The Prevalence of Obstetric Violence Against Women During Pregnancy and After Delivery in Syria: A Cross-Sectional Study

The Prevalence of Obstetric Violence Against Women During Pregnancy and After Delivery in Syria: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Prevalence of Obstetric Violence Against Women During Pregnancy and After Delivery in Syria: A Cross-Sectional Study Raghad Farhat, Rawan Al-Deeb, Shahd Almansour, Alyamama Kousa, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7557296/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Feb, 2026 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 10 You are reading this latest preprint version Abstract Introduction Violence against pregnant women has become a public health issue and a violation of human rights. It has been observed in every social, cultural, economic, and religious group. Pregnant victims of violence often describe being choked, scalded, forced out of moving cars, punched, kicked, shoved downstairs, threatened with knives, and having things thrown at them. The WHO statement has highlighted the elimination of obstetric violence toward women during childbirth because it contradicts human rights principles and threatens their right to life, physical, mental, and moral integrity, as well as freedom from discrimination. We aimed to find out how often obstetric violence happens in Syria, what kinds of abuse women face during pregnancy, birth, and after delivery, and which factors are connected to a higher risk of experiencing it. Methods In this cross-sectional study, we publicized an online survey across Syria utilizing official social media platforms, including Facebook, WhatsApp, Instagram, and Telegram, in order to check how aware women are of obstetric violence, and check out the quality of healthcare provided during delivery in hospitals. The questionnaire was also distributed in public places such as parks and streets in urban and rural areas to check inclusivity and representativeness. The data collection employed both chain-referral sampling and convenience sampling methods. Results The sample included 1229 women, most of whom were between 26 and 30 years old. There was a significant association between exposure to violence and age, education, and number of pregnancies. Doctors delivered most women (84.8%). (47.2%) were forced into a supine position. (21.6%) experienced discomfort and fear of any word/phrase/behavior mentioned or done by the medical staff, and (22.2%) did not feel private during the childbirth. Conclusion It was indicated that many women experience violence committed by healthcare providers before, during, and after labor without realizing it. As a result of their ignorance of their rights, violence is more prevalent among these women. As a recommendation, to expand on the rights, humanitarian organizations should dedicate more efforts and launch campaigns to raise awareness of violence among other women. Obstetric violence Childbirth Labor and delivery Maternal health Cross-sectional study. Figures Figure 1 Figure 2 Figure 3 Introduction Violence against women (VAW) is a serious human rights violation, a significant threat to women’s health and wellbeing, and a major social and public health problem. It has been observed in every social, cultural, economic, and religious group ( 1 ). VAW has severe health consequences, both in the short-term and long-term (including after the violence has ended and, in some cases, across generations), making VAW a priority for health systems to prevent and address ( 2 ). Around the world, violence affects over one-third (27%) of women between the ages of 15 and 49 ( 3 ). Violence against pregnant women has become a public health issue and a violation of human rights. Also, it is considered a hidden epidemic. Obstetric violence can lead to significant health consequences affecting both mother and child ( 4 ). Pregnant victims of violence often describe being choked, scalded, forced out of moving cars, punched, kicked, shoved downstairs, threatened with knives, and having things thrown at them. As a result of the abuse they endure, individuals also suffer from a variety of violence-related ailments, such as cuts, bruises, fractures, concussions, tooth injuries, knife wounds, vaginal bleeding, and chronic migraines ( 5 ). Violence currently has a significant impact on neonatal health outcomes such as low birth weight (LBW), preterm birth (PTB), stillbirth, and pregnancy outcomes such as abortion, hypertension, and postpartum hemorrhage ( 3 ). It has been reported to significantly increase the risk for low-birth-weight infants, pre-term delivery, and neonatal death and also affected breastfeeding postpartum. Other complications may include abortions, stillbirth, and even death ( 6 ),( 7 ). Pregnancy and childbirth, as important events in women’s lives, should be guided based on quality and humanized principles. The World Health Organization (WHO) emphasizes the quality of interaction between women and healthcare providers and considers good interactions a prerequisite for favorable pregnancy and childbirth outcomes ( 8 ). The WHO statement has highlighted the elimination of obstetric violence toward women during childbirth because it contradicts human rights principles and threatens their right to life, physical, mental, and moral integrity, as well as freedom from discrimination ( 9 ). Obstetric violence often focuses on labor and childbirth even when referring to maternity care, which includes pregnancy, given that these are moments in which women are particularly vulnerable to healthcare abuse and over-medicalization, or non-medically justified obstetric interventions, e.g., episiotomy and cesarean section. Other important components of obstetric violence are dehumanization and non-consensual care, as well as the overall conversion of biological processes into pathological ones ( 10 ). Since the 1990s, patients in healthcare, particularly female patients who have been experiencing violence—i.e., abuse, neglect, disrespect, or mistreatment—in healthcare facilities have been examined through the concepts of patient satisfaction and dissatisfaction, with the aim of improving patient care. However, growing evidence suggests that using the satisfaction typology only reflects what one is asking for; that is, patients report more satisfaction when asked specifically about "patient satisfaction" than if asked about their dissatisfaction. This might explain why the emergent issue of women experiencing violence in healthcare, particularly in maternity healthcare facilities—also referred to as obstetric violence—has long been silenced or neglected worldwide ( 11 ),( 12 ). Acknowledging the importance of this issue, the White Ribbon Alliance for Safe Motherhood outlined seven fundamental rights for pregnant women in 2011: 1.Protection from harm and mistreatment; 2. Access to information, informed consent, and respect for decisions, including the option to have a chosen companion present when possible; 3. Assurance of confidentiality and privacy; 4. Treatment with dignity and respect; 5. Equal and non-discriminatory care; 6. Access to timely healthcare and the highest possible standard of health; 7. The right to personal freedom, autonomy, self-determination, and protection from unjust confinement ( 10 ),( 13 ). Additionally, regions with fewer reported cases of violence against women are often influenced by cultural norms. For example, in societies where violence against women is stigmatized or ignored, reporting rates remain very low. Similarly, communities with rigid gender hierarchies that marginalize women tend to show comparable underreporting. Violence against women is generally more prevalent in rural areas compared to urban settings, where access to information, counseling, and healthcare services is typically better ( 14 ). This cross-sectional study aims to determine the prevalence and forms of obstetric violence experienced by women during pregnancy, childbirth, and the postpartum period in Syria, and to identify the sociodemographic and clinical factors associated with its occurrence." Methods Study Design Between May 7 and June 10 in 2025, a cross-sectional study was conducted, aimed to assess the prevalence of the violence against women during pregnancy and after childbirth, check how aware women are of obstetric violence, and check out the quality of healthcare provided during delivery in hospitals in Syria. For data collection, we publicized an online survey across Syria utilizing official social media platforms, including Facebook, WhatsApp, Instagram, and Telegram. The data collection employed both chain-referral sampling and convenience sampling methods. The questionnaire was also distributed in public places such as parks and streets in urban and rural areas to check inclusivity and representativeness. We obtained the informed consent electronically or in written form, with participants explicitly confirming their agreement before starting the survey. All responses were anonymized and securely stored in a password-protected database, accessible only to the principal investigator. Completing the survey took approximately 5 to 8 minutes. The study abided by the ethical standards of national and institutional committees overseeing human research and the principles outlined in the Helsinki Declaration. We obtained ethical approval from the Faculty of Medicine at Homs University (7/5/2025). Study population The inclusion criteria were all women who gave birth aged ≥ 18 years, and voluntary participation. The exclusion criteria were missing any data and those who aged < 18 years. Measures The questionnaire was adapted from a prior study conducted in Saudi Arabia ( 15 ). It was translated from English to Arabic by a professional translator, then back-translated into English by another translator to ensure accuracy. A committee of specialists in gynecology, obstetrics, statistics, Arabic and English literature reviewed the final questionnaire to ensure its relevance and clarity for the Syrian context. This process ensured that the questionnaire was conceptually accurate and culturally sensitive. To validate the questionnaire's clarity and reliability, a pilot study was conducted with 40 randomly