More than one-third of new mothers in four poor countries are abused during childbirth, a study published Wednesday in the medical journal The Lancet.

The study, carried out in Ghana, Guinea, Myanmar and Nigeria by the World Health Organization, found that 42% of the women experienced physical or verbal abuse or some form of stigma or discrimination at maternity health facilities.

The study also found a high number of caesarean sections, vaginal exams and other procedures being performed without the patient's consent.

Of the 2,016 women observed for the study, 14% said they were either hit, slapped or punched during childbirth. Some 38% of the women said they were subjected to verbal abuse, most often by being shouted at, mocked or scolded.

An alarming 75% had episiotomies performed without consent. The procedure involves surgically enlarging the opening of the vagina.

The authors of the study urged officials to hold those who mistreat women during childbirth accountable. They also urged the governments to put into place clear policies and sufficient resources to ensure that women have a safe place to give birth.

Among the specific steps proposed by the study are: making sure all medical procedures are performed only after getting an informed consent; allowing the patient to have a companion of their choice in the delivery room; redesigning maternity wards to offer the maximum privacy; and making sure no health facility tolerates instances of physical or verbal abuse.