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Maternal healthcare services use in Mwanza Region, Tanzania: a cross-sectional baseline survey. BMC Pregnancy Childbirth 2019; 19:474. [PMID: 31805887 PMCID: PMC6896688 DOI: 10.1186/s12884-019-2653-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/29/2019] [Indexed: 02/03/2023] Open
Abstract
Background Improving maternal health by reducing maternal mortality/morbidity relates to Goal 3 of the Sustainable Development Goals. Achieving this goal is supported by antenatal care (ANC), health facility delivery, and postpartum care. This study aimed to understand levels of use and correlates of uptake of maternal healthcare services among women of reproductive age (15–49 years) in Mwanza Region, Tanzania. Methods A cross-sectional multi-stage sampling household survey was conducted to obtain data from 1476 households in six districts of Mwanza Region. Data for the 409 women who delivered in the 2 years before the survey were analyzed for three outcomes: four or more ANC visits (ANC4+), health facility delivery, and postpartum visits. Factors associated with the three outcomes were determined using generalized estimating equations to account for clustering at the district level while adjusting for all variables. Results Of the 409 eligible women, 58.2% attended ANC4+, 76.8% delivered in a health facility, and 43.5% attended a postpartum clinic. Women from peri-urban, island, and rural regions were less likely to have completed ANC4+ or health facility delivery compared with urban women. Education and early first antenatal visit were associated with ANC4+ and health facility delivery. Mothers from peri-urban areas and those who with health facility delivery were more likely to attend postpartum check-ups. Conclusion Use of ANC services in early pregnancy influences the number of ANC visits, leading to higher uptake of ANC4+ and health facility delivery. Postpartum check-ups for mothers and newborns are associated with health facility delivery. Encouraging early initiation of ANC visits may increase the uptake of maternal healthcare services.
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Orpin J, Puthussery S, Burden B. Healthcare providers' perspectives of disrespect and abuse in maternity care facilities in Nigeria: a qualitative study. Int J Public Health 2019; 64:1291-1299. [PMID: 31673736 PMCID: PMC6867981 DOI: 10.1007/s00038-019-01306-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 06/22/2019] [Accepted: 10/04/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives To explore healthcare providers’ perspectives of disrespect and abuse in maternity care and the impact on women’s health and well-being.
Methods Qualitative interpretive approach using in-depth semi-structured interviews with sixteen healthcare providers in two public health facilities in Nigeria. Interviews were audio-recorded, transcribed, and analysed thematically. Results Healthcare providers’ accounts revealed awareness of what respectful maternity care encompassed in accordance with the existing guidelines. They considered disrespectful and abusive practices perpetrated or witnessed as violation of human rights, while highlighting women’s expectations of care as the basis for subjectivity of experiences. They perceived some practices as well-intended to ensure safety of mother and baby. Views reflected underlying gender-related notions and societal perceptions of women being considered weaker than men. There was recognition about adverse effects of disrespect and abuse including its impact on women, babies, and providers’ job satisfaction. Conclusions Healthcare providers need training on how to incorporate elements of respectful maternity care into practice including skills for rapport building and counselling. Women and family members should be educated about right to respectful care empowering them to report disrespectful practices.
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Affiliation(s)
- Joy Orpin
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire LU2 8LE UK
| | - Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire LU2 8LE UK
| | - Barbara Burden
- School of Health Care Practice, University of Bedfordshire, Luton, Bedfordshire UK
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Mselle LT, Kohi TW, Dol J. Humanizing birth in Tanzania: a qualitative study on the (mis) treatment of women during childbirth from the perspective of mothers and fathers. BMC Pregnancy Childbirth 2019; 19:231. [PMID: 31277609 PMCID: PMC6612108 DOI: 10.1186/s12884-019-2385-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/27/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While there has been a trend for greater number of women to deliver at health facilities across Tanzania, mothers and their family members continue to face mistreatment with respectful maternity care during childbirth being violated. The objective of this study was to describe the experience of mothers and fathers in relation to (mis) treatment during childbirth in Tanzania. METHODS Using a qualitative descriptive design, 12 semi-structured interviews and four focus group discussions were held with mothers and fathers who were attending a postnatal clinic in the Lake Zone region of Tanzania. Mothers' age ranged from 20 to 45 years whereas fathers' age ranged from 25 to 60 years. Data were analyzed using a priori coding based on Bohren's et al. typology of the mistreatment of women during childbirth. RESULTS Mothers reported facing mistreatment and disrespectful maternity care through verbal abuse (harsh or rude language and judgmental or accusatory comments), failure to meet professional standards of care (refused pain relief, unconsented surgical operations, neglect, abandonment or long delays, and skilled attendant absent at time of delivery), poor rapport between women and providers (poor communication, lack of supportive care, denied husbands presence at birth, denied mobility, denied safe traditional practices, no respect for their preferred birth positions), and health system conditions and constraints (poor physical condition of facilities, supply constraints, bribery and extortion, unclear fee structures). Despite some poor care, some mothers also reported positive birthing experiences and respectful maternity care by having a skilled attendant assistance at delivery, having good communication from nurses, receiving supportive care from nurses and privacy during delivery. CONCLUSION Despite the increasing number of deliveries occurring in the hospital, there continue to be challenges in providing respectful maternity care. Humanizing birth care in Tanzania continues to have a long way to go, however, there is evidence that changes are occurring as mothers notice and report positive changes in delivery care practices.