selected of the target sample then they were excluded from the final sample to avoid potential bias. The pilot study confirmed the questionnaire’s internal consistency, with Cronbach’s alpha values of 0.737 for the whole questionnaire. The questionnaire was divided into three sections: The first section assessed socio-demographic characteristics, including age, governorate of origin, living place (urban or rural), marital status (married, divorced or widow), financial status, education level and work. The second section involved the obstetric history detailing the instances of abortion, number of pregnancies, fetal outcomes, follow-up procedures, privacy considerations, and the forced supine position. Additionally, this section gathered information pertaining to pre-labor conditions, including labor duration, the presence of a companion, notification of rules, assistance received, fetal pulse monitoring, intravenous treatments, and vaginal examinations. The third section gathered data regarding the delivery process, including the method of delivery, location, assistance provided, the attending physician, maternal positioning, drinking offered, instances of verbal violence, inquiries made, induction procedures, surgical cuts, and any resultant wounds. Furthermore, this section also included post-delivery data on maternal engagement with the child, breastfeeding practices, maternal satisfaction, maternity leave, and the cleaning process following delivery. All questions were closed-ended to simplify analysis and minimize variability in responses. Sample Size The sample size was calculated using the Cochran formula for sample size estimation. The calculations were done utilizing multiple parameters, including a confidence level of 95% (represented by Z = 1.96), a margin of error set at 5% (represented by e), and an estimated population proportion (p) of 50% (or 0.5) for the attribute of interest. The complementary value, q, was determined as 1 − p. The formula employed is expressed as: n = (Z² ⋅ p ⋅ q)/e², the required sample size was 385. To account for potential non-responses, we increased the total sample size. Eventually, 1229 participants completed the survey, surpassing the required sample size and assuring the study retained powerful statistical power for significant analysis. Statistical analysis: Data were analyzed using IBM SPSS statistics version 24. Qualitative variables were prescribed using numbers and percentages. The chi-square test was used to determine if there is a significant relationship between categorical variables, pre, during post variables and the exposure to violence. Statistical significance was set at P-value < 0.05. Cronbach's alpha was calculated to assess the internal consistency of the survey instrument, which values greater than 0.6 considered acceptance. Results Demographic characteristics of women The sample included 1229 women, 24.3% of them were from the central Governorates (Damascus and Homs), 27.3% from the southern Governorates (Rural Damascus, Daraa, As-Sweida and Quneitra), 15.3% from the northern Governorates (Aleppo and Idlib), 13.8% from the northeast (Al-Hasakah, Ar-Raqqa and Deir-Ez-Zor), and 19.2% from the northwest (Tartous, Lattakia, and Hama). 15.6% of the participants were less than 25 years old, 28.2% between 26 and 30 years old, 41.2% between 31 and 45 years old, and 15.1% more than 45 years old. With regards to the education level, about half of the sample had a bachelor's degree, 20.3% had high school, and only 1.4% were uneducated. For marital status, 94.8% were married, 2.7% divorced and 2.5% widowed. About two- thirds of the sample were from urban areas, and 39.6% from rural areas. Concerning employment, 57,1% women were working, and 42.9% were not. 54.8% of the participants’ family income was moderate, 25.9% was good, and 19.3% was low. It was reported that 26.4% of the sample had a two-time pregnancy, 22.6% had a four-time pregnancy or more, 21.8 had a one-time pregnancy, and 20.2% had a three-time pregnancy. There was significant association between exposure to violence and the following sociodemographic characteristics: age (P = 0.048 < 0.05), Education (P = 0.041 < 0.05), marital status (P = 0.001 < 0.05), number of pregnancies (P = 0.013 < 0.05). (Table 1) Pre-childbirth period According to the participants' responses, 93 (7.6%) of women did not monitor their pregnancy regularly, and 1.5% were not sure. On the other hand, A total of 852 women (69.3%) did not have the right to choose a companion, 81 (6.6%) were not sure, and 604 (49.1%) were not informed of the rules regarding having a companion during childbirth, and 165 (13.4%) were not sure. The study found that 268 (21.8%) of women’s pulse were not checked for their fetus's heartbeat, 192 (15.6%) were not sure, and 224 (18.2%) did not receive intravenous treatment by the medical staff during delivery, and 64 (5.2%) were not sure. Moreover, when it was asked about what kind of help they receive before the childbirth, 572 women (46.5%) did not receive anything. There was significant association between exposure to violence and the following variables: Pregnancy regular monitoring (P = 0.017 < 0.05), the right to choose a companion (P = 0.043 < 0.05), notification of the accompanying rules (P = 0.012 < 0.05), vaginal examination (P = 0.003 < 0.05). (Table 2) During childbirth When we asked the participants about their latest delivery, 646 responses (52.6%) indicated a Caesarean section while 583 responses (47.4%) indicated a natural delivery. Moreover, 1153 (93.8%) of cases occurred in the delivery room, and a doctor delivered 1042 of the women (84.8%). With regards to the childbirth period, 460 (37.4%) delivered their baby before week 36, 373 (30.3%) before week 34, 351 (28.6%) between 36–40 weeks. Of the participants, 353 (28.7%) reported that they were not instructed to avoid eating or drinking. On the other hand, 1036 (84.3%) reported that medical staff did not offer a drink, while 128 (10.4%) did. A total of 1202 (97.8%) women delivered their babies while in the supine position, but only 222 (18.1%) were notified of additional support positions, and 580 (47.2%) were Forced for supine position. Of the participants, 265 (21.6%) experienced discomfort and fear of any word/phrase/behavior mentioned or done by the medical staff, and 273 (22.2%) did not feel private during the childbirth. 507 (41.3%) out of 1229 women did not ask any question during the childbirth. The analysis of the data found a significant association between childbirth period (P = 0.001 < 0.05), type of the childbirth (P = 0.007 < 0.05), instruction not to drink or eat (P = 0.001 < 0.05), being forced for Supine position (P = 0.036 < 0.05), the person who delivered the baby (P = 0.002 < 0.05), experiences of discomfort and fear (P = 0.000 < 0.05), and feeling private (P = 0.000 < 0.05). Furthermore, 389 (31.7%) underwent episiotomy, and of these, 299 (76.9%) received anesthesia, while 90 (23.1%) did not. Participants also were asked if they felt pain while their perineum was sewn; 191 (49.1%) responded in the affirmative and 198 (50%) responded negatively. (Table 4) Post-childbirth period Of the participants, 695 (56.6%) did not hold their baby in the delivery room, 266 (21.6%) were not notified about the need for breastfeeding after delivery, 105 (8.5%) were not topical cleaned after the delivery, and 85 (6.9%) experienced the death of their baby after delivery. When it was asked about being satisfied with the medical staff, 980 women (79.7%) were satisfied while 179 (14.6%) were not, and 70 (5.7%) were not sure. Regarding taking maternity leave after the childbirth, 291 (23.7%) did not have the option to take it, and 141 (11.5%) were not sure about this matter. The analysis of the data revealed a significant association between experiences of violence and the following variables during the postpartum period: notification of the need of breastfeeding (P = 0.001 < 0.05), satisfaction with the medical staff (P = 0.000 < 0.05), topical cleaned after the delivery (P = 0.000 < 0.05), and infant death after birth (P = 0.000 < 0.05). Discussion This is the first study in Syria to quantify the prevalence of violence committed by healthcare providers against women before, during, and after childbirth, with a rate of 9.60% (Yes) versus 90.40% (No). When compared with international and regional data, our reported prevalence falls below published estimates. A systematic review and meta-analysis included 18 studies shows that about 47% of women in East Africa experience mistreatment during facility-based childbirth, with country-level estimates ranging from 15% in Tanzania to 79% in Ethiopia, and 72% in Kenya ( 16 ) Similarly, a recent systematic review in high-income countries found a pooled prevalence of 45.3% for obstetric violence (Pérez-D’Gregorio et al., 2024) ( 17 ). Within the Middle East, rates are also considerably higher: a recent cross-sectional study in Saudi Arabia found that 31% of women reported experiencing violence before or during childbirth ( 18 ). A meta-analysis from Iran reported 19% physical violence, 42% verbal violence, and 37% psychological violence among pregnant women (Shohreh Shafiei et al., 2022) ( 19 ). In Türkiye, obstetric violence prevalence reached 76.4%, with 44.4% experiencing physical abuse (Özlem Aşci et al., 2023) ( 19 )); and In the Gaza Strip, 23% of women reported at least one form of mistreatment during facility-based childbirth; specifically 5.2% reported physical abuse, 20% reported verbal abuse, and 0.4% reported stigma or discrimination (Niveen ME Abu‑Rmeileh et al., 2022). ( 20 ). Several factors may help explain the relatively lower prevalence observed in our study. One important factor is that cultural perceptions and reporting practices may lead women to normalize certain mistreatments (e.g., verbal abuse, denial of consent) and thus underreport them as 'violence'; Kaveri Mayra and colleagues (2022) found that women in Bihar described experiences of disrespect and abuse, not in legal or medical terms, but simply as what felt “bad” or “good” care, often without recognizing mistreatment as abnormal or reportable, having internalized expectations of being subdued or mistreated. ( 21 ). This may be especially true