A study by the World Health Organization (WHO) shows that women face both physical and sexual abuse in health facilities during childbirth.
The authors assessed 65 published studies undertaken in 34 countries and identified seven areas of mistreatment and abuse.
The mistreatment included physical (such as slapping), sexual, verbal, stigma and discrimination, a failure to meet professional standards of care and poor rapport between women and providers and health system constraints (such as a lack of resources to provide women with privacy), the study said.
"The rates of skilled birth attendance and of facility-based childbirth have risen in resource-limited countries over the past two decades, but almost a third of women in these countries still deliver without a skilled birth attendant," the study said.
Among the obstacles likely to prevent further increase in the proportion of women delivering in a health facility is women's fear of mistreatment during delivery.
"Women need to be sure that they will receive dignified and respectful care during childbirth," said the study by Meghan Bohren and colleagues of the WHO Department of Reproductive Health and Research.
One of the United Nations Millennium Development Goals is to bring about a 75% reduction in the maternal mortality ratio. In 2010, some 289,000 maternal deaths occurred worldwide, many in low and middle income countries.
While these numbers explain why attention is focused on a reduction in maternal deaths, attention is also needed to defining and measuring the extent of problems around childbirth, such as mistreatment, to better inform constructive changes in policies and practices, the study emphasized.
The results indicate that, although the mistreatment of women during delivery in health facilities often occurs at the level of the interaction between women and healthcare providers, systemic failures at the levels of the health facility and the health system also contribute to its occurrence.
The results appeared in the journal PLOS Medicine