DisrespEct and abuse during ChIlDbirth in pEru (DECIDE): a cross-sectional study in 14 hospitals of nine cities of Peru

Maria Reneé Montesinos-Segura (PE), Diego Urrunaga-Pastor (PE), Giuston Mendoza-Chuctaya (PE), Alvaro Taype-Rondan (PE), Luis M. Helguero-Santin (PE), Franklin W. Martinez-Ninanqui (PE), Dercy L. Centeno (PE), Yanina Jiménez-Meza (PE), Ruth C. Taminche-Canayo (PE), Liz Paucar-Tito (PE), Wilfredo Villamonte-Calanche (PE)

[Montesinos-Segura] 1. Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru., [Urrunaga-Pastor] Sociedad Científica de Estudiantes de Medicina de la Universidad de San Martin de Porres, Facultad de Medicina Humana, Universidad de San Martin de Porres, Lima, Peru, [Mendoza-Chuctaya] Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru., [Taype-Rondan] CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru, [Helguero-Santin] 4. Sociedad Cientifica de Estudiantes de Medicina de la Universidad Nacional de Piura, Facultad de Medicina Humana, Universidad Nacional de Piura, Piura, Peru, [Martinez-Ninanqui] Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru., [Centeno] Sociedad Científica Medico Estudiantil San Cristobal, Escuela Profesional de Medicina Humana. Universidad Nacional de San Cristbal de Huamang

Context: Disrespect and Abuse during childbirth (D&A) in health facilities is considered a form of gender violence, which directly affects the women’s rights proposed by the United Nations, such as the rights to respect, timely care, autonomy, self-determination, and information during childbirth. Objective: To assess the prevalence of D&A during childbirth and its associated factors in Peru. Methods: A cross-sectional study was carried out. D&A was assessed according to the seven categories proposed by Bowser & Hill. To evaluate factors associated to each D&A category, prevalence ratios (PR) and their 95% confidence intervals (95% CI) were calculated using adjusted Poisson models with robust variances. Patients: Women who gave birth in the last 48 hours in 14 hospitals in nine Peruvian cities: two in the coastal region (Chiclayo and Piura), five in the highlands (Cusco, Huamanga, Huancayo, Cerro de Pasco, and Puno), and two in the jungle (Iquitos and Tarapoto). Main Outcome: We surveyed 1528 postpartum women. The prevalence of having suffered at least one category of D&A was 97.4%. The most prevalent D&A category was non-dignified care (86.2%), followed by non-consented care (74.6%). Women in the jungle had a lower prevalence of abandonment of care and a higher prevalence of discrimination, women in the highlands had a lower prevalence of non-dignified care, compared to those in the coastal region. Measure(s): We haved evaluated the following variables: Sociodemographic [age in years, level of education, and area of residence (urban or rural)], number of previous deliveries (0 or ≥1), number of antenatal care visits (dichotomized as <6 or ≥6 visits, according to the cut point proposed by the Peruvian Ministry of Health guidelines), whether woman was referred from another health facility for the current delivery (yes or no), type of delivery (vaginal or caesarean) and dependence of the health facility (Ministry of Health or Social Security System). Result(s): Regarding D&A categories, the most prevalent form of disrespect and abuse was non-dignified care had (86.2%), followed by non-consented care (74.6%) and non-confidential care. Conclusions: Nearly all women reported to have suffered at least one category of D&A during care delivery. The type of delivery, referral from any other health establishment, dependency of the health facility, and geographic region were associated with at least one category of D&A.