in Syria, where the healthcare system has been severely impacted by years of conflict, potentially affecting both the quality of care and women’s expectations of treatment (Goleen Samari, 2017) ( 22 ). Additionally, differences in study methodology such as sample size, data collection methods, and whether surveys use behaviorally specific versus general questions are known to produce significant variation in reported prevalence (Bohren et al., 2015). ( 23 ). Our study demonstrated significant associations between exposure to violence before, during, and after childbirth and several sociodemographic characteristics, including age, education, marital status, and number of pregnancies. These findings align with previous research in regional and global contexts. For example, in Jordan, lower educational attainment was significantly associated with higher risk of obstetric violence, with more educated women being more likely to perceive and report mistreatment (( 24 ). Similarly, a multicounty survey including Middle Eastern contexts found that women with lower educational levels had significantly higher odds of severe maternal outcomes, underlining education as a structural determinant of vulnerability ( 25 ). Similarly, marital status has been highlighted as a determinant in violence exposure, with divorced or separated women often reporting higher levels of mistreatment (Chen Liu et al,2024; Bohren et al 2015) ( 26 ) ( 23 ). The association with parity is also supported by studies in Ethiopia and Kenya, where women with multiple pregnancies reported greater risk of neglect and verbal abuse, possibly due to provider biases (Abuya et al., 2015) ( 27 ). At the same time, our findings diverge from some reports. For instance, a study from the West Bank, Palestine, indicated that older women were less likely to report physical or verbal abuse during childbirth, suggesting that age is not always a consistent predictor of obstetric mistreatment (Dwekat et al., 2022). ( 28 ) These discrepancies may reflect cultural variations in provider attitudes, as well as methodological differences across studies. The observed associations suggest that obstetric violence is not evenly distributed among all women but is shaped by intersecting sociodemographic factors. Lower education, marital instability, and higher parity may increase women’s vulnerability by limiting their ability to advocate for themselves or by influencing provider perceptions of “deservingness” of respectful care. ( 29 ) In conflict-affected settings like Syria, where the healthcare system has been severely disrupted, these vulnerabilities may be further exacerbated. Exposure to violence was significantly associated with pregnancy monitoring regularity, the right to choose a companion, notification of companion rules, and vaginal examination. These patterns align with international evidence that labour companionship is both a WHO-recommended standard and protective against mistreatment/obstetric violence: WHO and FIGO recommend a companion of choice for all women during labour and birth( 30 ). A WHO-based multi-country community survey across Ghana, Guinea, Nigeria, and Myanmar found that women supported by a labour companion during childbirth experienced significantly less mistreatment, including lower reports of abuse and disrespect, compared to those without a companion. ( 31 ). Likewise, non-consented or poorly communicated procedures such as vaginal examinations are core domains of mistreatment in the Bohren typology, underlying failures in informed consent and dignity during childbirth (Bohren et al., 2015) ( 23 ). These have also been documented in the Middle East; for instance, in Jordan, intrapartum care commonly involves frequent vaginal examinations by multiple providers, undermining maternal autonomy ( 32 ). Similarly, Palestinian women in the West Bank reported numerous, short-interval VEs, even up to eight times by five different individuals, described as painful, embarrassing, and lacking respect or privacy. ( 33 ). Our analysis revealed significant associations between exposure to violence/mistreatment during childbirth and several key variables, including the childbirth period, type of childbirth, instruction not to drink or eat, being forced into the supine position, the person who delivered the baby, experiences of discomfort and fear, and perceptions of privacy. These findings are consistent with global evidence showing that intrapartum care practices such as restrictive labor management, enforced birthing positions, and poor communication are strongly linked with women’s negative childbirth experiences and perceptions of mistreatment. For instance, Bohren et al. (2015) synthesized evidence from multiple countries and documented widespread mistreatment of women during childbirth, including denial of mobility, lack of privacy, and verbal or physical abuse, all of which undermine respectful maternity care. ( 23 ). Similarly, the WHO Intrapartum Care for a Positive Childbirth Experience guidelines (2018) emphasize that unnecessary restrictions on food and drink, as well as lack of mobility and choice of birthing position, are non-evidence-based practices that compromise women’s dignity and autonomy. ( 34 ). Regional studies further support these findings; for example, Balde et al. (2017) in Guinea reported that women who experienced intimidation from staff or lack of privacy were significantly more likely to describe their childbirth as disrespectful or abusive. ( 35 ). The finding that the type of childbirth (cesarean vs. vaginal) and the provider responsible for delivery were significantly associated with reported mistreatment highlights a critical structural issue: women undergoing cesarean sections or those attended by less experienced staff may be especially vulnerable to poor communication, insufficient consent, or inadequate pain management. Supporting this, a study in Israel found that cesarean delivery was significantly associated with women reporting mistreatment, including failure to meet professional standards and poor rapport with their providers ( 36 ) Likewise, broader analyses using the Disrespect and Mistreatment during Childbirth Questionnaire (DMCQ) revealed that emergency cesarean births carry the highest risk of obstetric mistreatment, and in some contexts such as among Italian women cesarean sections were often reported as being performed without proper information or consent ( 37 ) The analysis of our data revealed significant associations between experiences of obstetric violence during the postpartum period and key variables: notification of the need for breastfeeding, satisfaction with the medical staff, postpartum hygienic care (topical cleaning after delivery), and infant death after birth. These findings provide important insights into how care practices and outcomes in the immediate postpartum phase contribute to women’s perceptions of mistreatment and disrespect. Satisfaction with medical staff also emerged as a correlate of reported violence. This echoes a large body of evidence demonstrating that interpersonal interactions like respect, empathy, and clear communication are among the most critical determinants of women’s birth experiences. A study in Canada ( 38 ) found that trauma- and violence-informed breastfeeding support from primary care providers improved maternal trust and breastfeeding outcomes among women with histories of intimate partner violence, highlighting the need for respectful engagement in maternity care. Satisfaction with medical staff also emerged as a correlate of reported violence. This echoes a large body of evidence demonstrating that interpersonal interactions, respect, empathy, and clear communication, are among the most critical determinants of women’s birth experiences. A study in 2024 ( 39 ) found that respectful engagement, characterized by trust, empathy, and clear communication, is crucial in mitigating negative childbirth experiences, even in resource-constrained settings. The association between postpartum hygienic care and violence is also notable. Inadequate cleaning or neglect of basic postpartum needs may be perceived as intentional disregard for women’s dignity. A study in Ethiopia found that women who experienced disrespect and abuse during childbirth reported inadequate hygiene and neglectful postpartum care as significant contributors to their negative experiences. ( 40 ) Infant death was associated with maternal reports of violence. While neonatal outcomes are multifactorial, women may perceive inadequate care, neglect, or poor communication as contributing to the loss. A study in Jordan found that mothers experiencing stillbirth often attributed their loss to insufficient support and poor communication from healthcare providers ( 41 ) Implications: The findings of this study have important implications for maternal health policy and practice in Syria and similar conflict-affected contexts. Interventions should prioritize strengthening respectful maternity care through: ( 1 ) systematic training of healthcare providers in communication, empathy, and informed consent; ( 2 ) guaranteeing women’s right to a birth companion of choice; ( 3 ) reducing harmful practices such as enforced birthing positions and non-consented procedures; and ( 4 ) integrating psychosocial and bereavement support into postpartum care. Policymakers should also develop standardized monitoring and reporting mechanisms to better capture women’s experiences, address underreporting, and ensure accountability. Future research should explore culturally sensitive strategies to shift norms around mistreatment and evaluate the effectiveness of interventions designed to promote dignity and respect in childbirth. Limitations The obstetric field faces many challenges, particularly in rural areas where many women who are in danger of violence cannot use the internet freely. The results are based on a self-administered survey; hence, reporting bias cannot be eliminated. The generalization of this study’s results should be made carefully. Conclusions This first study on obstetric violence in Syria found a lower prevalence than regional and international estimates, yet mistreatment remains a significant concern. Notably, exposure to violence