This study found that women who had vaginal delivery were exposed to verbal, psycho-emotional, and physical violence. The literature reports the prevalence of exposure to obstetric violence between 15% and 97% (4–10, 19, 37, 41). The findings of this study are in line with the literature. This result is considered to be caused by factors such as the high number of deliveries in the hospital where the study was conducted, inadequate number of health professionals, high workload, high burnout rates caused by the COVID-19 pandemic, and a lack of knowledge of health personnel about women’s rights for respectful care.
In this study, ¼ of women indicated verbal violence as not having the opportunity to express themselves, being exposed to inappropriate verbal treatment, being threatened with hospital rules and male doctors, being criticized, not being allowed to ask questions, not being able to communicate with health professionals when they wanted, and getting no respect for their decisions. The women also stated that they perceived these behaviors as violence. Souza et al. (2017) reported that women who had childbirth could not communicate with health personnel when they wanted (31); Balde et al. (2017) reported that they could not cooperate with health professionals and were insulted (42) and Alzyoud et al. (2018) found that they were humiliated and exposed to aggressive tone of voice (43). Studies conducted by Vedam et al. (2019), Bohren et al. (2019), Hameed et al. (2018), Galle et al. (2019) and Sharma et al. (2019) reported that women were exposed to verbal violence behaviors such as being scolded, threatened, and shouted at (7, 19, 20, 44, 45). The study conducted by Annborn and Finnbogadóttir (2022) indicated that women were not informed about the decisions taken and practices implemented in the childbirth process, and their behaviors were not respected (46). The study conducted by Ulaşlı Kaban (2022) found that women were exposed to humiliation, threat, and aggressive tone of voice during childbirth 14). Studies show that women perceive these experiences as violence. The findings of this study are in line with the literature.
This study found that all participating women were exposed to physical violence. The results of the study showed that around 1/3 of women were given oxytocin without indications, received vaginal examinations by different health personnel, received fundal pressure, and were exposed to physical violence. All of the women were administered constant fetal monitorization, forced to stay in the same position for a long time, prevented from food intake, forced to give birth in the lithotomy position, and their legs were put in metal stirrups while giving birth. In line with the findings of this study, the literature also reported that women were given unwanted touches during childbirth; they frequently received vaginal examinations by different individuals; they were prevented from food intake; they received stitches for episiotomy incisions or lacerations without anesthesia; their movements were restricted; they received fundal pressure and amniotomy without the presence of medical indication; they were given oxytocin; their privacy were not considered; they received constant fetal monitorization; they were forced to give birth in lithotomy position; and the procedures were administered without their knowledge or approval (12,13,59,45,47–51).
The findings of this study were not in line with the criteria indicated in the Intrapartum Care for a Positive Childbirth Experience Model developed by the WHO and the “Mother-friendly Hospital” program developed by the Ministry of Health. The women in the study were found not to perceive having to stay in the same position, undergoing frequent vaginal examinations, food intake restriction, and giving birth in lithotomy position as violence. These findings indicate that women do not have knowledge about childbirth and thus accept the interventions performed without questioning. In addition, in patriarchal societies, more importance is given to woman’s bringing a child into the world than the treatments they were exposed to during childbirth. Due to transmission from generation to generation from mothers to daughters, women seem to internalize the procedures during childbirth and do not perceive them as violence. Unlike the findings of the present study, Martínez-Galiano et al. (2021), Bohren et al. (2019), Souza et al. (2017), and Brandão et al. (2018) reported that staying in the same position for a long time and food restriction were perceived as physical violence by women (7, 23, 27, 31). This study found that women generally were not given information about the physical interventions they received. Similarly, Brandão et al. (2018) also reported that women were not given information about the procedures they received (23). Lanky et al. (2019), Abuya et al. (2018), Mither et al. (2019) and Hameed et al. (2018) found that women were given no/inadequate information about the interventions, and their consent was not received (9, 18, 20, 21).
The present study found that 1/3 of participating women were exposed to psycho-emotional violence. The results showed that spouses or companions were not allowed in the delivery room; women’s privacy was not considered during childbirth; no cooperation could be achieved with health professionals; and the women did not feel safe. Privacy was reported not to be given importance by 32,7% of women in the study conducted by Limmer et al. (2021) in Germany, by 58,2% of women in the study conducted by Perrette et al. (2020) in Mozambique, by 40,8% of the women in a study conducted in the USA, and by 5,5% of women in Malawi (2, 52). Studies conducted by Martinez- Vázquez et al. (2021) and Lansky et al. (2019) reported that the women felt unsafe and vulnerable as they did not have a companion with them (21, 27). Besides, 40,4% of women in the study conducted by Asefa et al. (2017) and 20,9% of women in the study conducted by Adinew et al. (2021) were not allowed to have a support person with them during labor (49, 53). The study conducted by Maldie et al. (2021) in Ethiopia reported that 19,5% of women had difficulty communicating with health personnel (54). The literature reports that women were not supported for initiating breastfeeding after childbirth (7, 23, 25, 27, 45, 50). The study conducted by Annborn and Finnbogadóttir (2022) reported that the women did not feel safe and felt scared, lonely, sad, and blamed (46). The findings of the study are in line with the literature.
This study found that verbal and psycho-emotional violence exposure rates were higher in women who were aged between 18 and 35, graduated from primary school, did not work, had social security, had income less than expenses, lived in a city, and had a nuclear family. Statistically significant differences were found only between the place of living among the socio-demographic characteristics and the type of obstetric violence (p < 0,05). Studies show that while the probability of exposure to violence increased in single women, in those who became mothers at a young age, who had low income and education level, who did not receive information about labor in the antenatal period, and who were multiparous, it decreased in those who received education in the antenatal period and gave birth in equipped hospitals (7, 10, 18–21).
Galle et al. (2019) reported that the ratio of exposure to violence in the town hospital was 3,5 times more than that of the city (19). The study conducted by Dinusha Perera (2022) reported that previous negative experiences increased the presence of violence and individuals who had low socioeconomic and education levels perceived violence more (3). The study conducted by Shrivastava and Sivakami indicated that socio-demographic variables and low social levels increased women’s probability of being exposed to obstetric violence (13). Another study indicated that young women and women with low education levels had a higher probability of being exposed to verbal violence (7). Juan Miguel Martmez-Galiano found that socio-demographic variables did not affect obstetric violence (8). Mihret (2019) reported that women living in cities were exposed to violence more than women living in the countryside, which was considered to be caused by a lack of awareness of women living in the countryside about their rights. In addition, the reason for the increase in obstetric violence with the increase in the education level was reported to be women’s awareness of their rights (9). Rates of exposure to verbal and psycho-emotional violence were higher in women who had their second childbirth, who had a duration of 24 months and more between deliveries, who planned their pregnancy, who received information about labor in the antenatal period, whose baby was delivered by a midwife, who had female personnel to deliver their baby, whose labor duration was < 5 hours, and who gave birth daytime.
No significant difference was found between women’s obstetric features and the type of obstetric violence (p > 0,05). Abuya et al. (2018) found that compared to those who gave birth daytime, women who gave birth at night had less exposure to vaginal /physical examination and vital signs taken because health professionals had a minimum level of communication with women at night (18). The study conducted by Mihret reported the exposure to obstetric violence during daytime as 66%, and women’s perception of obstetric violence was found 47,2% when a midwife delivered their baby (9).
This study found that women generally had low satisfaction levels of the childbirth experience. Negative experiences of women during childbirth are considered to decrease the level of satisfaction. The literature also reported that negative experiences decreased satisfaction (55, 56).