"Being Treated Like an Infant Who Doesn't Know Anything" Obstetric Violence From Perspectives of Women, Health Care Providers and Key Community Informants in Central Zone Tanzania: A Qualitative Exploratory Case Study.

Background: Violence during pregnancy, childbirth and after childbirth is a critical issue globally. There remains a lack of consensus on operational definitions of the components across different cultures globally since the definitions of respect, disrespect and violence can differ among cultures, traditions and places. Obstetric violence presents a significant barrier to seeking facility-based care during pregnancy and childbirth and instead women may opt for home deliveries with unskilled attendants. As a result, some experience complications thus contributing to the high prevalence of maternal mortality and morbidity. Objective: To explore the contextual components of obstetric violence as perceived by postnatal mothers, health care providers and key community informants in central zone Tanzania. Methodology: An exploratory qualitative case study employed in-depth interviews with purposefully selected 24 postnatal mothers, 18 healthcare providers, and 4 religious leaders. Additionally, 6 focus group discussions were conducted with male partners, community health workers, and 10-cell leaders. Data analysis followed qualitative content analysis process, incorporating both inductive and deductive approaches. Results: Nine categories of obstetric violence experienced by women during health facility care emerged from the analysis. These categories are lack of supportive care and treatment, autonomy limitations, non-consented care, compromised privacy and confidentiality, painful routine procedures that are not evidence-based, verbal violence, sexual violence, stigma and discrimination, emotional violence. Additionally, six categories of obstetric violence emerged related to experiences of women at the community level. They included: forceful insertion of herbs to the vagina, verbal violence, physical violence, psychological violence, forced home delivery and inappropriate sexual practices. Conclusion: Contextual components gathered by this study help to better define obstetric violence in the Tanzanian context and serve as a reference. This might help to validate measurement methods, and provide a pathway for developing evidence-based interventions to reduce obstetric violence and promote respectful maternity care.