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Affiliation(s)
- Lilian T Mselle
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Thecla W Kohi
- School of Medicine, St. Joseph College of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Justine Dol
- Faculty of Health, Dalhousie University, Halifax, Canada
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LeFevre AE, Scott K, Mohan D, Shah N, Bhatnagar A, Labrique A, Dhar D, Chamberlain S, Ved R. Development of a Phone Survey Tool to Measure Respectful Maternity Care During Pregnancy and Childbirth in India: Study Protocol. JMIR Res Protoc 2019; 8:e12173. [PMID: 31021329 PMCID: PMC6658236 DOI: 10.2196/12173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/08/2019] [Accepted: 01/20/2019] [Indexed: 01/19/2023] Open
Abstract
Background Respectful maternity care (RMC) is a key barometer of the underlying quality of care women receive during pregnancy and childbirth. Efforts to measure RMC have largely been qualitative, although validated quantitative tools are emerging. Available tools have been limited to the measurement of RMC during childbirth and confined to observational and face-to-face survey modes. Phone surveys are less invasive, low cost, and rapid alternatives to traditional face-to-face methods, yet little is known about their validity and reliability. Objective The primary objective of this study was to develop validated face-to-face and phone survey tools for measuring RMC during pregnancy and childbirth for use in India and other low resource settings. The secondary objective was to optimize strategies for improving the delivery of phone surveys for use in measuring RMC. Methods To develop face-to-face and phone surveys for measuring RMC, we describe procedures for assessing content, criterion, and construct validity as well as reliability analyses. To optimize the delivery of phone surveys, we outline plans for substudies, which aim to assess the effect of survey modality, and content on survey response, completion, and attrition rates. Results Data collection will be carried out in 4 districts of Madhya Pradesh, India, from July 2018 to March 2019. Conclusions To our knowledge, this is the first RMC phone survey tool developed for India, which may provide an opportunity for the rapid, routine collection of data essential for improving the quality of care during pregnancy and childbirth. Elsewhere, phone survey tools are emerging; however, efforts to develop these surveys are often not inclusive of rigorous pretesting activities essential for ensuring quality data, including cognitive, reliability, and validity testing. In the absence of these activities, emerging data could overestimate or underestimate the burden of disease and health care practices under assessment. In the context of RMC, poor quality data could have adverse consequences including the naming and shaming of providers. By outlining a blueprint of the minimum activities required to generate reliable and valid survey tools, we hope to improve efforts to develop and deploy face-to-face and phone surveys in the health sector. International Registered Report Identifier (IRRID) DERR1-10.2196/12173
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Affiliation(s)
- Amnesty E LeFevre
- Division of Epidemiology and Biostatistics , School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Neha Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Diva Dhar
- Bill and Melinda Gates Foundation, New Delhi, India
| | | | - Rajani Ved
- National Health Systems Resource Center, Delhi, India
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Larson E, Geldsetzer P, Mboggo E, Lema IA, Sando D, Ekström AM, Fawzi W, Foster DW, Kilewo C, Li N, Machumi L, Magesa L, Mujinja P, Mungure E, Mwanyika-Sando M, Naburi H, Siril H, Spiegelman D, Ulenga N, Bärnighausen T. The effect of a community health worker intervention on public satisfaction: evidence from an unregistered outcome in a cluster-randomized controlled trial in Dar es Salaam, Tanzania. HUMAN RESOURCES FOR HEALTH 2019; 17:23. [PMID: 30922341 PMCID: PMC6440091 DOI: 10.1186/s12960-019-0355-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/17/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is a dearth of evidence on the causal effects of different care delivery approaches on health system satisfaction. A better understanding of public satisfaction with the health system is particularly important within the context of task shifting to community health workers (CHWs). This paper determines the effects of a CHW program focused on maternal health services on public satisfaction with the health system among women who are pregnant or have recently delivered. METHODS From January 2013 to April 2014, we carried out a cluster-randomized controlled health system implementation trial of a CHW program. Sixty wards in Dar es Salaam, Tanzania, were randomly allocated to either a maternal health CHW program (36 wards) or the standard of care (24 wards). From May to August 2014, we interviewed a random sample of women who were either currently pregnant or had recently delivered a child. We used five-level Likert scales to assess women's satisfaction with the CHW program and with the public-sector health system in Dar es Salaam. RESULTS In total, 2329 women participated in the survey (response rate 90.2%). Households in intervention areas were 2.3 times as likely as households in control areas to have ever received a CHW visit (95% CI 1.8, 3.0). The intervention led to a 16-percentage-point increase in women reporting they were satisfied or very satisfied with the CHW program (95% CI 3, 30) and a 15-percentage-point increase in satisfaction with the public-sector health system (95% CI 3, 27). CONCLUSIONS A CHW program for maternal and child health in Tanzania achieved better public satisfaction than the standard CHW program. Policy-makers and implementers who are involved in designing and organizing CHW programs should consider the potential positive impact of the program on public satisfaction. TRIAL REGISTRATION ClinicalTrials.gov, EJF22802.
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Affiliation(s)
- Elysia Larson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Building 1, 11th floor, Boston, MA 02115 United States of America
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Building 1, 11th floor, Boston, MA 02115 United States of America
| | - Eric Mboggo
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - David Sando
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Building 1, 11th floor, Boston, MA 02115 United States of America
| | - Anna Mia Ekström
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Building 1, 11th floor, Boston, MA 02115 United States of America
| | - Dawn W. Foster
- Department of Psychiatry, Yale School of Medicine, New Haven, United States of America
| | - Charles Kilewo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nan Li
- Janssen Research & Development, LLC, Raritan, United States of America
| | - Lameck Machumi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Lucy Magesa
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Phares Mujinja
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ester Mungure
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Helga Naburi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hellen Siril
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Donna Spiegelman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United States of America
- Center for Methods on Implementation and Prevention Science and Department if Biostatistics, Yale School of Public Health, New Haven, CT USA
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Bishanga DR, Massenga J, Mwanamsangu AH, Kim YM, George J, Kapologwe NA, Zoungrana J, Rwegasira M, Kols A, Hill K, Rijken MJ, Stekelenburg J. Women's Experience of Facility-Based Childbirth Care and Receipt of an Early Postnatal Check for Herself and Her Newborn in Northwestern Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030481. [PMID: 30736396 PMCID: PMC6388277 DOI: 10.3390/ijerph16030481] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 11/23/2022]
Abstract
Negative experiences of care may act as a deterrent to current and/or future utilization of facility-based health services. To examine the situation in Tanzania, we conducted a sub-analysis of a cross-sectional household survey conducted in April 2016 in the Mara and Kagera regions of Tanzania. The sample included 732 women aged 15–49 years who had given birth in a health facility during the previous two years. Log binomial regression models were used to investigate the association between women’s experiences of care during childbirth and the receipt of early postnatal checks before discharge. Overall, 73.1% of women reported disrespect and abuse, 60.1% were offered a birth companion, 29.1% had a choice of birth position, and 85.5% rated facility cleanliness as good. About half of mothers (46.3%) and newborns (51.4%) received early postnatal checks before discharge. Early postnatal checks for both mothers and newborns were associated with no disrespect and abuse (RR: 1.23 and 1.14, respectively) and facility cleanliness (RR: 1.29 and 1.54, respectively). Early postnatal checks for mothers were also associated with choice of birth position (RR: 1.18). The results suggest that a missed opportunity in providing an early postnatal check is an indication of poor quality of the continuum of care for mothers and newborns. Improved quality of care at one stage can predict better care in subsequent stages.
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Affiliation(s)
- Dunstan R Bishanga
- Jhpiego Tanzania, Dar es Salaam, Tanzania.
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
| | | | | | | | - John George
- USAID's Maternal and Child Survival Program/Jhpiego Tanzania, Dar es Salaam, Tanzania.
| | - Ntuli A Kapologwe
- President's Office-Regional Administration and Local Government, Dodoma, Tanzania.
| | | | | | | | - Kathleen Hill
- USAID's Maternal and Child Survival Program/Jhpiego, Baltimore, MD 21231, USA.
| | - Marcus J Rijken
- Department of Obstetrics and Gynecology, Division of Woman and Baby, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, 8934 AD Leeuwarden, The Netherlands.
