Article Text

Labour companionship and women’s experiences of mistreatment during childbirth: results from a multi-country community-based survey
  1. Mamadou Dioulde Balde1,
  2. Khalidha Nasiri2,3,
  3. Hedieh Mehrtash3,
  4. Anne-Marie Soumah1,
  5. Meghan A Bohren4,
  6. Boubacar Alpha Diallo1,
  7. Theresa Azonima Irinyenikan5,
  8. Thae Maung Maung6,
  9. Soe Soe Thwin3,
  10. Adeniyi K Aderoba5,7,
  11. Joshua P Vogel8,
  12. Nwe Oo Mon6,
  13. Kwame Adu-Bonsaffoh9,
  14. Özge Tunçalp3
  1. 1 Cellulle de Recherche en Sante de la Reproduction en Guinee (CERREGUI), Conakry, Guinea
  2. 2 Schulich School of Medicine and Dentistry, London, Ontario, Canada
  3. 3 Department of Sexual and Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
  4. 4 Centre for Health Equity, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
  5. 5 Obstetrics and Gynaecology, Faculty of Clinical Schools, University of Medical Sciences Teaching Hospital Complex, Akure, Ondo, Nigeria
  6. 6 Department of Medical Research, Yangon, Myanmar
  7. 7 Obstetrics and Gynaecology, Mother and Child Hospital, Akure, Ondo, Nigeria
  8. 8 Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, Victoria, Australia
  9. 9 Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
  1. Correspondence to Dr Mamadou Dioulde Balde; baldemddka{at}


Background Evidence has shown the benefits of labour companions during childbirth. Few studies have documented the relationship between the absence of labour companions and mistreatment of women during childbirth in low-income and middle-income countries using a standardised tool.

Methods We conducted a secondary analysis of the WHO multi-country study on how women are treated during childbirth, where a cross-sectional community survey was conducted with women up to 8 weeks after childbirth in Ghana, Guinea, Nigeria and Myanmar. Descriptive analysis and multivariable logistic regression were used to examine whether labour companionship was associated with various types of mistreatment.

Results Of 2672 women, about half (50.4%) reported the presence of a labour companion. Approximately half (49.6%) of these women reported that the timing of support was during labour and after childbirth and most of the labour companions (47.0%) were their family members. Across Ghana, Guinea and Nigeria, women without a labour companion were more likely to report physical abuse, non-consented medical procedures and poor communication compared with women with a labour companion. However, there were country-level variations. In Guinea, the absence of labour companionship was associated with any physical abuse, verbal abuse, or stigma or discrimination (adjusted OR (AOR) 3.6, 1.9–6.9) and non-consented vaginal examinations (AOR 3.2, 1.6–6.4). In Ghana, it was associated with non-consented vaginal examinations (AOR 2.3, 1.7–3.1) and poor communication (AOR 2.0, 1.3–3.2). In Nigeria, it was associated with longer wait times (AOR 0.6, 0.3–0.9).

Conclusion Labour companionship is associated with lower levels of some forms of mistreatment that women experience during childbirth, depending on the setting. Further work is needed to ascertain how best to implement context-specific labour companionship to ensure benefits while maintaining women’s choices and autonomy.

  • maternal health
  • obstetrics
  • health policy
  • health systems
  • community-based survey

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  • MDB and KN are joint first authors.

  • Handling editor Kerry Scott

  • Twitter @khalidhanasiri, @hediehmm,,,, @otuncalp

  • MDB and KN contributed equally.

  • Contributors KN, MDB, HM and OT conceptualised the analysis. MDB, SL, KA-B, JPV, MAB, EM, RA, CG, MDB, BAD, A-MS, AOS, BF, TAI, AOA, AKA, TMM and NOM conducted training, data collection and management. KN, HM, MDB and SST conducted the data analysis. KN and MDB prepared the first draft of this manuscript. All authors were involved in data interpretation and review of the final manuscript.

  • Funding This research was made possible by the support of the American People through the United States Agency for International Development (USAID), and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the WHO Ethical Review Committee (A65880), WHO Review Panel on Research Projects and in-country ethics committees: Guinea (le comité national d’éthique pour la recherche en santé); Nigeria (Federal Capital Territory Health Research Ethics Committee; Research Ethical Review Committee, Oyo State; and State Health Research Ethics Committee of Ondo State); Ghana (Ethical Review Committee of the Ghana Health Service; Ethical and Protocol Review Committee of the College of Health Sciences, University of Ghana); and Myanmar (Ethics Review Committee, Department of Medical Research).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request. The analytic study dataset from the WHO Study: 'How women are treated during facility-based childbirth' is de-identified and archived through WHO/HRP’s electronic record management system. Data requests with an expression of interest in pursuing multi-country secondary analyses with a specific research question can be made to More information about the study tools are available here: and the primary publication from the study here:

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.