JOHANNESBURG (AP) — A new report says more than one-third of women in four low-income countries in Africa and Asia were slapped, mocked, forcibly treated or otherwise abused during childbirth in health centers.

The study published Wednesday in The Lancet medical journal says women in Nigeria, Myanmar, Ghana and Guinea also experienced high rates of cesarean sections and surgical cuts to the vagina without their consent.

The study led by the World Health Organization followed more than 2,000 women during labor and interviewed more than 2,600 women after childbirth.

Some 42% reported physical or verbal abuse or discrimination during childbirth. The study says younger, less-educated women are at risk of mistreatment including neglect or the use of force during procedures.

Some women were detained afterward for not being able to pay the bill.

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