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Dynes MM, Binzen S, Twentyman E, Nguyen H, Lobis S, Mwakatundu N, Chaote P, Serbanescu F. Client and provider factors associated with companionship during labor and birth in Kigoma Region, Tanzania. Midwifery 2019; 69:92-101. [PMID: 30453122 PMCID: PMC11019777 DOI: 10.1016/j.midw.2018.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/25/2018] [Accepted: 11/04/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Labor and birth companionship is a key aspect of respectful maternity care. Lack of companionship deters women from accessing facility-based delivery care, though formal and informal policies against companionship are common in sub-Saharan African countries. AIM To identify client and provider factors associated with labor and birth companionship DESIGN: Cross-sectional evaluation among delivery clients and providers in 61 health facilities in Kigoma Region, Tanzania, April-July 2016. METHODS Multilevel, mixed effects logistic regression analyses were conducted on linked data from providers (n = 249) and delivery clients (n = 935). Outcome variables were Companion in labor and Companion at the time of birth. FINDINGS Less than half of women reported having a labor companion (44.7%) and 12% reported having a birth companion. Among providers, 26.1% and 10.0% reported allowing a labor and birth companion, respectively. Clients had significantly greater odds of having a labor companion if their provider reported the following traits: working more than 55 hours/week (aOR 2.46, 95% CI 1.23-4.97), feeling very satisfied with their job (aOR 3.66, 95% CI 1.36-9.85), and allowing women to have a labor companion (aOR 3.73, 95% CI 1.58-8.81). Clients had significantly lower odds of having a labor companion if their provider reported having an on-site supervisor (aOR 0.48, 95% CI 0.24-0.95). Clients had significantly greater odds of having a birth companion if they self-reported labor complications (aOR 2.82, 95% CI 1.02-7.81) and had a labor companion (aOR 44.74, 95% CI 11.99-166.91). Clients had significantly greater odds of having a birth companion if their provider attended more than 10 deliveries in the last month (aOR 3.43, 95% CI 1.08-10.96) compared to fewer deliveries. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These results suggest that health providers are the gatekeepers of companionship, and the work environment influences providers' allowance of companionship. Facilities where providers experience staff shortages and high workload may be particularly responsive to programmatic interventions that aim to increase staff acceptance of birth companionship.
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Affiliation(s)
- Michelle M Dynes
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta 30341, GA, USA.
| | - Susanna Binzen
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta 30341, GA, USA.
| | - Evelyn Twentyman
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta 30341, GA, USA.
| | - Hannah Nguyen
- Emory University, 201 Dowman Dr, Atlanta 30322, GA, USA.
| | - Samantha Lobis
- Vital Strategies, 61 Broadway #1010, New York 10006, NY, USA.
| | | | - Paul Chaote
- Regional Medical Officer, Kigoma Town, Tanzania
| | - Florina Serbanescu
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta 30341, GA, USA.
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O'Connor M, McGowan K, Jolivet RR. An awareness-raising framework for global health networks: lessons learned from a qualitative case study in respectful maternity care. Reprod Health 2019; 16:1. [PMID: 30621726 PMCID: PMC6323747 DOI: 10.1186/s12978-018-0662-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 12/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background The increase in global health networks as mechanisms for improving health and affecting social change has been recognized as a key component of the global health landscape today. To successfully raise awareness of shared causes, global health networks need tools to help them plan successful campaigns and evaluate the impact of their work, as well as to coordinate and reinforce each other’s efforts. One global health network, the Respectful Maternity Care (RMC) Global Council, can be credited with raising the profile of the issues of disrespect and abuse (D&A) in childbirth and the need for RMC within global maternal health. We set out to learn from the work of the RMC Global Council and the RMC movement at large to develop a tool—a framework for planning and evaluating awareness-raising efforts—useful for networks focused on global health and human rights. Methods We reviewed the literature for theoretical models on awareness raising and, finding a lack of appropriate tools, developed a new, draft framework using components of the Framework for Effective Campaigns, the SpitFire SmartChart 3.0, and Network Theory. We conducted semi-structured interviews with members of the RMC Global Council to validate the draft framework and identify any additional strategies or tactics that were used during their efforts to raise awareness of D&A and RMC. We also interviewed “influenced” individuals to validate inputs from the influencers and determine the key documents, events, individuals, and organizations that made the greatest contribution to the increased awareness of D&A/RMC. Data were analyzed using deductive and inductive qualitative research methods. Results The validated awareness-raising framework includes five strategies that characterize a successful awareness-raising effort. Each strategy has a set of tactics that can operationalize those strategies. Each tactic is classified as essential, helpful, or variable based on the number of key informants who utilized it. Conclusion This case study offers an example of how global health networks can create a movement that effects change at global and local levels by providing an empirically-grounded framework to help plan, coordinate, and evaluate future campaigns designed to raise awareness and create momentum in global health, human rights, and quality of care. Electronic supplementary material The online version of this article (10.1186/s12978-018-0662-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Meaghan O'Connor
- Maternal Health Task Force, Women and Health Initiative, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, Boston, MA, 02115, USA.
| | - Kayla McGowan
- Maternal Health Task Force, Women and Health Initiative, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, Boston, MA, 02115, USA
| | - R Rima Jolivet
- Maternal Health Task Force, Women and Health Initiative, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, Boston, MA, 02115, USA
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Sociodemographic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.100164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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60
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Bohren MA, Vogel JP, Fawole B, Maya ET, Maung TM, Baldé MD, Oyeniran AA, Ogunlade M, Adu-Bonsaffoh K, Mon NO, Diallo BA, Bangoura A, Adanu R, Landoulsi S, Gülmezoglu AM, Tunçalp Ö. Methodological development of tools to measure how women are treated during facility-based childbirth in four countries: labor observation and community survey. BMC Med Res Methodol 2018; 18:132. [PMID: 30442102 PMCID: PMC6238369 DOI: 10.1186/s12874-018-0603-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/01/2018] [Indexed: 01/10/2023] Open
Abstract
Background Efforts to improve maternal health are increasingly focused on improving the quality of care provided to women at health facilities, including the promotion of respectful care and eliminating mistreatment of women during childbirth. A WHO-led multi-country research project aims to develop and validate two tools (labor observation and community survey) to measure how women are treated during facility-based childbirth. This paper describes the development process for these measurement tools, and how they were implemented in a multi-country study (Ghana, Guinea, Myanmar and Nigeria). Methods An iterative mixed-methods approach was used to develop two measurement tools. Methodological development was conducted in four steps: (1) initial tool development; (2) validity testing, item adjustment and piloting of paper-based tools; (3) conversion to digital, tablet-based tools; and (4) data collection and analysis. These steps included systematic reviews, primary qualitative research, mapping of existing tools, item consolidation, peer review by key stakeholders and piloting. Results The development, structure, administration format, and implementation of the labor observation and community survey tools are described. For the labor observations, a total of 2016 women participated: 408 in Nigeria, 682 in Guinea, and 926 in Ghana. For the community survey, a total of 2672 women participated: 561 in Nigeria, 644 in Guinea, 836 in Ghana, and 631 in Myanmar. Of the 2016 women who participated in the labor observations, 1536 women (76.2%) also participated in the community survey and have linked data: 779 in Ghana, 425 in Guinea, and 332 in Nigeria. Conclusions An important step to improve the quality of maternity care is to understand the magnitude and burden of mistreatment across contexts. Researchers and healthcare providers in maternal health are encouraged to use and implement these tools, to inform the development of more women-centered, respectful maternity healthcare services. By measuring the prevalence of mistreatment of women during childbirth, we will be able to design and implement programs and policies to transform maternity services. Electronic supplementary material The online version of this article (10.1186/s12874-018-0603-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Meghan A Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, 1211, Geneva, Switzerland. .,Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, 3053, Australia.
