Experiences of disrespect and abuse during childbirth in the World Health Organization European region: A mixed-method study among 22 countries

Anna Galle¹, Helga Berghman¹, Ilaria Mariani², Maria Verdecchia², Arianna Bomben², Eline Skirnisdottir Vik³, Daniela Drandic⁴, Elizabete Pumpure^{5

6}, Raquel Costa^{7

8

9}, Helen Elden^{10

11}, Céline Miani¹², Barbara Baranowska¹³, Antigoni Sarantaki¹⁴, Zalka Drglin¹⁵, Jelena Radetic¹⁶, Alina Liepinaitienė^{17

18}, Virginie Rozée¹⁹, Alessia Abderhalden-Zellweger²⁰, Amira Cerimagic²¹, Martina König-Bachmann²², Ourania Kolokotroni²³, Ilana Chertok^{24

25}, Maryse Arendt²⁶, Stefano Delle Vedove², Ingvild Hersoug Nedberg²⁷, Magdalena Kurbanovic²⁸, Gunta Lazdane²⁹, Tiago Miguel Pinto³⁰, Karolina Lindén³¹, Stephanie Batram-Zantvoort¹², Urszula Tataj-Puzyna¹³, Dimitra Metallinou³², Anja Bohinec¹⁵, Jovana Ružičić³³, Marija Mizgaitienė³⁴, Elise de La Rochebrochard¹⁹, Michael Gemperle³⁵, Imola Simon³⁶, Maria Karanikola³⁷, Barbara Tasch^{26

38}, Simona Fumagalli³⁹, Marzia Lazzerini^{2

40}; IMagiNE EURO study group

Collaborators, Affiliations

Collaborators

IMagiNE EURO study group:
Martina König-Bachmann, Christoph Zenzmaier, Simon Imola, Elisabeth D'Costa, Anna Galle, Silke D'Hauwers, Amira Ćerimagić, Ourania Kolokotroni, Eleni Hadjigeorgiou, Maria Karanikola, Nicos Middleton, Ioli Orphanide Eteocleous, Daniela Drandić, Magdalena Kurbanović, Lenka Laubrova Zirovnicka, Miloslava Kramná, Rozée Virginie, Elise de La Rochebrochard, Kristina Löfgren, Céline Miani, Stephanie Batram-Zantvoort, Antigoni Sarantaki, Dimitra Metallinou, Aikaterini Lykeridou, Ilana Chertok, Rada Artzi-Medvedik, Marzia Lazzerini, Emanuelle Pessa Valente, Ilaria Mariani, Arianna Bomben, Stefano Delle Vedove, Sandra Morano, Antonella Nespoli, Simona Fumagalli, Elizabete Pumpure, Dace Rezeberga, Dārta Jakovicka, Gita Jansone-Šantare, Anna Šibalova, Elīna Voitehoviča, Dārta Krēsliņa, Alina Liepinaitienė, Želika Kondrakova, Marija Mizgaitienė, Simona Juciūtė, Maryse Arendt, Barbara Tasch, Enrico Lopriore, Thomas Van den Akker, Ingvild Hersoug Nedberg, Sigrun Kongslien, Eline Skirnisdottir Vik, Barbara Baranowska, Urszula Tataj-Puzyna, Beata Szlendak, Paulina Pawlicka, Raquel Costa, Catarina Barata, Teresa Santos, Heloísa Dias, Tiago Miguel Pinto, Sofia Marques, Ana Meireles, Joana Oliveira, Mariana Pereira, Maria Arminda Nunes, Marina Ruxandra Otelea, Jelena Radetić, Jovana Ružičić, Zalka Drglin, Anja Bohinec, Serena Brigidi, Alejandra Oliden, Lara Martín Castañeda, Helen Elden, Karolina Linden, Mehreen Zaigham, Claire de Labrusse, Alessia Abderhalden-Zellweger, Anouck Pfund, Harriet Thorn, Susanne Grylka, Michael Gemperle, Antonia Mueller

