Maternity care providers perspectives and experiences of obstetric violence in low-, middle- and high-income countries: an integrative review

Aim: To explore the perspectives and experiences of maternity care providers regarding obstetric violence across low-, middle-, and high-income countries. Design: An integrative review of the literature. Methods: A systematic literature search in CINAHL, Medline (via Ovid), SCOPUS, and the Cochrane Library was conducted from 2014 to 2024. Further papers were identified through a review of the reference lists of identified studies and through email alerts from searched databases. Articles were appraised using the applicable Joanna Briggs Institute qualitative or cross-sectional critical appraisal tool. Results: Title and abstract screen were undertaken on 2748 records. Fifty-four studies using qualitative, quantitative, and mixed-methods designs were included. Maternity providers across all socio-economic levels described witnessing, and/or involvement in both respectful care and incidents of obstetric violence. The most common forms of obstetric violence were verbal and physical abuse, coercion, unconsented and unnecessary interventions, and violations of privacy and autonomy. Women who were socially marginalised, impoverished, and illiterate were vulnerable to obstetric violence. Differences were noted between low- and high-income countries, with detention of women for non-payment, privacy violations due to building design and lack of space, mistreatment due to HIV status, and women who were considered non-compliant being more vulnerable to obstetric violence in low-and low-middle-income countries. Obstetric violence was justified and normalised in the name of saving the baby, with less focus on the psychological health of the mother. Conclusion: Our findings demonstrate that obstetric violence is a gender-based violence enabled through patriarchal structures and power imbalances. Maternity providers are witnessing or enacting obstetric violence across low-, middle- and high-income countries, with significant impacts on women and maternity care providers alike. This review highlights opportunities for further research and action to develop health and legal frameworks to prevent instances of obstetric violence and improve outcomes for women and maternity care providers. Impact: A woman-centred approach underpinned by respectful maternity care has benefits for pregnant and birthing women. Obstetric violence, including verbal and physical abuse, coercion, and overmedicalisation, is prevalent in maternity services globally. This integrative review explored the perspectives and experiences of maternity care providers regarding obstetric violence across low-, middle-, and high-income countries. This review highlights the similarities and differences of witnessed, enacted, and perceived obstetric violence from the experience of maternity care providers. This review identifies the covert and overt nature of obstetric violence across low-, middle- and high-income countries. Gaining insight into provider perspectives across low-, middle-, and high-income countries may inform policy and practice reforms to eliminate obstetric violence and advance the provision of respectful maternity care. Reporting Method: This integrative review adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Patient or Public Contribution: No patient or public contribution.