| | - Joshua P Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, 1211, Geneva, Switzerland
| | - Bukola Fawole
- Department of Obstetrics and Gynecology, National Institute of Maternal and Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ernest T Maya
- School of Public Health, University of Ghana, Accra, Ghana
| | | | - Mamadou Diouldé Baldé
- Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea.,Faculté de Médecine, Pharmacie et Odontostomatologie, Université G.A. Nasser de Conakry, Conakry, Guinea
| | - Agnes A Oyeniran
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Modupe Ogunlade
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Nwe Oo Mon
- Department of Medical Research, Yangon, Myanmar
| | - Boubacar Alpha Diallo
- Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea.,Faculté de Médecine, Pharmacie et Odontostomatologie, Université G.A. Nasser de Conakry, Conakry, Guinea
| | - Abou Bangoura
- Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea.,Département de sociologie, Université Sonfonia, Conakry, Guinea
| | - Richard Adanu
- School of Public Health, University of Ghana, Accra, Ghana
| | - Sihem Landoulsi
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, 1211, Geneva, Switzerland
| | - A Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, 1211, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, 1211, Geneva, Switzerland
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Erchafo B, Alaro T, Tsega G, Adamu A, Yitbarek K, Siraneh Y, Hailu M, Woldie M. Are we too far from being client centered? PLoS One 2018; 13:e0205681. [PMID: 30321212 PMCID: PMC6188795 DOI: 10.1371/journal.pone.0205681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background Quality of service provision in health facilities is fundamental to ensure effective care. However, women’s actual experience of care is often neglected. Objective To assess perceived quality of institutional delivery services and associated factors among women who delivered in public health facilities of Southwest Ethiopia. Method Community based cross-sectional study was conducted in three districts of Jimma zone, Southwestern Ethiopia, from February 29 to March 20, 2016. A total of 423 mothers who delivered in public health facilities during the last 12 months were selected to participate in the study. Study participants were identified using simple random sampling procedure. Principal component analysis was used to generate scores for three sub-dimensions of perceived quality. Multiple linear regression analysis was performed to identify predictors of these sub-dimensions. Results Perceived quality of institutional delivery services was measured with three dimensions: perceived interpersonal interaction, health care delivery and health facility/structure. We found that perceived quality of interpersonal interaction was negatively affected by educational level (read and write) (β: -0.331, 95% CI: -0.523, -0.140), urban residence (β: -0.485, 95% CI: -0.696, -0.275), antenatal care (less than three visits) (β: -0.238, 95% CI: -0.419,-0.056) and delivery service attended by male provider (β: -1.286, 95% CI: -1.463,-1.109). Perceived quality of health care delivery was negatively associated with still birth (β: -0.642, 95% CI: -1.092,-0.193) and delivery services attended by male provider (β: -0.689, 95% CI: -0.907,-0.472). Urban residence (β: -0.260, 95% CI: -0.515,-0.005), and antenatal care (less than three visits) (β: -0.394, 95% CI: -0.628,-0.161) were negatively associated with perceived quality of health facility/structure. Conclusion Overall, the perceived quality of institutional delivery services was low. We recommend that health managers and health care providers jointly work to transform birth care at the health facilities to deliver person-centered care. Addressing the preferences of clients is as important as taking care of structural concerns pinpointed in this study.
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Affiliation(s)
- Belay Erchafo
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Tesfamichael Alaro
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Gebeyehu Tsega
- Department of Health Service Management, College of Public Health, Bahirdar University, Bahirdar, Ethiopia
| | - Ayinengida Adamu
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Yibeltal Siraneh
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Meaza Hailu
- Health Service Quality Division, Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
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Wilson-Mitchell K, Eustace L, Robinson J, Shemdoe A, Simba S. Overview of literature on RMC and applications to Tanzania. Reprod Health 2018; 15:167. [PMID: 30285782 PMCID: PMC6171292 DOI: 10.1186/s12978-018-0599-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 09/03/2018] [Indexed: 11/25/2022] Open
Abstract
Respectful maternity care research in Tanzania continues to increase. This is an overview of the literature summarizing research based on the domains which comprise this quality of care indicator, ranging from exploratory and descriptive to quantitative measurements of birth perinatal outcomes when respectful interventions are made. The domains of respectful care are reflected in the seven Universal Rights of Childbearing Women but go further to implicate facility administrators and policy makers to provide supportive infrastructure to allay disrespect and abuse.The research methodologies continue to be problematic and several ethical cautions restrict how much control is possible. Similarly, the barriers to collecting accurate accounts in qualitative studies of disrespect require astute interviewing and observation techniques. The participatory community-based and the critical sociology and human rights frameworks appear to provide a good basis for both researcher and participants to identify problems and determine possible solutions to the multiple factors that contribute to disrespect and abuse. The work-life conditions of midwives in the Global South are plagued with poor infrastructure and significantly low resources which deters respectful care while decreasing retention of workers. Researchers and policy-makers have addressed disrespectful care by building human resource capacity, by strengthening professional organizations and by educating midwives in low-resource countries. Furthermore, researchers encourage midwives not only to acquire attitudinal change and to adopt respectful maternity care skills, but also to emerge as leaders and change agents.Safe methods for conducting care while addressing low resources, skilled management of conflict and creative innovations to engage the community are all interventions that are being considered for quality improvement research. Tanzania is poised to evaluate the outcomes of education workshops that address all seven domains of respectful care.
