Obstetric violence and complications of childbirth in healthcare facilities in Uttar Pradesh, India: contextualizing institutional birth experiences and practices towards dignity
Bibliographic record
Abstract
Maternal, newborn, and child mortality and morbidity are declining globally with persisting regional disparities in survival. India accounts for a high burden of maternal and child deaths with the highest perinatal and early child mortality rates in Uttar Pradesh (UP). Decreasing mortality rates in India have been largely attributed to increased facility-based delivery. The rapid rise of facility deliveries worldwide, however, has revealed poor quality of care and widespread mistreatment of women during childbirth, particularly among marginalized, subaltern women. Obstetric violence is significantly associated with maternal complications, suffering, and trauma. Using a critical theory lens and ethnographic approach, this study examined the structural context and dynamics of obstetric violence and complications of childbirth – postpartum haemorrhage, birth asphyxia, and anemia – in public hospitals and community health centres in two districts in UP. The study drew on datasets from a larger hospital ethnography evaluation of a maternal and newborn initiative in UP. Multistage analyses of direct patient case observations, interviews, and hospital records data were centred on birth stories of twenty-two women patients to understand experiences and interactions of institutional actors. Obstetric and epistemic violence were pervasive across the continuum of intrapartum and immediate postpartum care including: physical/verbal abuse; neglect; erasure; non-consented interventions; and substandard care. Obstetric violence and birth complications were deeply entangled in complex assemblages of birth. Social and biomedical processes underlying obstetric care within contexts of scarcity contributed to systems of dysfunction and precarity. Violence emerged as relational and structured harms, mediated by biomedicalized, gendered, classed relations of power, synergistic with caste, religion, and age. Violence functioned as reproductive governance through routine disciplining, force, and coercion that were normalized within institutional cultures. Birthing women and healthcare providers negotiated hierarchical, hegemonic systems of institutional birth, facing various forms of othering and inhumane conditions of birth. Study findings point to a pressing need to reform the structural and relational contexts in which institutional birth violence and inadequate maternal and newborn care thrive. Actionable change requires: attention to robust governance and accountability structures; ethical engagement with frontline providers; and inclusion of birthing women’s knowledge towards birth justice and dignity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.007 | 0.008 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.008 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".