Factors associated with disrespect and abuse of women during labour and birth in health facilities in low-and middle-income countries: A systematic review and meta-analysis

Background: Disrespect and abuse by health providers during birth is a traumatic experience that jeaporadises women’s mental and physical health, lowers satisfaction with care and results in lower willingness to use health services. Objective: We aimed to assess the factors associated with disrespect and abuse of women during birth in low- and middle-income countries, in order to understand which women are more at risk of abuse, and to inform strategies for health service improvement. Method: The systematic review and meta-analysis followed PRISMA guidelines. Three databases were searched for articles published between 2018-2022. Of the 57 articles retrieved, nine met the inclusion criteria. Result: Women were more likely to experience disrespect and abuse if they had no formal education (aOR 5.92), gave birth in a public facility (aOR 4.34), had birth complications (aOR= 3.72), an instrumental vaginal birth (aOR 2.35) or lived in a rural area (aOR 2.03). Conclusion: Women who are already disadvantaged in terms of lack of education, rural residence and expieriencing birth complications are also the ones more likely to be mistreated by health providers during birth. The widespread discrimination and compounding intersections of inequality faced by women within birthing services deserves urgent attention. Future research and action should seek to understand the models of maternity care that underpin respectful client-practioner engagment, and the health system requirements to support these models.