was significantly associated with key demographic characteristics such as age, education level, marital status, and number of pregnancies. This suggests that certain sociodemographic groups may be more vulnerable to experiencing violence, underscoring the importance of tailored interventions. Moreover, during the pre-childbirth period, the data indicate concerning gaps in care, with a substantial proportion of women reporting a lack of regular pregnancy monitoring, limited autonomy in choosing a companion, and insufficient information regarding accompanying rules. Furthermore, a notable percentage did not have their fetus's heartbeat checked or receive intravenous treatment. This suggests that inadequate care and lack of autonomy may be linked to experiences of violence. A large proportion of women were not instructed to avoid eating or drinking, were not offered drinks by staff, and were forced into a supine position. High percentages of women also reported discomfort, fear of medical staff behavior, and a lack of privacy. The strong associations between violence and factors like childbirth period, type of childbirth, instructions on eating/drinking, forced supine position, and experiences of discomfort and fear emphasize that the circumstances and treatment during delivery significantly impact women's well-being and their susceptibility to experiencing violence. Finally, in the post-childbirth period, a substantial number of women did not hold their baby in the delivery room, were not notified about breastfeeding, or did not receive topical cleaning. This highlights how post-delivery care and outcomes can be intertwined with experiences of violence. Obstetric violence in Syria appears shaped by cultural norms, systemic constraints, and strained health services in a conflict-affected context. Addressing these gaps requires provider training in respectful care, improved communication and consent practices, guaranteed labour companionship, and integration of bereavement and psychosocial support. Future research should focus on women lived experiences and context-specific strategies to promote respectful maternity care as a human right. Declarations Author contributions statement: R.F conceived, designed the study and analyzed the data. R.AD and S.AM contributed to the literature review. A.K provided critical feedback and helped shape the research. A.Y supervised the research project, provided guidance throughout the study, and critically reviewed the manuscript. All authors collected data and contributed to the writing of the manuscript, read, and approved the final manuscript. Ethical Approval and consent to participate: The study received ethical approval from Faculty of Medicine, Homs university. The study adhered to the ethical standards of national and institutional committees overlooking human research and the principles announced in the Helsinki Declaration. Consent for publication: This study does not include the publication of any individual's personal data, including images, videos, or other identifiable information. All data presented in this study are anonymized and aggregated, ensuring that no participant can be identified. Availability data and materials. All research materials used in this study were included. Competing interest. The authors declare that they have no competing interests. Funding. The authors received no specific funding for this work. Acknowledgments We would like to acknowledge and thank who have contributed to data collection of this study: Baraa Mohammad Firas Manaa - Faculty of Medicine - Aleppo University ( [email protected] ) Alaa Abdullah Al Abdul Rahman - Faculty of Medicine - Al Hwash University ( [email protected] ) References Nimi T, Fraga S, Costa D, Campos P, Barros H. Prevalence, determinants, and effects of violence during pregnancy: a maternity-based cross-sectional study in Luanda, Angola. Journal of public health in Africa. 2020;10(2):1050. Yakubovich AR, Steele B, Cullum J, Johnson CP, Parker LN, Wilson SJ, et al. Health system preparedness to respond to domestic and sexualized violence: A cross-sectional survey in Nova Scotia, Canada. Preventive Medicine Reports. 2025;53:103058. Organization WH. 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Prevalence of obstetric violence in high‐income countries: A systematic review of mixed studies and meta‐analysis of quantitative studies. Acta obstetricia et gynecologica Scandinavica. 2025;104(1):13-28. Shafiei S, Chegeni M, Afrashteh S, Shoraka HR, Bazrafshan A, Bagherinezhad Z, et al. Prevalence of violence in Iranian pregnant women: a systematic review and meta-analysis. Maternal and child health journal. 2022;26(10):1983-2019. Aşci Ö, Bal MD. The prevalence of obstetric violence experienced by women during childbirth care and its associated factors in Türkiye: a cross-sectional study. Midwifery. 2023;124:103766. ME Abu-Rmeileh N, Wahdan Y, Mehrtash H, Hamad KA, Awad A, Tunçalp Ӧ. Exploring women’s experiences during childbirth in health facilities during COVID-19 pandemic in occupied palestinian territory: A cross-sectional community survey. BMC Pregnancy and Childbirth. 2022;22(1):957. Mayra K, Sandall J, Matthews Z, Padmadas SS. Breaking the silence about obstetric violence: Body mapping women’s narratives of respect, disrespect and abuse during childbirth in Bihar, India. BMC pregnancy and childbirth. 2022;22(1):318. Samari G. Syrian refugee women's health in Lebanon, Turkey, and Jordan and recommendations for improved practice. World medical & health policy. 2017;9(2):255-74. Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS medicine. 2015;12(6):e1001847. Azzam OA, Sindiani AM, Eyalsalman MM, Odeh MK, AbedAlkareem KY, Albanna SA, et al., editors. Obstetric violence among pregnant Jordanian women: an observational study between the private and public hospitals in Jordan. Healthcare; 2023: MDPI. Tunçalp Ö, Souza J, Hindin M, Santos C, Oliveira T, Vogel J, et al. Education and severe maternal outcomes in developing countries: a multicountry cross‐sectional survey. 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Balde MD, Nasiri K, Mehrtash H, Soumah A-M, Bohren MA, Irinyenikan TA, et al. Labour companionship and women’s experiences of mistreatment during childbirth: results from a multi-country community-based survey. BMJ global health. 2022;5(Suppl 2):e003564. Msc AAB. Jordanian women's perceptions of intrapartum vaginal examination. Evidence Based Midwifery. 2012;10(4):131. Hassan S, Sundby J, Husseini A, Bjertness E. Palestinian women's feelings and opinions about vaginal examinations during normal childbirth: an exploratory study. The Lancet. 2012;380:S35. Organization WH. Making childbirth a positive experience. Geneva: World Health Organization. 2018. Morris Z, Halabi SE, Hanson C, Kandeya B, Ayebare E, Houngbo G, et al. Measuring responsiveness and respectful treatment in maternity care in sub-Saharan Africa: a questionnaire validation and development of a score. BMC Pregnancy and Childbirth. 2025;25(1):1-13. Korem K, Polachek IS, Shabot SC, Kedar R, Bardicef M, Sagi S, et al. Prevalence and characteristics of mistreatment during childbirth in two Israeli hospitals. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2025;305:285-91. Suttora C, Nardozza O, Menabò L, Preti E, Passaquindici I, Fasolo M, et al. Development and validation of the Disrespect and Mistreatment during Childbirth Questionnaire: risk factors and effects on parenting stress. Frontiers in Psychology. 2025;16:1562679. Jackson KT, Larose S, Mantler T. Accessing trauma-and violence-informed breastfeeding support from primary care providers among women with histories of intimate partner violence: An exploratory interpretive description study. Canadian Journal of Nursing Research. 2025;57(2):177-87. Glover A, Holman C, Boise P. Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice. BMC pregnancy and childbirth. 2024;24(1):267. Dolatabadi Z, Farahani LA, Zargar Z, Haghani S, Mousavi SS. Disrespect and abuse during childbirth and associated factors among women: a cross-sectional study. BMC Pregnancy and Childbirth. 2025;25(1):229. Al-Shuqerat SM, Bawadi HA. Understanding Jordanian Mothers’ Experience after Stillbirth: A Qualitative Study Protocol. Open Journal of Nursing. 2020;10(03):277. Tables Tables 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Published Journal Publication published 09 Feb, 2026 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 29 Dec, 2025 Reviews received at journal 23 Dec, 2025 Reviewers agreed at journal 15 Dec, 2025 Reviews received at journal 28 Oct, 2025 Reviewers agreed at journal 11 Oct, 2025 Reviewers invited by journal 13 Sep, 2025 Editor invited by journal 11 Sep, 2025 Editor assigned by journal 10 Sep, 2025 Submission checks completed at journal 10 Sep, 2025 First submitted to journal 07 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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It has been observed in every social, cultural, economic, and religious group (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). VAW has severe health consequences, both in the short-term and long-term (including after the violence has ended and, in some cases, across generations), making VAW a priority for health systems to prevent and address (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAround the world, violence affects over one-third (27%) of women between the ages of 15 and 49 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eViolence against pregnant women has become a public health issue and a violation of human rights. Also, it is considered a hidden epidemic. Obstetric violence can lead to significant health consequences affecting both mother and child (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Pregnant victims of violence often describe being choked, scalded, forced out of moving cars, punched, kicked, shoved downstairs, threatened with knives, and having things thrown at them. As a result of the abuse they endure, individuals also suffer from a variety of violence-related ailments, such as cuts, bruises, fractures, concussions, tooth injuries, knife wounds, vaginal bleeding, and chronic migraines (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Violence currently has a