Affiliations

¹ International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University Gent, Ghent, Belgium.
² WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
³ Department of Health and Caring Science, Western Norway University of Applied Sciences, Bergen, Norway.
⁴ Roda-Parents in Action, Zagreb, Croatia.
⁵ Riga Maternity Hospital, Riga, Latvia.
⁶ Department of Obstetrics and Gynecology, Riga Stradins University, Riga, Latvia.
⁷ EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.
⁸ Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
⁹ Hei-Lab:Digital Human-Environment Interaction Lab. Faculty of Psychology, Education and Sports, Lusófona University, Porto, Portugal.
¹⁰ Institute of Health and Caring Sciences, Sahlgrenska Academy, Gothenburg, Gothenburg University, Gothenburg, Sweden.
¹¹ Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹² Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.
¹³ Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland.
¹⁴ Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece.
¹⁵ National Institute of Public Health, Ljubljana, Slovenia.
¹⁶ Center for Moms, Belgrade, Serbia.
¹⁷ Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Kaunas, Lithuania.
¹⁸ Republican Siauliai County Hospital, Siauliai, Lithuania.
¹⁹ Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), Paris, France.
²⁰ School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.
²¹ NGO Baby Steps, Sarajevo, Bosnia and Herzegovina.
²² Health University of Applied Sciences Tyrol, Innsbruck, Austria.
²³ School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
²⁴ School of Nursing, Ohio University, Athens, Ohio, USA.
²⁵ Department of Nursing, Ruppin Academic Center, Emek Hefer, Israel.
²⁶ Beruffsverband Vun de Laktatiounsberoderinnen zu Lëtzebuerg Asbl (Professional Association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg.
²⁷ UiT the Arctic University of Norway, Tromso, Norway.
²⁸ University of Rijeka Faculty of Health Studies, Rijeka, Croatia.
²⁹ Institute of Public Health, Rīga Stradiņš University, Riga, Latvia.
³⁰ HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal.
³¹ University of Gothenburg, Goteborg, Sweden.
³² Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece.
³³ Centar Za Mame, Belgrade, Serbia.
³⁴ Kaunas Hospital of the Lithuanian University of Health Sciences, Kaunas, Lithuania.
³⁵ Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Wädenswil, Switzerland.
³⁶ University of Applied Sciences Burgenland, Pinkafeld, Austria.
³⁷ Cyprus University of Technology School of Health Sciences, Cyprus.
³⁸ Neonatal Intensive Care Unit, KannerKlinik, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
³⁹ University of Milano Bicocca, Milan, Italy.
⁴⁰ London School of Hygiene & Tropical Medicine, London, UK.

PMID: 40919727
DOI: 10.1002/ijgo.70516

Experiences of disrespect and abuse during childbirth in the World Health Organization European region: A mixed-method study among 22 countries

Anna Galle et al. Int J Gynaecol Obstet. 2025.

. 2025 Sep 8.

doi: 10.1002/ijgo.70516. Online ahead of print.

Authors

Collaborators

IMagiNE EURO study group:
Martina König-Bachmann, Christoph Zenzmaier, Simon Imola, Elisabeth D'Costa, Anna Galle, Silke D'Hauwers, Amira Ćerimagić, Ourania Kolokotroni, Eleni Hadjigeorgiou, Maria Karanikola, Nicos Middleton, Ioli Orphanide Eteocleous, Daniela Drandić, Magdalena Kurbanović, Lenka Laubrova Zirovnicka, Miloslava Kramná, Rozée Virginie, Elise de La Rochebrochard, Kristina Löfgren, Céline Miani, Stephanie Batram-Zantvoort, Antigoni Sarantaki, Dimitra Metallinou, Aikaterini Lykeridou, Ilana Chertok, Rada Artzi-Medvedik, Marzia Lazzerini, Emanuelle Pessa Valente, Ilaria Mariani, Arianna Bomben, Stefano Delle Vedove, Sandra Morano, Antonella Nespoli, Simona Fumagalli, Elizabete Pumpure, Dace Rezeberga, Dārta Jakovicka, Gita Jansone-Šantare, Anna Šibalova, Elīna Voitehoviča, Dārta Krēsliņa, Alina Liepinaitienė, Želika Kondrakova, Marija Mizgaitienė, Simona Juciūtė, Maryse Arendt, Barbara Tasch, Enrico Lopriore, Thomas Van den Akker, Ingvild Hersoug Nedberg, Sigrun Kongslien, Eline Skirnisdottir Vik, Barbara Baranowska, Urszula Tataj-Puzyna, Beata Szlendak, Paulina Pawlicka, Raquel Costa, Catarina Barata, Teresa Santos, Heloísa Dias, Tiago Miguel Pinto, Sofia Marques, Ana Meireles, Joana Oliveira, Mariana Pereira, Maria Arminda Nunes, Marina Ruxandra Otelea, Jelena Radetić, Jovana Ružičić, Zalka Drglin, Anja Bohinec, Serena Brigidi, Alejandra Oliden, Lara Martín Castañeda, Helen Elden, Karolina Linden, Mehreen Zaigham, Claire de Labrusse, Alessia Abderhalden-Zellweger, Anouck Pfund, Harriet Thorn, Susanne Grylka, Michael Gemperle, Antonia Mueller

