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

Background: Disrespect and abuse by health providers during childbirth is a traumatic experience that jeopardises women's mental and physical health, lowers satisfaction with care, and results in a lower willingness to use health services. Objective: To assess the factors associated with disrespect and abuse of women during childbirth in low-middle-income countries. Method: This 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. Results: 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 childbirth complications (aOR 3.72), had an instrumental vaginal delivery (aOR 2.35), or lived in a rural area (aOR 2.03). Conclusion: Disadvantaged women (in terms of lack of education, rural residence, and childbirth complications) were more likely to be mistreated by health providers during childbirth. The widespread discrimination and compounding intersections of inequality that women face within birthing services deserve urgent attention. Future research and action should seek to understand maternity care models that underpin respectful client-practitioner engagement and health system requirements to support these models.