'They did not care for me. I was alone on bed like a dead person': A qualitative study on mistreatment, dignity and power during childbirth in Nepal.

Mistreatment during institutional childbirth is multifactorial and can have a detrimental effect on women's health and future care-seeking behaviour. Understanding its determinants is essential for improving respectful maternity care. This study aimed to explore women's experiences of mistreatment during childbirth in Nepal. Sixteen in-depth interviews were conducted with women who had recently given birth in a tertiary health facility (between 5 and 16 weeks postpartum). Participants were selected using purposive sampling to ensure a heterogenous sample. Data were analysed using Nvivo12, following Braun and Clarke's thematic analysis approach. Four themes were identified: (1) mistreatment and undignified care, (2) health system constraints, (3) adverse hospital culture, (4) power and territorial display. Mistreatment and undignified care included abuse, threats, neglect, inadequate communication, painful medical procedures and lack of autonomy. Health system constraints included inadequate resources and overcrowding. Adverse hospital culture was characterised by work stress among health professionals, a rigid hierarchical structure and the normalisation of mistreatment practices. Power and territoriality were evident in an atmosphere of fear for women with restricted companionship during birth. Favorable institutional strategies and tailored interventions are needed to eliminate solitary births and to provide women-centered respectful care by motivated and competent health professionals.