Frequency of reported abuse, stigma and discrimination during facility-based childbirth among migrant mothers and their suggestions for improvement: a mixed method WHO standards-based multicentre study in Italy

Abstract

Objectives: This study aims at documenting the frequency of reported abuse, stigma and discrimination and exploring the perspectives for improving the quality of maternal-newborn care (QMNC) of migrant mothers' reporting abuse, stigma or discrimination.

Design: Mixed methods multicentre cross-sectional study.

Setting: All maternal facilities (tertiary and secondary levels of care, n=9) from Friuli-Venezia Giulia region, Northeast Italy, between November 2019 and January 2022 in Northeast Italy.

Participants: 874 migrant and 3968 non-migrant women answering a validated WHO Standard-based questionnaire after birth.

Outcome measures: Frequency of reported abuse, stigma and discrimination during facility-based childbirth was calculated and compared with those of non-migrant mothers. Thematic analysis was conducted on eight open questions, using WHO Standards as a framework for the analysis.

Results: Among migrant women, 84 (9.6%) reported some type of abuse, stigma and discrimination, a frequency similar to non-migrant women (9.8%, p=0.880). The most frequently reported was verbal abuse (87.7%), followed by stigma and discrimination (15.1%). Most women (86.9%) provided at least one comment, with a frequency comparable to non-migrant women (p=0.076). Among a total of 327 comments, 104 (31.8%) were practical suggestions for improving QMNC. Experience of care was the domain with the highest frequency both of negative (64.9% of negative comments) and positive comments (51.7% of positive comments) and with the highest frequency of suggestions for improving QMNC (52.9% of suggestions). Overall, suggestions mainly focused on strengthening healthcare professionals' communication skills, allowing companionship during childbirth, increasing healthcare professionals' availability and timely support.

Discussions: This study shows that both migrant and non-migrant mothers are exposed to abuse, stigma and discrimination during childbirth, and that both are willing to provide practical suggestions, which should be used for planning actions to improve QMNC.

Keywords: Child; Cross-Sectional Studies; OBSTETRICS; PERINATOLOGY; Quality in health care; Surveys and Questionnaires.

Figure 1. Comments from migrant mothers reporting abuse, stigma and discrimination during facility-based childbirth, by WHO Quality Statement. Panel A. Comments describing negative aspects of care. Panel B Comments describing positive aspects of care. Panel C. Comments with suggestions to improve quality of care. Note: *during childbirth. HCP, healthcare professional.