Experiences and Perceptions of Disrespect and Abuse in the Western Highlands of Guatemala: Who Is Most Vulnerable?

Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Disrespect and abuse (D&A) during facility-based childbirth weakens trust in the health system and affects willingness to deliver in facilities. Little is known about D&A in indigenous populations who are less likely to deliver in facilities and may be at higher risk of D&A.   We therefore undertook a study in rural Guatemala, which has a predominantly indigenous Mayan population, to assess prevalence and risk factors for D&A among women delivering in facilities and examine perceptions of D&A in facilities among women delivering at home.

Methods: All women with children <5 from 15 rural Guatemalan highlands communities completed household surveys. D&A was evaluated using a three-item composite measure. A first multivariate model examined sociodemographic and geographic risk factors for reported D&A among women whose last delivery was in a facility; a second model examined the same risk factors for perceived D&A in facilities among women whose last delivery was at home.

Results: Of the 706 interviewed, 20% delivered their last child in facilities, 18% of whom reported experiencing D&A. Among women with home deliveries, 9% believed that peers who deliver in facilities experience D&A. A higher risk of reported D&A was observed for women who were poorer, were indigenous language speakers, had >5 children, no education, and lived closer to health facilities.   Among women delivering at home, women with these same characteristics (except proximity) had a lower risk of perceiving that D&A occurs in health facilities.

Conclusion: Reported D&A was frequent during facility deliveries, with the most disadvantaged being at the greatest risk. Perceived risk of facility D&A among women delivering at home was lower than actual risk. Paradoxically, among home deliveries, disadvantaged women were less likely to perceive that D&A occurs during facility deliveries. Efforts are needed to ensure the acceptability and quality of care for “left behind” populations.