Labour companionship and respectful treatment of women during childbirth: a cross-sectional study across 16 hospitals in Benin, Malawi, Tanzania and Uganda.

Introduction: Evidence suggests that women value and benefit from having a labour companion during childbirth. However, the applicability of the evidence to low-income and lower-middle-income countries is limited and varies. Thus, we assessed the association between the presence of labour companions and mistreatment in 16 hospitals of Benin, Malawi, Tanzania and Uganda. Methods: We conducted a cross-sectional survey using a validated questionnaire administered to women at discharge after birth between December 2021 and March 2024. The main outcomes were factor-weighted respectful treatment score and its subscores on maintained respect and dignity, privacy and maintained confidentiality and no physical and verbal abuse. The independent variable was labour companionship. We assessed the association between labour companionship and mistreatment using a linear regression model with fixed effects and cluster robust standard errors. Results: Of the 4006 included women, 39% (n=1573) had a companion during labour and/or birth. Women across the four countries and regardless of companions' presence reported high degrees of maintained privacy and confidentiality (subscores ranging between 9.5/10 in Benin to 9.9/10 in Malawi). The presence of a labour companion was significantly associated with the absence of physical and verbal abuse experiences (β=0.07; p=0.004; 95% CI: 0.02; 0.12). Conclusions: Our study adds evidence on the positive relation between labour companionship and physical and verbal abuse. The coverage of labour companionship was low across the four countries. We call for the implementation of labour companionship to allow for greater benefits of this practice.