Giving birth is like going to war: Obstetric violence in public maternity centers in Niger

Obstetric violence has been recognized as a significant risk factor for maternal morbidity and mortality globally. However, there is lack of literature on the abuse of birthing women and their maternal rights in formal healthcare settings in Niger. This paper explores womens experiences of violence in public maternity care in Niger to identify drivers, facilitators, manifestations, and consequences of the maltreatment of women during labor and delivery. We qualitatively explored the experiences of women who gave birth in a public maternity hospital or clinic within the 5 years preceding the study. We conducted five key informant interviews to help inform recruitment and interview protocols, a listening session with eight mothers, and individual interviews with 50 women from four areas of the urban region of Niamey. The 58 participating mothers shared experiences that included physical abuse (slapping), verbal abuse (insults), psychological abuse (mockery), discrimination (social status/ economic status), financial coercion (demanding money prior to care), and harmful birthing practices (forcing the baby out with elbows). Socio-cultural aspects driving maltreatment of women included beliefs about expression of pain during labor and delivery, while social connection and the presence of the physician during delivery were protective factors. Our study findings reflect global concerns about obstetric violence and its consequences. Given the high burden of maternal and infant morbidity and mortality in Niger, it is critical to train clinical staff in safe and respectful maternity care, to improve supervision of care, to institute legal recourse for women, and to consider the integration of traditional birth attendants in clinical settings.