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Affiliation(s)
- Karline Wilson-Mitchell
- Midwifery Education Program, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - Lucia Eustace
- Tanzanian Midwives Association, P.O. Box 65524, Muhimbili Dar Es Salaam, Tanzania
| | - Jamie Robinson
- Canadian Association of Midwives, 2330 Notre-Dame W., Suite 300, Montreal,, Quebec H3J 1N4 Canada
| | - Aloisia Shemdoe
- Tanzanian Midwives Association, P.O. Box 65524, Muhimbili Dar Es Salaam, Tanzania
| | - Stephano Simba
- Tanzanian Midwives Association, P.O. Box 65524, Muhimbili Dar Es Salaam, Tanzania
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Mbatia R, Cohen J, Zuakulu M, Bukuku A, Chandarana S, Eliakimu E, Moshi S, Larson E. Basic Accountability to Stop Ill-Treatment (BASI); Study Protocol for a Cluster Randomized Controlled Trial in Rural Tanzania. Front Public Health 2018; 6:273. [PMID: 30320053 PMCID: PMC6165889 DOI: 10.3389/fpubh.2018.00273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/03/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Poor health system experiences negatively affect the lives of poor people throughout the world. In East Africa, there is a growing body of evidence of poor quality care that in some cases is so poor that it is disrespectful or abusive. This study will assess whether community feedback through report cards (with and without non-financial rewards) can improve patient experience, which includes aspects of patient dignity, autonomy, confidentiality, communication, timely attention, quality of basic amenities, and social support. Methods/Design: This cluster-randomized controlled study will randomize 75 primary health care facilities in rural Pwani Region, Tanzania to one of three arms: private feedback (intervention), social recognition reward through public reporting (intervention), or no feedback (control). Within both intervention arms, we will give the providers at the study facilities feedback on the quality of patient experience the facility provides (aggregate results from all providers) using data from patient surveys. The quality indicators that we report will address specific experiences, be observable by patients, fall into well-identified domains of patient experience, and be within the realm of action by healthcare providers. For example, we will measure the proportion of patients who report that providers definitely “explained things in a way that was easy to understand.” This feedback will be delivered by a medical doctor to all the providers at the facility in a small group session. A formal discussion guide will be used. Facilities randomized to the social recognition intervention reward arm will have two additional opportunities for social recognition. First, a poster that displays their achieved level of patient experience will be publicly posted at the health facility and village government offices. Second, recognition from senior officials at the local NGO and/or the Ministry of Health will be given to the facility with the best or most-improved patient experience ratings at endline. We will use surveys with parents/guardians of sick children to measure patient experience, and surveys with healthcare providers to assess potential mechanisms of effect. Conclusion: Results from this study will provide evidence for whether, and through what mechanisms, patient reported feedback can affect interpersonal quality of care. Pan African Clinical Trials Registry (PACTR): 201710002649121 Protocol version 7, November 8, 2017
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Affiliation(s)
| | - Jessica Cohen
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Martin Zuakulu
- Tanzania Health Promotion Support (THPS), Msasani, Tanzania
| | | | - Shikha Chandarana
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Eliudi Eliakimu
- Ministry of Health, Community Development, Gender, Elderly and Children-MoHCDGEC, Dodoma, Tanzania
| | - Sisty Moshi
- Tanzania Health Promotion Support (THPS), Msasani, Tanzania
| | - Elysia Larson
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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Abuya T, Sripad P, Ritter J, Ndwiga C, Warren CE. Measuring mistreatment of women throughout the birthing process: implications for quality of care assessments. REPRODUCTIVE HEALTH MATTERS 2018; 26:48-61. [DOI: 10.1080/09688080.2018.1502018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - Pooja Sripad
- Associate, Population Council, Washington, DC, 20008, USA
| | - Julie Ritter
- Program Manager, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Charity Ndwiga
- Senior Program Officer, Population Council, Nairobi, Kenya
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Freedman LP, Kujawski SA, Mbuyita S, Kuwawenaruwa A, Kruk ME, Ramsey K, Mbaruku G. Eye of the beholder? Observation versus self-report in the measurement of disrespect and abuse during facility-based childbirth. REPRODUCTIVE HEALTH MATTERS 2018; 26:107-122. [PMID: 30199353 DOI: 10.1080/09688080.2018.1502024] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Human rights has been a vital tool in the global movement to reduce maternal mortality and to expose the disrespect and abuse that women experience during childbirth in facilities around the world. Yet to truly transform the relationship between women and providers, human rights-based approaches (HRBAs) will need to go beyond articulation, dissemination and even legal enforcement of formal norms of respectful maternity care. HRBAs must also develop a deeper, more nuanced understanding of how power operates in health systems under particular social, cultural and political conditions, if they are to effectively challenge settled patterns of behaviour and health systems structures that marginalise and abuse. In this paper, we report results from a mixed methods study in two hospitals in the Tanga region of Tanzania, comparing the prevalence of disrespect and abuse during childbirth as measured through observation by trained nurses stationed in maternity wards to prevalence as measured by the self-report upon discharge of the same women who had been observed. The huge disparity between these two measures (baseline: 69.83% observation vs. 9.91% self-report; endline: 32.91% observation vs. 7.59% self-report) suggests that disrespect and abuse is both internalised and normalised by users and providers alike. Building on qualitative research conducted in the study sites, we explore the mechanisms by which hidden and invisible power enforces internalisation and normalisation, and describe the implications for the development of HRBAs in maternal health.
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Affiliation(s)
- Lynn P Freedman
- a Professor of Population and Family Health and Director, Averting Maternal Death and Disability Program , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Stephanie A Kujawski
- b Researcher, Department of Epidemiology , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Selemani Mbuyita
- c Research Scientist , Ifakara Health Institute , Dar es Salaam , Tanzania
| | | | - Margaret E Kruk
- e Associate Professor of Health Policy and Management , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Kate Ramsey
- f Senior Research Officer, Averting Maternal Death and Disability Program , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Godfrey Mbaruku
- g Chief Research Scientist , Ifakara Health Institute , Dar es Salaam , Tanzania
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Wesson J, Hamunime N, Viadro C, Carlough M, Katjiuanjo P, McQuide P, Kalimugogo P. Provider and client perspectives on maternity care in Namibia: results from two cross-sectional studies. BMC Pregnancy Childbirth 2018; 18:363. [PMID: 30185161 PMCID: PMC6126026 DOI: 10.1186/s12884-018-1999-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/28/2018] [Indexed: 12/30/2022] Open
Abstract
Background Disrespectful and abusive maternity care is a complex phenomenon. In Namibia, HIV and high maternal mortality ratios make it vital to understand factors affecting maternity care quality. We report on two studies commissioned by Namibia’s Ministry of Health and Social Services. A health worker study examined cultural and structural factors that influence maternity care workers’ attitudes and practices, and a maternal and neonatal mortality study explored community perceptions about maternity care. Methods The health worker study involved medical officers, matrons, and registered or enrolled nurses working in Namibia’s 35 district and referral hospitals. The study included a survey (N = 281) and 19 focus group discussions. The community study conducted 12 focus groups in five southern regions with recently delivered mothers and relatives. Results Most participants in the health worker study were experienced maternity care nurses. One-third (31%) of survey respondents reported witnessing or knowing of client mistreatment at their hospital, about half (49%) agreed that “sometimes you have to yell at a woman in labor,” and a third (30%) agreed that pinching or slapping a laboring woman can make her push harder. Nurses were much more likely to agree with these statements than medical officers. Health workers’ commitment to babies’ welfare and stressful workloads were the two primary reasons cited to justify “harsh” behaviors. Respondents who were dissatisfied with their workload were twice as likely to approve of pinching or slapping. Half of the nurses surveyed (versus 14% of medical officers) reported providing care above or beneath their scope of work. The community focus group study identified 14 negative practices affecting clients’ maternity care experiences, including both systemic and health-worker-related practices. Conclusions Namibia’s public sector hospital maternity units confront health workers and clients with structural and cultural impediments to quality care. Negative interactions between health workers and laboring women were reported as common, despite high health worker commitment to babies’ welfare. Key recommendations include multicomponent interventions that address heavy workloads and other structural factors, educate communities and the media about maternity care and health workers’ roles, incorporate client-centered care into preservice education, and ensure ongoing health worker mentoring and supervision. Electronic supplementary material The online version of this article (10.1186/s12884-018-1999-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Wesson
- IntraHealth International, 6340 Quadrangle Drive, Suite 200, Chapel Hill, NC, USA.
