A qualitative exploration of the mistreatment of women during childbirth in a rural Guatemalan hospital

In Guatemala, many women still give birth together with traditional birth attendants at home particularly in rural settings even though births attended by skilled birth attendants in healthcare facilities have been recommended. Mistreatment of women during childbirth is recognized as one of the obstacles to childbirth in healthcare facilities. However, little research has been conducted on childbirth care and the mistreatment of women during facility-based childbirth in Guatemala. Thus, this study aimed to explore women's experiences of care during childbirth in a rural Guatemalan hospital. The women narrated their experiences from which themes were derived (whether mistreatment or not, and if mistreatment prevailed, the type). This qualitative study involved interviews with 20 women of reproductive age who had given birth in a hospital in Quiché Department, Guatemala, within the past six months. Data were collected by semistructured interviews between December 2022 and February 2023. The contents of the semistructured interviews were past birth experiences, a recent birth experience in a hospital, and care received from healthcare providers. Thematic analysis was performed with deductive and inductive approaches using Bohren et al.'s typology of the mistreatment of women during childbirth. The study was approved by St. Luke's International University Research Ethics Committee and the study hospital. Women reported experiencing various forms of mistreatment during childbirth in the rural Guatemalan hospital. These included six of the seven categories from Bohren et al.'s typology including physical abuse, verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers, and health system conditions and constraints. Specifically, the participants reported experiences of reprimands and neglect by healthcare providers, as well as discrimination of those who do not speak Spanish. It became evident that mistreatment of women by healthcare providers had become normalized, and that culturally appropriate care was not adequately provided. Eliminating or reducing mistreatment requires a multilevel approach. Healthcare providers must acquire up-to-date knowledge and skills and develop appropriate professional attitudes. Both healthcare providers and women should have increased awareness of women's rights and mistreatment. In Guatemala, many women still prefer to give birth at home with traditional birth attendants particularly in rural areas. Although many factors prevent women from giving birth in healthcare facilities, mistreatment of women during childbirth has received increasing attention in recent years. There are some reports of mistreatment of women during childbirth in healthcare facilities in Guatemala. However, little research has been conducted to investigate the actual conditions of mistreatment. In this study, 20 women who had given birth within the past six months at a hospital in Quiché Department, Guatemala, were interviewed between December 2022 and February 2023. The interviews aimed to explore their experiences of care during childbirth and to describe, if any, instances and types of mistreatment from the women's narratives. The study found that women faced various forms of mistreatment, namely, physical abuse, verbal abuse, stigma, and discrimination, failure to meet professional standards of care, poor rapport between women and providers, and health system conditions and constraints. The women specifically shared their experiences of being scolded or neglected by healthcare providers and being discriminated for not speaking Spanish. It also became evident that mistreatment was seen as normal by both healthcare providers and women. Culturally appropriate care was not properly provided to women. Eliminating or reducing mistreatment of women during childbirth requires actions at many levels (individual, facility, policy). Healthcare providers must undergo regular training and education to acquire up-to-date knowledge and skills and develop appropriate professional attitudes. Both healthcare providers and women should be aware of women's rights during childbirth and forms of mistreatment.