The association between mistreatment of women during childbirth and postnatal maternal and child health care: Findings from "Birth in Brazil".

BACKGROUND: The mistreatment of women during pregnancy, childbirth, and the puerperium is a global public health problem besides being a violation of human rights. However, research exploring the consequences of mistreatment of women and newborns is scarce.

QUESTION: To shed light on this issue, we investigated the association between the mistreatment of women during childbirth and the subsequent use of postnatal health services by women and their newborns.

METHODS: We used data from the study "Birth in Brazil", a national hospital-based survey of puerperal women and their newborns, carried out in 2011/2012. This analysis involved 19,644 women. Mistreatment was a latent variable composed of seven indicators. We assessed the attendance of women and newborns to a review consultation following birth, and the timing of this appointment. We applied multigroup structural equation modeling (based on childbirth payment source) and considered separate analysis for women (vaginal births and0 caesarean-sections) and newborns.

FINDINGS: We found a causal association between mistreatment during childbirth and decreased and/or delayed use of postnatal health services, for both women and their newborns. These results also revealed that women who use the public sector are affected more than those who pay for private healthcare.

CONCLUSION: Mistreatment during childbirth has broader implications than "maternal mental health", and it would be useful to understand that experience of care has vast implications for families. In Brazil, the mistreatment must be mitigated via the implementation of public policy. This is part of the path to dignified and respectful childbirth care for all women.