| | - Ndapewa Hamunime
- Ministry of Health and Social Services, Windhoek, Private Bag 13198, Namibia
| | | | - Martha Carlough
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Puumue Katjiuanjo
- Ministry of Health and Social Services, Windhoek, Private Bag 13198, Namibia
| | - Pamela McQuide
- IntraHealth International, 351 Dr. Sam Nujoma Dr., Klein Windhoek, Windhoek, Namibia
| | - Pearl Kalimugogo
- IntraHealth International, 351 Dr. Sam Nujoma Dr., Klein Windhoek, Windhoek, Namibia
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John TW, Mkoka DA, Frumence G, Goicolea I. An account for barriers and strategies in fulfilling women's right to quality maternal health care: a qualitative study from rural Tanzania. BMC Pregnancy Childbirth 2018; 18:352. [PMID: 30165838 PMCID: PMC6117932 DOI: 10.1186/s12884-018-1990-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 08/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background Tanzania has ratified and abides to legal treaties indicating the obligation of the state to provide essential maternal health care as a basic human right. Nevertheless, the quality of maternal health care is disproportionately low. The current study sets to understand maternal health services’ delivery from the perspective of rural health workers’, and to understand barriers for and better strategies for realization of the right to quality maternal health care. Methods Semi-structured in-depth interviews were conducted, involving 11 health workers mainly; medical attendants, enrolled nurses and Assistant Medical Officers from primary health facilities in rural Tanzania. Structured observation complemented data from interviews. Interview data were analyzed using thematic analysis guided by the conceptual framework of the right to health. Results Three themes emerged that reflected health workers’ opinion towards the quality of health care services; “It’s hard to respect women’s preferences”, “Striving to fulfill women’s needs with limited resources”, and “Trying to facilitate women’s access to services at the face of transport and cost barriers”. Conclusion Health system has left health workers as frustrated right holders, as well as dis-empowered duty bearers. This was due to the unavailability of adequate material and human resources, lack of motivation and lack of supervision, which are essential for provision of quality maternal health care services. Pregnant women, users of health services, appeared to be also left as frustrated right holders, who incurred out-of-pocket costs to pay for services, which were meant to be provided free.
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Affiliation(s)
- Thomas Wiswa John
- Health Department, Mkinga District Council, Po. Box 6005, Tanga, Tanzania.
| | - Dickson Ally Mkoka
- Department of Clinical Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gasto Frumence
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Isabel Goicolea
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, 901 85, Umeå, Sweden
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Maya ET, Adu-Bonsaffoh K, Dako-Gyeke P, Badzi C, Vogel JP, Bohren MA, Adanu R. Women’s perspectives of mistreatment during childbirth at health facilities in Ghana: findings from a qualitative study. REPRODUCTIVE HEALTH MATTERS 2018; 26:70-87. [DOI: 10.1080/09688080.2018.1502020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Ernest T Maya
- Lecturer, School of Public Health, University of Ghana, Accra, Ghana
| | - Kwame Adu-Bonsaffoh
- Lecturer, Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Phyllis Dako-Gyeke
- Senior Lecturer, School of Public Health, University of Ghana, Accra, Ghana
| | - Caroline Badzi
- PhD candidate, School of Public Health, University of Ghana, Accra, Ghana
| | - Joshua P Vogel
- Technical Officer, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A Bohren
- Research Consultant, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Richard Adanu
- Professor and Dean, School of Public Health, University of Ghana, Accra, Ghana
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Sokol-Hessner L, Folcarelli PH, Annas CL, Brown SM, Fernandez L, Roche SD, Sarnoff Lee B, Sands KE, Atlas T, Benoit DD, Burke GF, Butler TP, Federico F, Gandhi T, Geller G, Hickson GB, Hoying C, Lee TH, Reynolds ME, Rozenblum R, Turner K. A Road Map for Advancing the Practice of Respect in Health Care: The Results of an Interdisciplinary Modified Delphi Consensus Study. Jt Comm J Qual Patient Saf 2018; 44:463-476. [DOI: 10.1016/j.jcjq.2018.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/14/2018] [Indexed: 10/28/2022]
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Shimpuku Y, Madeni FE, Horiuchi S, Kubota K, Leshabari SC. Evaluation of a family-oriented antenatal group educational program in rural Tanzania: a pre-test/post-test study. Reprod Health 2018; 15:117. [PMID: 29954398 PMCID: PMC6025829 DOI: 10.1186/s12978-018-0562-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 06/18/2018] [Indexed: 11/18/2022] Open
Abstract
Background To increase births attended by skilled birth attendants in Tanzania, studies have identified the need for involvement of the whole family in pregnancy and childbirth education. This study aimed to develop, implement, and evaluate a family-oriented antenatal group educational program to promote healthy pregnancy and family involvement in rural Tanzania. Methods This was a quasi-experimental 1 group pre-test/post-test study with antenatal education provided to pregnant women and their families in rural Tanzania. Before and after the educational program, the pre-test/post-test study was conducted using a 34-item Birth Preparedness Questionnaire. Acceptability of the educational program was qualitatively assessed. Results One-hundred and thirty-eight participants (42 pregnant women, 96 family members) attended the educational program, answered the questionnaire, and participated in the feasibility inquiry. The mean knowledge scores significantly increased between the pre-test and the post-test, 7.92 and 8.33, respectively (p = 0.001). For both pregnant women and family members, the educational program improved Family Support (p = 0.001 and p = 0.000) and Preparation of Money and Food (p = 0.000 and p = 0.000). For family members, the scores for Birth Preparedness (p = 0.006) and Avoidance of Medical Intervention (reversed item) (p = 0.002) significantly increased. Despite the educational program, the score for Home-based Value (reversed item) (p = 0.022) and References of SBA (p = 0.049) decreased in pregnant women. Through group discussions, favorable comments about the program and materials were received. The comments of the husbands reflected their better understanding and appreciation of their role in supporting their wives during the antenatal period. Conclusions The family-oriented antenatal group educational program has potential to increase knowledge, birth preparedness, and awareness of the need for family support among pregnant women and their families in rural Tanzania. As the contents of the program can be taught easily by reading the picture drama, lay personnel, such as community health workers or traditional birth attendants, can use it in villages. Further development of the Birth Preparedness Questionnaire is necessary to strengthen the involved factors. A larger scale study with a more robust Birth Preparedness Questionnaire and documentation of skilled care use is needed for the next step. Trial registration No.2013–273-NA-2013-101. Registered 12 August 2013.
