Mistreatment of newborns after childbirth in health facilities in Nepal


An observational cohort study addresses the evidence gap on the mistreatment of newborns in hospitals in Nepal. The majority of the included newborns received some unnecessary or not-consented medical intervention, and one-quarter experienced disrespectful treatment. There was evidence of greater mistreatment among infants from disadvantaged ethnic groups and those born to younger mothers. Further interventions are required to reduce inequity and mistreatment of newborns.

The rise in institutional births brings new challenges. These challenges include maintaining the quality of care for mothers and newborns to prevent the many neonatal deaths attributed to poor quality of care. Sadly, several studies conducted in South Asia and Sub Saharan Africa have revealed disrespectful care towards the mother during and after childbirth. As for the infant’s situation, the World Health Organization has included newborn care in their new standards and guidelines. Nevertheless, there is a lack of studies on the existence and factors associated with suspected mistreatment of newborns in health facilities.

A group of researchers conducted a study in four public hospitals in Nepal to observe the newborns’ mistreatment during the period of 18 months. All the hospitals had specialised units for sick newborns, and each had more than 6000 deliveries per year. Data was collected at each hospital, also with the help of independent nurses who used observation checklists and conducted semi-structured interviews with families.

To assess the mistreatment of 31,804 newborns in Nepal, researchers compared the data with the WHO’s 2016 “standards for improving quality of maternal and newborn care in health facilities” statements. Among the included newborns, almost two-thirds received medical interventions without the parents’ consent, and even more than 70% experienced unnecessary or rushed medical procedures, such as cord-clamping. One-quarter of the infants were not treated with kindness and respect. As for the beneficial and sometimes necessary measures that were not conducted properly, skin-to-skin contact after birth received the poorest results, with only 3.5% of newborns having experienced it. Concerningly, three-quarters of children were not breastfed within one hour of birth, despite very clear recommendations by the WHO.

Mistreatment differed depending on women’s age, ethnicity, education, term or preterm infant status, and sex of the newborn. The greatest variation could be identified in infants born to women from disadvantaged ethnic groups. The mother’s age also played a significant role in the mistreatment, with a higher index of infant mistreatment among mothers aged 18 years or less. Lastly, the study showed that female newborns were more likely to be mistreated than male newborns.

In Nepal, caste and ethnicity remain the centrepiece of the social hierarchy. Studies like this show the implications caste systems have for fundamental rights such as neonatal care. Despite some observational limitations of the study, one can determine a clear association between newborn’s mistreatment with maternal socio-demographic status and conclude the necessity of further interventions to reduce inequity and mistreatment in Nepal and beyond.

Paper available at: Journals PLOS ONE

Full list of authors: Ashish K. C., Md Moinuddin, Mary Kinney, Emma Sacks, Rejina Gurung, Avinash K. Sunny, Pratiksha Bhattarai, Srijana Sharma, Mats Målqvist