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    • The systematic devaluation of women is further

    2018-11-02

    The systematic devaluation of women is further perpetuated through hegemonic power relations on the maternity ward, leading to the normalization and acceptance of healthcare providers using abusive tactics to gain control and punish disobedience (Jewkes & Penn-Kekana, 2015). Although midwives are the backbone of maternity services in LMICs, they Ferrostatin-1 Supplier often work in disempowering environments where their contributions may not be adequately recognized, and they may be disrespected and unsupported by their supervisors (Brodie, 2013). Midwives are predominantly women and frequently work in their own communities, facing the same challenges that other women face: low social status, disrespect and gender inequality. Furthermore the health system, particularly in public facilities, can be a disabling environment plagued by chronic low salaries, physical resource constraints, and understaffing. Working in such conditions is clearly disempowering for healthcare providers, and there are limited avenues to alleviate stress and foster motivation. However, such disabling work environments can provide only a partial explanation for mistreating a woman during childbirth, not a justification for such abuse. In Nigeria and other low-resource settings, no redress mechanisms exist to voice complaints over such treatment, and women are often not allowed a labor companion who could act as the woman\'s advocate and provide her with emotional support.
    Competing interests
    Funding The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding for this project was received from 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, World Health Organization.
    Author contributions
    Acknowledgements
    Introduction Racial disparities in preterm delivery (PTD), or birth prior to 37 completed weeks of gestation, have existed for decades, with African American (AA) women being disproportionately impacted (Branum & Schoendorf, 2002; Costa, 2004). While the leading cause of infant mortality in the United States is PTD, the etiology of PTD remains unknown (Romero, Dey, & Fisher, 2014). Social conditions have been posited as fundamental causes of health inequalities (Phelan, Link, & Tehranifar, 2010). For instance, the quality of the residential environment (or neighborhood) is patterned by racial/ethnic status and social position, (Diez Roux & Mair, 2010) such prolactin AAs compared to Non-Hispanic whites (NHW), are more likely to reside in disadvantaged neighborhoods, including those with inadequate municipal services and health care resources, increased crime, violence, and poor housing quality (Culhane & Elo, 2005). Much of the literature on the relationship between neighborhood context and PTD uses vital statistics data (Miranda, Messer & Kroeger, 2012; Farley 2006; Masho, Munn & Archer, 2014; O’Campo, Burke & Culhane, 2008; Janevic et al., 2010; Vinikoor-Imler, Messer, Evenson & Laraia, 2011; Ma, Liu, Hardin, Zhao & Liese, 2015; Masi, Hawkley, Piotrowski & Pickett, 2007; Wallace et al., 2013; Messer, Kaufman, Dole, Savitz & Laraia, 2006; Ncube, Enquobahrie, Albert, Herrick & Burke, 2016). Results from a recent meta-analysis, which included three studies focused on AAs, all of which used vital statistics data, suggested modest positive associations, with a stronger relationship among Whites compared to AAs (Ncube et al., 2016). However, limitations of using vital statistics data include inaccurate reporting of clinical information including gestational age, and that the data is collected for public health surveillance, rather than to answer specific clinical or population-based research questions (Schoendorf & Branum, 2006). Studies which use primary collected data can include a more complete assessment and control for social determinants which may confound or modify the association between neighborhood context and PTD. In the most recently published study using primary collected data, Bastek and colleagues reported no significant association between neighborhood Ferrostatin-1 Supplier context and PTD in a cohort of 817 mostly AA women from Philadelphia (Bastek et al., 2015). Similarly, Phillips et al. examined the association between an aggregate socioeconomic measure of neighborhood quality and spontaneous PTD, using data from the Black Women\'s Health Study and found no significant associations (Phillips, Wise, Rich-Edwards, Stampfer, and Rosenberg, 2013).