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Affiliation(s)
- Yoko Shimpuku
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Frida E Madeni
- Magunga District Hospital, P. O. Box 430, Old-Korogwe, Tanga, Tanzania
| | - Shigeko Horiuchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kazumi Kubota
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Sebalda C Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences, P. O. Box 65169, Dar es Salaam, Tanzania
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Orpin J, Puthussery S, Davidson R, Burden B. Women's experiences of disrespect and abuse in maternity care facilities in Benue State, Nigeria. BMC Pregnancy Childbirth 2018; 18:213. [PMID: 29879944 PMCID: PMC5992700 DOI: 10.1186/s12884-018-1847-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Disrespect and abuse (D&A) of women in health facilities continues to be a prevailing public health issue in many countries. Studies have reported significantly high prevalence of D&A among women during pregnancy and childbirth in Nigeria, but little is known about women’s perceptions and experiences of D&A during maternity care in the country. The aim of this study was to explore: 1) how women perceived their experiences of D&A during pregnancy, childbirth, and in the postnatal period in Benue State, Nigeria; and 2) how women viewed the impact of D&A on the future use of health facilities for maternity care. Method Five focus group discussions with a sample of 32 women were conducted as part of a qualitative phenomenological study. All the women received maternity care in health facilities in Benue State, Nigeria and had experienced at least one incident of disrespect and abuse. Audio-recorded discussions were transcribed and analysed using a six-stage thematic analysis using NVivo11. Results The participants perceived incidents such as being shouted at and the use of abusive language as a common practice. Women described these incidents as devaluing and dehumanising to their sense of dignity. Some women perceived that professionals did not intend to cause harm by such behaviours. Emerged themes included: (1) ‘normative’ practice; (2) dehumanisation of women; (3) 'no harm intended' and (4) intentions about the use of maternity services in future. The women highlighted the importance of accessing health facilities for safe childbirth and expressed that the experiences of D&A may not impact their intended use of health facilities. However, the accounts reflected their perceptions about the inherent lack of choice and an underlying sense of helplessness. Conclusion Incidents of D&A that were perceived as commonplace carry substantial implications for the provision of respectful maternity care in Nigeria and other similar settings. As a country with one of the highest rates of maternal deaths, the findings point to the need for policy and practice to address the issue urgently through implementing preventive measures, including empowering women to reinforce their right to be treated with dignity and respect, and sensitising health care professionals.
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Affiliation(s)
- Joy Orpin
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK
| | - Shuby Puthussery
- School of Health Care Practice & Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK.
| | - Rosemary Davidson
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK
| | - Barbara Burden
- School of Health Care Practice & Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK
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Sjödin M, Rådestad I, Zwedberg S. A qualitative study showing women’s participation and empowerment in instrumental vaginal births. Women Birth 2018; 31:e185-e189. [DOI: 10.1016/j.wombi.2017.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 07/12/2017] [Accepted: 09/08/2017] [Indexed: 11/29/2022]
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Banks KP, Karim AM, Ratcliffe HL, Betemariam W, Langer A. Jeopardizing quality at the frontline of healthcare: prevalence and risk factors for disrespect and abuse during facility-based childbirth in Ethiopia. Health Policy Plan 2018; 33:317-327. [PMID: 29309598 PMCID: PMC5886294 DOI: 10.1093/heapol/czx180] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/13/2022] Open
Abstract
Disrespect and abuse (D&A) experienced by women during facility-based childbirth has gained global recognition as a threat to eliminating preventable maternal mortality and morbidity. This study explored the frequency and associated factors of D&A in four rural health centres in Ethiopia. Experiences of women who delivered in these facilities were captured by direct observation of client-provider interaction (N = 193) and exit interview at time of discharge (N = 204). Incidence of D&A was observed in each facility, with failure to ask woman for preferred birth position most commonly observed [n = 162, 83.9%, 95% confidence interval (95% CI) 78.0-88.5%]. During exit interviews, 21.1% (n = 43, 95% CI 15.4-26.7%) of respondents reported at least one occurrence of D&A. Bivariate models using client characteristics and index birth experience showed that women's reporting of D&A was significantly associated with childbirth complications [odds ratio (OR) = 7.98, 95% CI 3.70, 17.22], weekend delivery (OR = 0.17, 95% CI 0.05, 0.63) and no previous delivery at the facility (OR = 3.20, 95% CI 1.27, 8.05). Facility-level fixed-effect models found that experience of complications (OR = 15.51, 95% CI 4.38, 54.94) and weekend delivery (OR = 0.05, 95% CI 0.01-0.32) remained significantly and most strongly associated with self-reported D&A. These data suggest that addressing D&A in health centres in Ethiopia will require a sustained effort to improve infrastructure, support the health workforce in rural settings, enforce professional standards and target interventions to improve women's experiences as part of quality of care initiatives.