significant impact on neonatal health outcomes such as low birth weight (LBW), preterm birth (PTB), stillbirth, and pregnancy outcomes such as abortion, hypertension, and postpartum hemorrhage (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It has been reported to significantly increase the risk for low-birth-weight infants, pre-term delivery, and neonatal death and also affected breastfeeding postpartum. Other complications may include abortions, stillbirth, and even death (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e),(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Pregnancy and childbirth, as important events in women\u0026rsquo;s lives, should be guided based on quality and humanized principles. The World Health Organization (WHO) emphasizes the quality of interaction between women and healthcare providers and considers good interactions a prerequisite for favorable pregnancy and childbirth outcomes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The WHO statement has highlighted the elimination of obstetric violence toward women during childbirth because it contradicts human rights principles and threatens their right to life, physical, mental, and moral integrity, as well as freedom from discrimination (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Obstetric violence often focuses on labor and childbirth even when referring to maternity care, which includes pregnancy, given that these are moments in which women are particularly vulnerable to healthcare abuse and over-medicalization, or non-medically justified obstetric interventions, e.g., episiotomy and cesarean section. Other important components of obstetric violence are dehumanization and non-consensual care, as well as the overall conversion of biological processes into pathological ones (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSince the 1990s, patients in healthcare, particularly female patients who have been experiencing violence\u0026mdash;i.e., abuse, neglect, disrespect, or mistreatment\u0026mdash;in healthcare facilities have been examined through the concepts of patient satisfaction and dissatisfaction, with the aim of improving patient care. However, growing evidence suggests that using the satisfaction typology only reflects what one is asking for; that is, patients report more satisfaction when asked specifically about \"patient satisfaction\" than if asked about their dissatisfaction. This might explain why the emergent issue of women experiencing violence in healthcare, particularly in maternity healthcare facilities\u0026mdash;also referred to as obstetric violence\u0026mdash;has long been silenced or neglected worldwide (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e),(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAcknowledging the importance of this issue, the White Ribbon Alliance for Safe Motherhood outlined seven fundamental rights for pregnant women in 2011:\u003c/p\u003e\u003cp\u003e1.Protection from harm and mistreatment; 2. Access to information, informed consent, and respect for decisions, including the option to have a chosen companion present when possible; 3. Assurance of confidentiality and privacy; 4. Treatment with dignity and respect; 5. Equal and non-discriminatory care; 6. Access to timely healthcare and the highest possible standard of health; 7. The right to personal freedom, autonomy, self-determination, and protection from unjust confinement (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e),(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Additionally, regions with fewer reported cases of violence against women are often influenced by cultural norms. For example, in societies where violence against women is stigmatized or ignored, reporting rates remain very low. Similarly, communities with rigid gender hierarchies that marginalize women tend to show comparable underreporting. Violence against women is generally more prevalent in rural areas compared to urban settings, where access to information, counseling, and healthcare services is typically better (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis cross-sectional study aims to determine the prevalence and forms of obstetric violence experienced by women during pregnancy, childbirth, and the postpartum period in Syria, and to identify the sociodemographic and clinical factors associated with its occurrence.\"\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003e Between May 7 and June 10 in 2025, a cross-sectional study was conducted, aimed to assess the prevalence of the violence against women during pregnancy and after childbirth, check how aware women are of obstetric violence, and check out the quality of healthcare provided during delivery in hospitals in Syria.\u003c/p\u003e\u003cp\u003eFor data collection, we publicized an online survey across Syria utilizing official social media platforms, including Facebook, WhatsApp, Instagram, and Telegram. The data collection employed both chain-referral sampling and convenience sampling methods. The questionnaire was also distributed in public places such as parks and streets in urban and rural areas to check inclusivity and representativeness. We obtained the informed consent electronically or in written form, with participants explicitly confirming their agreement before starting the survey. All responses were anonymized and securely stored in a password-protected database, accessible only to the principal investigator. Completing the survey took approximately 5 to 8 minutes. The study abided by the ethical standards of national and institutional committees overseeing human research and the principles outlined in the Helsinki Declaration. We obtained ethical approval from the Faculty of Medicine at Homs University (7/5/2025).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria were all women who gave birth aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years, and voluntary participation.\u003c/p\u003e\u003cp\u003eThe exclusion criteria were missing any data and those who aged\u0026thinsp;\u0026lt;\u0026thinsp;18 years.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was adapted from a prior study conducted in Saudi Arabia (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). It was translated from English to Arabic by a professional translator, then back-translated into English by another translator to ensure accuracy. A committee of specialists in gynecology, obstetrics, statistics, Arabic and English literature reviewed the final questionnaire to ensure its relevance and clarity for the Syrian context. This process ensured that the questionnaire was conceptually accurate and culturally sensitive.\u003c/p\u003e\u003cp\u003eTo validate the questionnaire's clarity and reliability, a pilot study was conducted with 40 randomly selected of the target sample then they were excluded from the final sample to avoid potential bias. The pilot study confirmed the questionnaire\u0026rsquo;s internal consistency, with Cronbach\u0026rsquo;s alpha values of 0.737 for the whole questionnaire.\u003c/p\u003e\u003cp\u003eThe questionnaire was divided into three sections: The first section assessed socio-demographic characteristics, including age, governorate of origin, living place (urban or rural), marital status (married, divorced or widow), financial status, education level and work.\u003c/p\u003e\u003cp\u003eThe second section involved the obstetric history detailing the instances of abortion, number of pregnancies, fetal outcomes, follow-up procedures, privacy considerations, and the forced supine position. Additionally, this section gathered information pertaining to pre-labor conditions, including labor duration, the presence of a companion, notification of rules, assistance received, fetal pulse monitoring, intravenous treatments, and vaginal examinations.\u003c/p\u003e\u003cp\u003eThe third section gathered data regarding the delivery process, including the method of delivery, location, assistance provided, the attending physician, maternal positioning, drinking offered, instances of verbal violence, inquiries made, induction procedures, surgical cuts, and any resultant wounds. Furthermore, this section also included post-delivery data on maternal engagement with the child, breastfeeding practices, maternal satisfaction, maternity leave, and the cleaning process following delivery.\u003c/p\u003e\u003cp\u003eAll questions were closed-ended to simplify analysis and minimize variability in responses.\u003c/p\u003e\n\u003ch3\u003eSample Size\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated using the Cochran formula for sample size estimation. The calculations were done utilizing multiple parameters, including a confidence level of 95% (represented by Z\u0026thinsp;=\u0026thinsp;1.96), a margin of error set at 5% (represented by e), and an estimated population proportion (p) of 50% (or 0.5) for the attribute of interest. The complementary value, q, was determined as 1\u0026thinsp;\u0026minus;\u0026thinsp;p. The formula employed is expressed as: n = (Z\u0026sup2; \u0026sdot; p \u0026sdot; q)/e\u0026sup2;, the required sample size was 385. To account for potential non-responses, we increased the total sample size. Eventually, 1229 participants completed the survey, surpassing the required sample size and assuring the study retained powerful statistical power for significant analysis.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\u003cp\u003eData were analyzed using IBM SPSS statistics version 24. Qualitative variables were prescribed using numbers and percentages. The chi-square test was used to determine if there is a significant relationship between categorical variables, pre, during post variables and the exposure to violence. Statistical significance was set at P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Cronbach's alpha was calculated to assess the internal consistency of the survey instrument, which values greater than 0.6 considered acceptance.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eDemographic characteristics of women\u003c/h2\u003e\u003cp\u003eThe sample included 1229 women, 24.3% of them were from the central Governorates (Damascus and Homs), 27.3% from the southern Governorates (Rural Damascus, Daraa, As-Sweida and Quneitra), 15.3% from the northern Governorates (Aleppo and Idlib), 13.8% from the northeast (Al-Hasakah, Ar-Raqqa and Deir-Ez-Zor), and 19.2% from the northwest (Tartous, Lattakia, and Hama). 