Obstetric violence during childbirth can be understood based on the concept of disrespect to women’s autonomy, feelings, mental integrity, physical reliability and abuse for identifying the directed violence act against pregnant women or her baby [23]. It can be considered as a phenomenon documented through various violence situations during gestation, delivery, puerperium, as well as the assisted cases like the reproductive cycle, miscarriage and post-miscarriage [24, 25]. The term OV denotes to maternal care professional deficiencies, it covers situations expressed in careless, abusive, wild, discrimination and disrespectful acts based on power relations and authority practiced mostly by the health professionals [26].
The term disrespect and abuse was suggested to identify any violence act during the professional assistance of childbirth, it describes care aspects comprising of non-dignified care, non-confidential care, non-consented care, facilities detention, discrimination built on precise patients’ attributes, physical abuse and care abandonment [27].
The WHO assured that low socioeconomic, ethnic minorities, adolescents, single women, are mostly subjected to suffer from disrespect and abuse (4). The knowledge, the understanding the concept “disrespect and abuse during childbirth”, and the respect experience are crucial to design strategies for strengthening the systems providing respectful care [28]. On the other hand, the alertless women of their rights and who have never been exposed to any further care system are not sensitive to the health care employees, disrespect and abuse [29].
In the present study, the results revealed that women of the read/write school and the university educational levels were higher in the public and private settings, respectively, a significant association was detected between the educational level and the settings. Globally, the incidence of OV was reported to be 15–97% globally with greater OV risk to the deprived women with lower educational level even in industrialized countries [30, 31], hence, OV had been predicted and associated significantly to various attributable factors including educational status.
In previous studies, OV was demonstrated to be predicted by the educational level [32, 33], which is significantly associated with OV, it was reported that women who attended low educational level are lesser than who attended higher educational level regarding their capability to report for OV, in fact the highly educated women are more alert of their rights and have the tendency to report any OV form they may be subjected to (34), also, the monthly income of the family was considered [34].
Regarding delivery supervision for physician and overall satisfaction for satisfied were higher in the private setting, while, it was lesser for occupation of housewife/unemployed when compared to the public setting. The obtained results showed significant association for occupation, delivery supervision and satisfaction. Furthermore, a statistically significant association was found in the monthly income which was equal or higher in the private setting than the public setting.
Concerning the different domains of OV, our results showed that the feeling of respect, not being subjected to any physical abuse by residents and professionals, delivery updates provision, feeling of discrimination and the delivery in a private room were higher in the private settings versus the public settings, while, it was lesser regarding informing the pregnant woman during delivery about the performance of episiotomy. Delivery in a private room and the absence of physical abuse by medical staff were significantly associated.
During childbirth, women are in need for privacy without unnecessary procedures because of being not favored, they wanted intervention with no cuts. Exposure, vaginal examinations, episiotomy and its repair can be considered abusive and disrespectful shameful act as stated by women [35]. In another study, the performance of episiotomy without taking an informed consent was identified as an aggressive practice without being considered as an OV [28].
The results obtained in the present study showed that women subjected to the performance of episiotomy during childbirth at public settings were significantly less likely to feel respect, in obtaining an informed episiotomy consent, to be informed about the delivery updates and the medications they receive (no significant odds), feeling of discrimination and the ability to pay is an indicator for perceiving the required maternal care, while, in public settings, significant association was noticed between the performance of episiotomy, perceiving physical abuse and the delivery in shared rooms (OR = 1.6, 1.8, respectively). Those findings are in line with the WHO study in four African countries which detect that about 30% of the women reported about experiencing disrespect and abuse during delivery their babies and the young women were more likely to experience physical abuse, the association between the low educational level and verbal abuse was prominent [36].
In another study conducted in North Showa Zone, Ethiopia, more than 40% of the participants seeing different forms of physical abuse such as slapping, pinching or beating due to the noise they have made or being uncooperative, also, they reported the performance and suturing of episiotomy without anaesthesia, even not allowance of the favoured birthing position and beating with the instruments were reported [37]. Furthermore, less or even no existing verbal and physical abuse were noticed in the private setup versus the public setup which was attributed to the available facilities and the small number of patients, this is in agreement with what we have obtained in the present study [38]. In the study of Anna and Hafrún, [39], found that the participated women had experienced both psychological and physical abuse including threats of violence and expressing giving birth comparable to rape, which is agreed by Cohen, [40].
Limitations to the study include the small sample size and the inability to add more questions regarding the religion, ethenity and the nationality of the participants, furthermore, the study was based on interviews not the contact observation.