A new report reveals more than a third of women in four Asian and African countries have experienced some form of mistreatment or abuse during childbirth, including being slapped, mocked and forcibly treated. 

The Lancet medical journal published a study on Wednesday, disclosing women in Ghana, Guinea, Myanmar and Nigeria — all low-income countries — experienced lack of consent for vaginal examinations, episiotomies and cesarean sections. Women also face all this, often without painkillers. 

The study followed more than 2,000 births and interviewed more than 2,600 women after labor. The study was led by the World Health Organization. 

In about 42% of the cases studied, women reported physical or verbal abuse or experiencing discrimination during labor. Most of the mistreatment occurred 30 minutes before and during birth. Some women were even detained after because they were not able to pay the hospital bill. 

“Mistreatment during childbirth can amount to a violation of human rights, and could be a powerful disincentive from seeking facility-based maternity care,” the study said in a discussion of similar research.

The WHO deems “respectful” maternity care as care that maintains “dignity, privacy, and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth.” 

The study explains that although concern for the baby’s well-being might serve as a partial explanation, such abuse will “likely only worsen women's anxiety, distress, and disempowerment.”

Lancet has also found, in a similar study, that mistreatment is not just an issue in low-income and low-resource countries. Similar abuse has occurred in high-income countries as well. The same study finds that there are disparities in how women are treated based on age and socio-economic status, as well as race and ethnicity. 

Abusive behaviors during childbirth have also been reported in Europe and Latin America, specifically Venezuela.