Affiliations

¹ International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University Gent, Ghent, Belgium.
² WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
³ Department of Health and Caring Science, Western Norway University of Applied Sciences, Bergen, Norway.
⁴ Roda-Parents in Action, Zagreb, Croatia.
⁵ Riga Maternity Hospital, Riga, Latvia.
⁶ Department of Obstetrics and Gynecology, Riga Stradins University, Riga, Latvia.
⁷ EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.
⁸ Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
⁹ Hei-Lab:Digital Human-Environment Interaction Lab. Faculty of Psychology, Education and Sports, Lusófona University, Porto, Portugal.
¹⁰ Institute of Health and Caring Sciences, Sahlgrenska Academy, Gothenburg, Gothenburg University, Gothenburg, Sweden.
¹¹ Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹² Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.
¹³ Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland.
¹⁴ Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece.
¹⁵ National Institute of Public Health, Ljubljana, Slovenia.
¹⁶ Center for Moms, Belgrade, Serbia.
¹⁷ Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Kaunas, Lithuania.
¹⁸ Republican Siauliai County Hospital, Siauliai, Lithuania.
¹⁹ Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), Paris, France.
²⁰ School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.
²¹ NGO Baby Steps, Sarajevo, Bosnia and Herzegovina.
²² Health University of Applied Sciences Tyrol, Innsbruck, Austria.
²³ School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
²⁴ School of Nursing, Ohio University, Athens, Ohio, USA.
²⁵ Department of Nursing, Ruppin Academic Center, Emek Hefer, Israel.
²⁶ Beruffsverband Vun de Laktatiounsberoderinnen zu Lëtzebuerg Asbl (Professional Association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg.
²⁷ UiT the Arctic University of Norway, Tromso, Norway.
²⁸ University of Rijeka Faculty of Health Studies, Rijeka, Croatia.
²⁹ Institute of Public Health, Rīga Stradiņš University, Riga, Latvia.
³⁰ HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal.
³¹ University of Gothenburg, Goteborg, Sweden.
³² Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece.
³³ Centar Za Mame, Belgrade, Serbia.
³⁴ Kaunas Hospital of the Lithuanian University of Health Sciences, Kaunas, Lithuania.
³⁵ Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Wädenswil, Switzerland.
³⁶ University of Applied Sciences Burgenland, Pinkafeld, Austria.
³⁷ Cyprus University of Technology School of Health Sciences, Cyprus.
³⁸ Neonatal Intensive Care Unit, KannerKlinik, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
³⁹ University of Milano Bicocca, Milan, Italy.
⁴⁰ London School of Hygiene & Tropical Medicine, London, UK.

PMID: 40919727
DOI: 10.1002/ijgo.70516

Abstract

Objective: Despite advancements in maternity quality care worldwide, mistreatment of women during childbirth persists. Currently, there is a gap of knowledge on the occurrence of disrespect and abuse during childbirth in the World Health Organization (WHO) European region.

Methods: Within the IMAgiNE EURO (Improving Maternal Newborn Care in the WHO European Region During COVID-19 Pandemic) study, women 18 years and older who gave birth in healthcare facilities in the WHO European region, were invited to complete an online validated questionnaire regarding quality of maternity care. Data were collected between March 2020 and May 2023, declared as the COVID-19 pandemic. A mixed-method analysis was conducted on women's experiences of abuse, involving descriptives and multivariate logistic regression for quantitative data and thematic analysis for qualitative data.

Results: Of 50 617 participants among 22 countries, 7683 (15.2%) reported experiences of abuse ranging from 6.4% in Israel to 30.7% in Bosnia-Herzegovina, with significant differences by country, age, and birth mode. Emotional, verbal, and physical abuses were reported by 10.3%, 7.3%, and 2.4%, respectively. The thematic analysis, including 737 responses, identified several shortcomings in care that women perceived as abusive, the experience associated with abuse, and the elicited emotions. Experiences of disrespect and abuse were often linked to a sequence of actions, resulting in women feeling violated and treated as an object.

Conclusion: Disrespectful maternity care was common during the COVID-19 pandemic in the WHO European region. Efforts are needed to improve communication, implementation of evidence-based practices, and respect for women's rights. Constant monitoring of disrespect and abuse indicators is needed. A paradigm shift must happen, ensuring safe and respectful care for all.

Keywords: COVID‐19; childbirth; disrespect and abuse; maternal and newborn health care; quality of care.

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References

REFERENCES

1. WHO. WHO recommendations on antenatal care for a positive pregnancy experience. [WHO website]. 2016. Accessed December 22, 2022. https://www.who.int/publications/i/item/9789241549912
1. Freedman LP, Ramsey K, Abuya T, et al. Defining disrespect and abuse of women in childbirth: a research, policy and rights agenda. Bull World Health Organ. 2014;92:915‐917.
1. Miller S, Lalonde A. The global epidemic of abuse and disrespect during childbirth: history, evidence, interventions, and FIGO's mother‐baby friendly birthing facilities initiative. Int J Gynaecol Obstet. 2015;131:S49‐S52.
1. Abderhalden‐Zellweger A, de Labrusse C, Gemperle M, et al. Women's experiences of disrespect and abuse in Swiss facilities during the COVID‐19 pandemic: a qualitative analysis of an open‐ended question in the IMAgiNE EURO study. BMC Pregnancy Childbirth. 2024;24:1‐14.
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Experiences of disrespect and abuse during childbirth in the World Health Organization European region: A mixed-method study among 22 countries

Collaborators

Affiliations

Experiences of disrespect and abuse during childbirth in the World Health Organization European region: A mixed-method study among 22 countries

Authors

Collaborators

Affiliations

Abstract

References

REFERENCES

LinkOut - more resources

Full Text Sources

Miscellaneous