Frequency of reported abuse, stigma and discrimination during facility-based childbirth among migrant mothers and their suggestions for improvement: a mixed method WHO standards-based multicentre study in Italy

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OBJECTIVES: This study aims at documenting the frequency of reported abuse, stigma and discrimination and exploring the perspectives for improving the quality of maternal-newborn care (QMNC) of migrant mothers' reporting abuse, stigma or discrimination. DESIGN: Mixed methods multicentre cross-sectional study. SETTING: All maternal facilities (tertiary and secondary levels of care, n=9) from Friuli-Venezia Giulia region, Northeast Italy, between November 2019 and January 2022 in Northeast Italy. PARTICIPANTS: 874 migrant and 3968 non-migrant women answering a validated WHO Standard-based questionnaire after birth. OUTCOME MEASURES: Frequency of reported abuse, stigma and discrimination during facility-based childbirth was calculated and compared with those of non-migrant mothers. Thematic analysis was conducted on eight open questions, using WHO Standards as a framework for the analysis. RESULTS: Among migrant women, 84 (9.6%) reported some type of abuse, stigma and discrimination, a frequency similar to non-migrant women (9.8%, p=0.880). The most frequently reported was verbal abuse (87.7%), followed by stigma and discrimination (15.1%). Most women (86.9%) provided at least one comment, with a frequency comparable to non-migrant women (p=0.076). Among a total of 327 comments, 104 (31.8%) were practical suggestions for improving QMNC. Experience of care was the domain with the highest frequency both of negative (64.9% of negative comments) and positive comments (51.7% of positive comments) and with the highest frequency of suggestions for improving QMNC (52.9% of suggestions). Overall, suggestions mainly focused on strengthening healthcare professionals' communication skills, allowing companionship during childbirth, increasing healthcare professionals' availability and timely support. DISCUSSIONS: This study shows that both migrant and non-migrant mothers are exposed to abuse, stigma and discrimination during childbirth, and that both are willing to provide practical suggestions, which should be used for planning actions to improve QMNC.

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