-019-0668-y.

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Shrivastava S, Sivakami M. Evidence of “obstetric violence” in India: an integrative review. J Biosoc Sci. 2020;52:610–628. https://doi.org/10.1017/S0021932019000695.

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