15.6% of the participants were less than 25 years old, 28.2% between 26 and 30 years old, 41.2% between 31 and 45 years old, and 15.1% more than 45 years old. With regards to the education level, about half of the sample had a bachelor's degree, 20.3% had high school, and only 1.4% were uneducated. For marital status, 94.8% were married, 2.7% divorced and 2.5% widowed. About two- thirds of the sample were from urban areas, and 39.6% from rural areas. Concerning employment, 57,1% women were working, and 42.9% were not. 54.8% of the participants\u0026rsquo; family income was moderate, 25.9% was good, and 19.3% was low. It was reported that 26.4% of the sample had a two-time pregnancy, 22.6% had a four-time pregnancy or more, 21.8 had a one-time pregnancy, and 20.2% had a three-time pregnancy.\u003c/p\u003e\u003cp\u003eThere was significant association between exposure to violence and the following sociodemographic characteristics: age (P\u0026thinsp;=\u0026thinsp;0.048\u0026thinsp;\u0026lt;\u0026thinsp;0.05), Education (P\u0026thinsp;=\u0026thinsp;0.041\u0026thinsp;\u0026lt;\u0026thinsp;0.05), marital status (P\u0026thinsp;=\u0026thinsp;0.001\u0026thinsp;\u0026lt;\u0026thinsp;0.05), number of pregnancies (P\u0026thinsp;=\u0026thinsp;0.013\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (Table\u0026nbsp;1)\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePre-childbirth period\u003c/h3\u003e\n\u003cp\u003eAccording to the participants' responses, 93 (7.6%) of women did not monitor their pregnancy regularly, and 1.5% were not sure. On the other hand, A total of 852 women (69.3%) did not have the right to choose a companion, 81 (6.6%) were not sure, and 604 (49.1%) were not informed of the rules regarding having a companion during childbirth, and 165 (13.4%) were not sure. The study found that 268 (21.8%) of women\u0026rsquo;s pulse were not checked for their fetus's heartbeat, 192 (15.6%) were not sure, and 224 (18.2%) did not receive intravenous treatment by the medical staff during delivery, and 64 (5.2%) were not sure. Moreover, when it was asked about what kind of help they receive before the childbirth, 572 women (46.5%) did not receive anything. There was significant association between exposure to violence and the following variables: Pregnancy regular monitoring (P\u0026thinsp;=\u0026thinsp;0.017\u0026thinsp;\u0026lt;\u0026thinsp;0.05), the right to choose a companion (P\u0026thinsp;=\u0026thinsp;0.043\u0026thinsp;\u0026lt;\u0026thinsp;0.05), notification of the accompanying rules (P\u0026thinsp;=\u0026thinsp;0.012\u0026thinsp;\u0026lt;\u0026thinsp;0.05), vaginal examination (P\u0026thinsp;=\u0026thinsp;0.003\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (Table\u0026nbsp;2)\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eDuring childbirth\u003c/h2\u003e\u003cp\u003eWhen we asked the participants about their latest delivery, 646 responses (52.6%) indicated a Caesarean section while 583 responses (47.4%) indicated a natural delivery. Moreover, 1153 (93.8%) of cases occurred in the delivery room, and a doctor delivered 1042 of the women (84.8%). With regards to the childbirth period, 460 (37.4%) delivered their baby before week 36, 373 (30.3%) before week 34, 351 (28.6%) between 36\u0026ndash;40 weeks. Of the participants, 353 (28.7%) reported that they were not instructed to avoid eating or drinking. On the other hand, 1036 (84.3%) reported that medical staff did not offer a drink, while 128 (10.4%) did. A total of 1202 (97.8%) women delivered their babies while in the supine position, but only 222 (18.1%) were notified of additional support positions, and 580 (47.2%) were Forced for supine position.\u003c/p\u003e\u003cp\u003eOf the participants, 265 (21.6%) experienced discomfort and fear of any word/phrase/behavior mentioned or done by the medical staff, and 273 (22.2%) did not feel private during the childbirth. 507 (41.3%) out of 1229 women did not ask any question during the childbirth.\u003c/p\u003e\u003cp\u003eThe analysis of the data found a significant association between childbirth period (P\u0026thinsp;=\u0026thinsp;0.001\u0026thinsp;\u0026lt;\u0026thinsp;0.05), type of the childbirth (P\u0026thinsp;=\u0026thinsp;0.007\u0026thinsp;\u0026lt;\u0026thinsp;0.05), instruction not to drink or eat (P\u0026thinsp;=\u0026thinsp;0.001\u0026thinsp;\u0026lt;\u0026thinsp;0.05), being forced for Supine position (P\u0026thinsp;=\u0026thinsp;0.036\u0026thinsp;\u0026lt;\u0026thinsp;0.05), the person who delivered the baby (P\u0026thinsp;=\u0026thinsp;0.002\u0026thinsp;\u0026lt;\u0026thinsp;0.05), experiences of discomfort and fear (P\u0026thinsp;=\u0026thinsp;0.000\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and feeling private (P\u0026thinsp;=\u0026thinsp;0.000\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eFurthermore, 389 (31.7%) underwent episiotomy, and of these, 299 (76.9%) received anesthesia, while 90 (23.1%) did not. Participants also were asked if they felt pain while their perineum was sewn; 191 (49.1%) responded in the affirmative and 198 (50%) responded negatively. (Table\u0026nbsp;4)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePost-childbirth period\u003c/h2\u003e\u003cp\u003eOf the participants, 695 (56.6%) did not hold their baby in the delivery room, 266 (21.6%) were not notified about the need for breastfeeding after delivery, 105 (8.5%) were not topical cleaned after the delivery, and 85 (6.9%) experienced the death of their baby after delivery.\u003c/p\u003e\u003cp\u003eWhen it was asked about being satisfied with the medical staff, 980 women (79.7%) were satisfied while 179 (14.6%) were not, and 70 (5.7%) were not sure. Regarding taking maternity leave after the childbirth, 291 (23.7%) did not have the option to take it, and 141 (11.5%) were not sure about this matter.\u003c/p\u003e\u003cp\u003eThe analysis of the data revealed a significant association between experiences of violence and the following variables during the postpartum period: notification of the need of breastfeeding (P\u0026thinsp;=\u0026thinsp;0.001\u0026thinsp;\u0026lt;\u0026thinsp;0.05), satisfaction with the medical staff (P\u0026thinsp;=\u0026thinsp;0.000\u0026thinsp;\u0026lt;\u0026thinsp;0.05), topical cleaned after the delivery (P\u0026thinsp;=\u0026thinsp;0.000\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and infant death after birth (P\u0026thinsp;=\u0026thinsp;0.000\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first study in Syria to quantify the prevalence of violence committed by healthcare providers against women before, during, and after childbirth, with a rate of 9.60% (Yes) versus 90.40% (No). When compared with international and regional data, our reported prevalence falls below published estimates. A systematic review and meta-analysis included 18 studies shows that about 47% of women in East Africa experience mistreatment during facility-based childbirth, with country-level estimates ranging from 15% in Tanzania to 79% in Ethiopia, and 72% in Kenya (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Similarly, a recent systematic review in high-income countries found a pooled prevalence of 45.3% for obstetric violence (P\u0026eacute;rez-D\u0026rsquo;Gregorio et al., 2024) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Within the Middle East, rates are also considerably higher: a recent cross-sectional study in Saudi Arabia found that 31% of women reported experiencing violence before or during childbirth (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). A meta-analysis from Iran reported 19% physical violence, 42% verbal violence, and 37% psychological violence among pregnant women (Shohreh Shafiei et al., 2022) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In T\u0026uuml;rkiye, obstetric violence prevalence reached 76.4%, with 44.4% experiencing physical abuse (\u0026Ouml;zlem Aşci et al., 2023) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)); and In the Gaza Strip, 23% of women reported at least one form of mistreatment during facility-based childbirth; specifically 5.2% reported physical abuse, 20% reported verbal abuse, and 0.4% reported stigma or discrimination (Niveen ME Abu‑Rmeileh et al., 2022). (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Several factors may help explain the relatively lower prevalence observed in our study. One important factor is that cultural perceptions and reporting practices may lead women to normalize certain mistreatments (e.g., verbal abuse, denial of consent) and thus underreport them as 'violence'; Kaveri Mayra and colleagues (2022) found that women in Bihar described experiences of disrespect and abuse, not in legal or medical terms, but simply as what felt \u0026ldquo;bad\u0026rdquo; or \u0026ldquo;good\u0026rdquo; care, often without recognizing mistreatment as abnormal or reportable, having internalized expectations of being subdued or mistreated. