Inequalities of Socioeconomic Status as a Driver of Disrespect and Abuse to Women during Childbirth in Nepal

Background

There is significant manifestation in reduction of maternal and neonatal deaths worldwide, following more health-facility-based childbirths. Nevertheless, evidence indicates a potential for women to become discouraged from facility-based-childbirth due to mistreatment in the hospitals. This study assessed association between women socioeconomic status and mistreatment during childbirth in health facilities in Nepal.

Method

This study used secondary datasets from previous 18 months prospective cohort study that occurred in 11 hospitals in Nepal. Relevant data was collected from women (n=41,581) in exit interviews during discharge. Bivariate and multivariate logistic models were applied to assess the association between socioeconomic status and mistreatment. Furthermore, Multi-variable modelling was also used to clear collinearity between education and income variables.

Results

Women experienced mistreatment differently based on their social backgrounds. According to Multi-variable modelling analysis, women from a less advantaged (Madhesi) ethnicity were less likely to receive better treatment such as counseling on maternal dangers (OR=0.59, 95%CI: 0.55, 0.64) compared to a relatively advantaged (Chhetri/Brahmin) ethnic group. Women with basic education were less likely to be counseled on maternal danger signs (OR=0.76, 95%CI: 0.71, 0.80) compared to those with secondary education. However, women with high income were less likely to be counseled on maternal danger signs (OR=0.13, 95%CI: 0.11, 0.14) compared to those whose monthly income ranged between NPR1000-NPR10000.

Conclusion

The study reveals women perceptional variations for mistreatment in childbirth based on their social backgrounds. Henceforth, a need-based-care approach should be promoted for all women, regardless of their social history.