Global prevalence and risk factors of obstetric violence: A systematic review and meta-analysis

Obstetric violence (OBV), defined as mistreatment or abuse during childbirth, is a pervasive global issue, albeit with regional differences, affecting women's physical and emotional well-being.

The purpose of this systematic review and meta-analysis is to assess the prevalence of OBV to identify risk factors associated with OBV and to make suggestions for improving maternal healthcare practices and policies.

In a systematic review and meta-analysis, we searched four electronic databases for studies published over 10 years up to 31 January 2024: Medline (PubMed), Scopus, Embase, and Web of Science (WOS). The search was conducted among English language papers using a carefully curated set of keywords.

We conducted a comprehensive review, including all observational reporting data on the prevalence of and risk factors associated with OBV, irrespective of geographical location. The studies included in the review were required to be published in peer-reviewed. journals and available in the English language.

The data of the studies were summarized in an Excel file (version 19) and analyzed using R (version 4.2.3). A meta-analysis was performed to evaluate the pooled prevalence of and identify risk factors associated with OBV.

The global prevalence of OBV estimated based on 25 studies, calculated with a random-effects model, was 59% (95% confidence interval [CI] 0.48-0.70; I² = 99.5%). The most prevalent subdomain of OBV was non-consented care (37%; 95% CI 0.23-0.50; I² = 99.7%). The following factors were found to be significantly associated with OBV: the presence of a midwife as skilled personnel beside the woman during childbirth (odds ratio [OR] [95% CI] = 0.4 [0.2-0.9]), which might reduce the likelihood of OBV; middle and high levels of income (OR [95% CI] = 0.5 [0.2-0.7]), which might also reduce the likelihood of OBV; and vaginal delivery (OR [95% CI] = 2.08 [1.1-3.08]), which is liable to increase the likelihood of OBV.

This systematic review and meta-analysis highlights the considerable prevalence and multifaceted nature of OBV, underscoring the urgent need for interventions at multiple levels to address this pervasive issue and ensure respectful, safe, and dignified maternal healthcare for all women.