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This may be especially true in Syria, where the healthcare system has been severely impacted by years of conflict, potentially affecting both the quality of care and women\u0026rsquo;s expectations of treatment (Goleen Samari, 2017) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Additionally, differences in study methodology such as sample size, data collection methods, and whether surveys use behaviorally specific versus general questions are known to produce significant variation in reported prevalence (Bohren et al., 2015). (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Our study demonstrated significant associations between exposure to violence before, during, and after childbirth and several sociodemographic characteristics, including age, education, marital status, and number of pregnancies. These findings align with previous research in regional and global contexts. For example, in Jordan, lower educational attainment was significantly associated with higher risk of obstetric violence, with more educated women being more likely to perceive and report mistreatment ((\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Similarly, a multicounty survey including Middle Eastern contexts found that women with lower educational levels had significantly higher odds of severe maternal outcomes, underlining education as a structural determinant of vulnerability (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Similarly, marital status has been highlighted as a determinant in violence exposure, with divorced or separated women often reporting higher levels of mistreatment (Chen Liu et al,2024; Bohren et al 2015) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The association with parity is also supported by studies in Ethiopia and Kenya, where women with multiple pregnancies reported greater risk of neglect and verbal abuse, possibly due to provider biases (Abuya et al., 2015) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). At the same time, our findings diverge from some reports. For instance, a study from the West Bank, Palestine, indicated that older women were less likely to report physical or verbal abuse during childbirth, suggesting that age is not always a consistent predictor of obstetric mistreatment (Dwekat et al., 2022). (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) These discrepancies may reflect cultural variations in provider attitudes, as well as methodological differences across studies. The observed associations suggest that obstetric violence is not evenly distributed among all women but is shaped by intersecting sociodemographic factors. Lower education, marital instability, and higher parity may increase women\u0026rsquo;s vulnerability by limiting their ability to advocate for themselves or by influencing provider perceptions of \u0026ldquo;deservingness\u0026rdquo; of respectful care. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) In conflict-affected settings like Syria, where the healthcare system has been severely disrupted, these vulnerabilities may be further exacerbated.\u003c/p\u003e\u003cp\u003eExposure to violence was significantly associated with pregnancy monitoring regularity, the right to choose a companion, notification of companion rules, and vaginal examination. These patterns align with international evidence that labour companionship is both a WHO-recommended standard and protective against mistreatment/obstetric violence: WHO and FIGO recommend a companion of choice for all women during labour and birth(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). A WHO-based multi-country community survey across Ghana, Guinea, Nigeria, and Myanmar found that women supported by a labour companion during childbirth experienced significantly less mistreatment, including lower reports of abuse and disrespect, compared to those without a companion. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Likewise, non-consented or poorly communicated procedures such as vaginal examinations are core domains of mistreatment in the Bohren typology, underlying failures in informed consent and dignity during childbirth (Bohren et al., 2015) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). These have also been documented in the Middle East; for instance, in Jordan, intrapartum care commonly involves frequent vaginal examinations by multiple providers, undermining maternal autonomy (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Similarly, Palestinian women in the West Bank reported numerous, short-interval VEs, even up to eight times by five different individuals, described as painful, embarrassing, and lacking respect or privacy. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Our analysis revealed significant associations between exposure to violence/mistreatment during childbirth and several key variables, including the childbirth period, type of childbirth, instruction not to drink or eat, being forced into the supine position, the person who delivered the baby, experiences of discomfort and fear, and perceptions of privacy.\u003c/p\u003e\u003cp\u003eThese findings are consistent with global evidence showing that intrapartum care practices such as restrictive labor management, enforced birthing positions, and poor communication are strongly linked with women\u0026rsquo;s negative childbirth experiences and perceptions of mistreatment. For instance, Bohren et al. (2015) synthesized evidence from multiple countries and documented widespread mistreatment of women during childbirth, including denial of mobility, lack of privacy, and verbal or physical abuse, all of which undermine respectful maternity care. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Similarly, the WHO Intrapartum Care for a Positive Childbirth Experience guidelines (2018) emphasize that unnecessary restrictions on food and drink, as well as lack of mobility and choice of birthing position, are non-evidence-based practices that compromise women\u0026rsquo;s dignity and autonomy. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Regional studies further support these findings; for example, Balde et al. (2017) in Guinea reported that women who experienced intimidation from staff or lack of privacy were significantly more likely to describe their childbirth as disrespectful or abusive. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). The finding that the type of childbirth (cesarean vs. vaginal) and the provider responsible for delivery were significantly associated with reported mistreatment highlights a critical structural issue: women undergoing cesarean sections or those attended by less experienced staff may be especially vulnerable to poor communication, insufficient consent, or inadequate pain management. Supporting this, a study in Israel found that cesarean delivery was significantly associated with women reporting mistreatment, including failure to meet professional standards and poor rapport with their providers (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eLikewise, broader analyses using the Disrespect and Mistreatment during Childbirth Questionnaire (DMCQ) revealed that emergency cesarean births carry the highest risk of obstetric mistreatment, and in some contexts such as among Italian women cesarean sections were often reported as being performed without proper information or consent (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) The analysis of our data revealed significant associations between experiences of obstetric violence during the postpartum period and key variables: notification of the need for breastfeeding, satisfaction with the medical staff, postpartum hygienic care (topical cleaning after delivery), and infant death after birth. These findings provide important insights into how care practices and outcomes in the immediate postpartum phase contribute to women\u0026rsquo;s perceptions of mistreatment and disrespect.\u003c/p\u003e\u003cp\u003eSatisfaction with medical staff also emerged as a correlate of reported violence. This echoes a large body of evidence demonstrating that interpersonal interactions like respect, empathy, and clear communication are among the most critical determinants of women\u0026rsquo;s birth experiences. A study in Canada (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) found that trauma- and violence-informed breastfeeding support from primary care providers improved maternal trust and breastfeeding outcomes among women with histories of intimate partner violence, highlighting the need for respectful engagement in maternity care.\u003c/p\u003e\u003cp\u003eSatisfaction with medical staff also emerged as a correlate of reported violence. This echoes a large body of evidence demonstrating that interpersonal interactions, respect, empathy, and clear communication, are among the most critical determinants of women\u0026rsquo;s birth experiences. A study in 2024 (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) found that respectful engagement, characterized by trust, empathy, and clear communication, is crucial in mitigating negative childbirth experiences, even in resource-constrained settings.\u003c/p\u003e\u003cp\u003eThe association between postpartum hygienic care and violence is also notable. Inadequate cleaning or neglect of basic postpartum needs may be perceived as intentional disregard for women\u0026rsquo;s dignity. A study in Ethiopia found that women who experienced disrespect and abuse during childbirth reported inadequate hygiene and neglectful postpartum care as significant contributors to their negative experiences. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) Infant death was associated with maternal reports of violence. While neonatal outcomes are multifactorial, women may perceive inadequate care, neglect, or poor communication as contributing to the loss. A study in Jordan found that mothers experiencing stillbirth often attributed their loss to insufficient support and poor communication from healthcare providers (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e)\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eImplications:\u003c/h2\u003e\u003cp\u003eThe findings of this study have important implications for maternal health policy and practice in Syria and similar conflict-affected contexts. Interventions should prioritize strengthening respectful maternity care through: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) systematic training of healthcare providers in communication, empathy, and informed consent; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) guaranteeing women\u0026rsquo;s right to a birth companion of choice; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) reducing harmful practices such as enforced birthing positions and non-consented procedures; and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) integrating psychosocial and bereavement support into postpartum care. Policymakers should also develop standardized monitoring and reporting mechanisms to better capture women\u0026rsquo;s experiences, address underreporting, and ensure accountability. Future research should explore culturally sensitive strategies to shift norms around mistreatment and evaluate the effectiveness of interventions designed to promote dignity and respect in childbirth.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe obstetric field faces many challenges, particularly in rural areas where many women who are in danger of violence cannot use the internet freely. The results are based on a self-administered survey; hence, reporting bias cannot be eliminated. The generalization of this study\u0026rsquo;s results should be made carefully.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis first study on obstetric violence in Syria found a lower prevalence than regional and international estimates, yet mistreatment remains a significant concern. Notably, exposure to violence was significantly associated with key demographic characteristics such as age, education level, marital status, and number of pregnancies. This suggests that certain sociodemographic groups may be more vulnerable to experiencing violence, underscoring the importance of tailored interventions. Moreover, during the pre-childbirth period, the data indicate concerning gaps in care, with a substantial proportion of women reporting a lack of regular pregnancy monitoring, limited autonomy in choosing a companion, and insufficient information regarding accompanying rules. Furthermore, a notable percentage did not have their fetus's heartbeat checked or receive intravenous treatment. This suggests that inadequate care and lack of autonomy may be linked to experiences of violence. A large proportion of women were not instructed to avoid eating or drinking, were not offered drinks by staff, and were forced into a supine position. High percentages of women also reported discomfort, fear of medical staff behavior, and a lack of privacy. The strong associations between violence and factors like childbirth period, type of childbirth, instructions on eating/drinking, forced supine position, and experiences of discomfort and fear emphasize that the circumstances and treatment during delivery significantly impact women's well-being and their susceptibility to experiencing violence. Finally, in the post-childbirth period, a substantial number of women did not hold their baby in the delivery room, were not notified about breastfeeding, or did not receive topical cleaning. This highlights how post-delivery care and outcomes can be intertwined with experiences of violence. Obstetric violence in Syria appears shaped by cultural norms, systemic constraints, and strained health services in a conflict-affected context. Addressing these gaps requires provider training in respectful care, improved communication and consent practices, guaranteed labour companionship, and integration of bereavement and psychosocial support. Future research should focus on women lived experiences and context-specific strategies to promote respectful maternity care as a human right.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthor contributions statement: R.F conceived, designed the study and analyzed the data.\u0026nbsp;\u003ca href=\"https://r.ad/\" target=\"_blank\" title=\"https://r.ad/\"\u003eR.AD\u003c/a\u003e and S.AM contributed to the literature review. A.K provided critical feedback and helped shape the research. A.Y supervised the research project, provided guidance throughout the study, and critically reviewed the manuscript. All authors collected data and contributed to the writing of the manuscript, read, and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eEthical Approval and consent to participate: The study received ethical approval from Faculty of Medicine, Homs university. The study adhered to the ethical standards of national and institutional committees overlooking human research and the principles announced in the Helsinki Declaration.\u003cbr\u003e\u0026nbsp;Consent for publication: This study does not include the publication of any individual\u0026apos;s personal data, including images, videos, or other identifiable information. All data presented in this study are anonymized and aggregated, ensuring that no participant can be identified.\u0026nbsp;\u003cbr\u003e\u0026nbsp;Availability data and materials. All research materials used in this study were included.\u003cbr\u003e\u0026nbsp;Competing interest. The authors declare that they have no competing interests.\u003cbr\u003e\u0026nbsp;Funding. The authors received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge and thank who have contributed to data collection of this study:\u003c/p\u003e\n\u003cp\u003eBaraa Mohammad Firas Manaa - Faculty of Medicine - Aleppo University\u003c/p\u003e\n\u003cp\u003e([email protected])\u003c/p\u003e\n\u003cp\u003eAlaa Abdullah Al Abdul Rahman - Faculty of Medicine - Al Hwash University\u003c/p\u003e\n\u003cp\u003e([email protected])\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNimi T, Fraga S, Costa D, Campos P, Barros H. Prevalence, determinants, and effects of violence during pregnancy: a maternity-based cross-sectional study in Luanda, Angola. 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European Journal of Obstetrics \u0026amp; Gynecology and Reproductive Biology. 2025;305:285-91.\u003c/li\u003e\n\u003cli\u003eSuttora C, Nardozza O, Menab\u0026ograve; L, Preti E, Passaquindici I, Fasolo M, et al. Development and validation of the Disrespect and Mistreatment during Childbirth Questionnaire: risk factors and effects on parenting stress. Frontiers in Psychology. 2025;16:1562679.\u003c/li\u003e\n\u003cli\u003eJackson KT, Larose S, Mantler T. Accessing trauma-and violence-informed breastfeeding support from primary care providers among women with histories of intimate partner violence: An exploratory interpretive description study. Canadian Journal of Nursing Research. 2025;57(2):177-87.\u003c/li\u003e\n\u003cli\u003eGlover A, Holman C, Boise P. Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice. 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Open Journal of Nursing. 2020;10(03):277.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Obstetric violence, Childbirth, Labor and delivery, Maternal health, Cross-sectional study.","lastPublishedDoi":"10.21203/rs.3.rs-7557296/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7557296/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction\u003c/p\u003e\u003cp\u003eViolence against pregnant women has become a public health issue and a violation of human rights. It has been observed in every social, cultural, economic, and religious group. Pregnant victims of violence often describe being choked, scalded, forced out of moving cars, punched, kicked, shoved downstairs, threatened with knives, and having things thrown at them. The WHO statement has highlighted the elimination of obstetric violence toward women during childbirth because it contradicts human rights principles and threatens their right to life, physical, mental, and moral integrity, as well as freedom from discrimination. We aimed to find out how often obstetric violence happens in Syria, what kinds of abuse women face during pregnancy, birth, and after delivery, and which factors are connected to a higher risk of experiencing it.\u003c/p\u003e\u003cp\u003eMethods\u003c/p\u003e\u003cp\u003e In this cross-sectional study, we publicized an online survey across Syria utilizing official social media platforms, including Facebook, WhatsApp, Instagram, and Telegram, in order to check how aware women are of obstetric violence, and check out the quality of healthcare provided during delivery in hospitals. The questionnaire was also distributed in public places such as parks and streets in urban and rural areas to check inclusivity and representativeness. The data collection employed both chain-referral sampling and convenience sampling methods.\u003c/p\u003e\u003cp\u003eResults\u003c/p\u003e\u003cp\u003eThe sample included 1229 women, most of whom were between 26 and 30 years old. There was a significant association between exposure to violence and age, education, and number of pregnancies. Doctors delivered most women (84.8%). (47.2%) were forced into a supine position. (21.6%) experienced discomfort and fear of any word/phrase/behavior mentioned or done by the medical staff, and (22.2%) did not feel private during the childbirth.\u003c/p\u003e\u003cp\u003eConclusion\u003c/p\u003e\u003cp\u003eIt was indicated that many women experience violence committed by healthcare providers before, during, and after labor without realizing it. As a result of their ignorance of their rights, violence is more\u003c/p\u003e\u003cp\u003eprevalent among these women. As a recommendation, to expand on the rights, humanitarian organizations should dedicate more efforts and launch campaigns to raise awareness of violence among other women.\u003c/p\u003e","manuscriptTitle":"The Prevalence of Obstetric Violence Against Women During Pregnancy and After Delivery in Syria: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 08:50:41","doi":"10.21203/rs.3.rs-7557296/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-29T18:43:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-23T11:49:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"331552333175127832190383764541906293547","date":"2025-12-15T13:06:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-28T17:31:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148005608931471350589677113190028924124","date":"2025-10-11T18:43:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-13T13:33:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-11T18:23:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-10T08:50:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-10T08:48:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-09-07T15:22:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a1e3b709-eea4-458e-901b-f3c1406e0d0a","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T16:00:24+00:00","versionOfRecord":{"articleIdentity":"rs-7557296","link":"https://doi.org/10.1186/s12884-026-08776-0","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2026-02-09 15:57:26","publishedOnDateReadable":"February 9th, 2026"},"versionCreatedAt":"2025-09-22 08:50:41","video":"","vorDoi":"10.1186/s12884-026-08776-0","vorDoiUrl":"https://doi.org/10.1186/s12884-026-08776-0","workflowStages":[]},"version":"v1","identity":"rs-7557296","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7557296","identity":"rs-7557296","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}