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Affiliation(s)
- Kathleen P Banks
- Department of Global Health and Population, Women and Health Initiative, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB 7th Floor, Boston, MA 02115, USA
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown Building, 3rd Floor, Boston, MA 02118, USA
| | - Ali M Karim
- JSI Research & Training Institute Inc., The Last Ten Kilometers Project, 44 Farnsworth St, Boston, MA 02210, USA, and
| | - Hannah L Ratcliffe
- Department of Global Health and Population, Women and Health Initiative, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB 7th Floor, Boston, MA 02115, USA
- Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA 02215, USA
| | - Wuleta Betemariam
- JSI Research & Training Institute Inc., The Last Ten Kilometers Project, 44 Farnsworth St, Boston, MA 02210, USA, and
| | - Ana Langer
- Department of Global Health and Population, Women and Health Initiative, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB 7th Floor, Boston, MA 02115, USA
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Mesenburg MA, Victora CG, Jacob Serruya S, Ponce de León R, Damaso AH, Domingues MR, da Silveira MF. Disrespect and abuse of women during the process of childbirth in the 2015 Pelotas birth cohort. Reprod Health 2018; 15:54. [PMID: 29587802 PMCID: PMC5870181 DOI: 10.1186/s12978-018-0495-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/12/2018] [Indexed: 11/26/2022] Open
Abstract
Background The disrespect and abuse of women during the process of childbirth is an emergent and global problem and only few studies have investigated this worrying issue. The objective of the present study was to describe the prevalence of disrespect and abuse of women during childbirth in Pelotas City, Brazil, and to investigate the factors involved. Methods This was a cross-sectional population-based study of women delivering members of the 2015 Pelotas birth cohort. Information relating to disrespect and abuse during childbirth was obtained by household interview 3 months after delivery. The information related to verbal and physical abuse, denial of care and invasive and/or inappropriate procedures. Poisson regression was used to evaluate the factors associated with one or more, and two or more, types of disrespectful treatment or abuse. Results A total of 4275 women took part in a perinatal study. During the three-month follow-up, we interviewed 4087 biological mothers with regards to disrespect and abuse. Approximately 10% of women reported having experienced verbal abuse, 6% denial of care, 6% undesirable or inappropriate procedures and 5% physical abuse. At least one type of disrespect or abuse was reported by 18.3% of mothers (95% confidence interval [CI]: 17.2–19.5); and at least two types by 5.1% (95% CI: 4.4–5.8). Women relying on the public health sector, and those whose childbirths were via cesarean section with previous labor, had the highest risk, with approximately a three- and two-fold increase in risk, respectively. Conclusions Our study showed that the occurrence of disrespect and abuse during childbirth was high and mostly associated with payment by the public sector and labor before delivery. The efforts made by civil society, governments and international organizations are not sufficient to restrain institutional violence against women during childbirth. To eradicate this problem, it is essential to 1) implement policies and actions specific for this type of violence and 2) formulate laws to promote the equality of rights between women and men, with particular emphasis on the economic rights of women and the promotion of gender equality in terms of access to jobs and education.
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Affiliation(s)
| | - Cesar Gomes Victora
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Suzzane Jacob Serruya
- Latin American Center of Perinatology, Women and Reproductive Health, Montevideo, Uruguay
| | - Rodolfo Ponce de León
- Latin American Center of Perinatology, Women and Reproductive Health, Montevideo, Uruguay
| | - Andrea Homsi Damaso
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Dynes MM, Twentyman E, Kelly L, Maro G, Msuya AA, Dominico S, Chaote P, Rusibamayila R, Serbanescu F. Patient and provider determinants for receipt of three dimensions of respectful maternity care in Kigoma Region, Tanzania-April-July, 2016. Reprod Health 2018; 15:41. [PMID: 29506559 PMCID: PMC5838967 DOI: 10.1186/s12978-018-0486-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lack of respectful maternity care (RMC) is increasingly recognized as a human rights issue and a key deterrent to women seeking facility-based deliveries. Ensuring facility-based RMC is essential for improving maternal and neonatal health, especially in sub-Saharan African countries where mortality and non-skilled delivery care remain high. Few studies have attempted to quantitatively identify patient and delivery factors associated with RMC, and none has modeled the influence of provider characteristics on RMC. This study aims to help fill these gaps through collection and analysis of interviews linked between clients and providers, allowing for description of both patient and provider characteristics and their association with receipt of RMC. METHODS We conducted cross-sectional surveys across 61 facilities in Kigoma Region, Tanzania, from April to July 2016. Measures of RMC were developed using 21-items in a Principal Components Analysis (PCA). We conducted multilevel, mixed effects generalized linear regression analyses on matched data from 249 providers and 935 post-delivery clients. The outcomes of interest included three dimensions of RMC-Friendliness/Comfort/Attention; Information/Consent; and Non-abuse/Kindness-developed from the first three components of PCA. Significance level was set at p < 0.05. RESULTS Significant client-level determinants for perceived Friendliness/Comfort/Attention RMC included age (30-39 versus 15-19 years: Coefficient [Coef] 0.63; 40-49 versus 15-19 years: Coef 0.79) and self-reported complications (reported complications versus did not: Coef - 0.41). Significant provider-level determinants included perception of fair pay (Perceives fair pay versus unfair pay: Coef 0.46), cadre (Nurses/midwives versus Clinicians: Coef - 0.46), and number of deliveries in the last month (11-20 versus < 11 deliveries: Coef - 0.35). Significant client-level determinants for Information/Consent RMC included labor companionship (Companion versus none: Coef 0.37) and religiosity (Attends services at least weekly versus less often: Coef - 0.31). Significant provider-level determinants included perception of fair pay (Perceives fair pay versus unfair: Coef 0.37), weekly work hours (Coef 0.01), and age (30-39 versus 20-29 years: Coef - 0.34; 40-49 versus 20-29 years: Coef - 0.58). Significant provider-level determinants for Non-abuse/Kindness RMC included the predictors of age (age 50+ versus 20-29 years: Coef 0.34) and access to electronic mentoring (Access to two mentoring types versus none: Coef 0.37). CONCLUSIONS These findings illustrate the value of including both client and provider information in the analysis of RMC. Strategies that address provider-level determinants of RMC (such as equitable pay, work environment, access to mentoring platforms) may improve RMC and subsequently address uptake of facility delivery.
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Affiliation(s)
- M. M. Dynes
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - E. Twentyman
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - L. Kelly
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - G. Maro
- Bloomberg Philanthropies Tanzania, Kigoma, Tanzania
| | | | | | - P. Chaote
- Kigoma Region Ministry of Health, Kigoma, Tanzania
| | - R. Rusibamayila
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - F. Serbanescu
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
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Jackson R, Hailemariam A. The Role of Health Extension Workers in Linking Pregnant Women With Health Facilities for Delivery in Rural and Pastoralist Areas of Ethiopia. Ethiop J Health Sci 2018; 26:471-478. [PMID: 28446853 PMCID: PMC5389062 DOI: 10.4314/ejhs.v26i5.9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Women's preference to give birth at home is deeply embedded in Ethiopian culture. Many women only go to health facilities if they have complications during birth. Health Extension Workers (HEWs) have been deployed to improve the utilization of maternal health services by bridging the gap between communities and health facilities. This study examined the barriers and facilitators for HEWs as they refer women to mid-level health facilities for birth. Methods A qualitative study was conducted in three regions: Afar Region, Southern Nations Nationalities and People's Region and Tigray Region between March to December 2014. Interviews and focus group discussions were conducted with 45 HEWs, 14 women extension workers (employed by Afar Pastoralist Development Association, Afar Region) and 11 other health workers from health centers, hospitals or health offices. Data analysis was done based on collating the data and identifying key themes. Results Barriers to health facilities included distance, lack of transportation, sociocultural factors and disrespectful care. Facilitators for facility-based deliveries included liaising with Health Development Army (HDA) leaders to refer women before their expected due date or if labour starts at home; the introduction of ambulance services; and, provision of health services that are culturally more acceptable for women. Conclusion HEWs can effectively refer more women to give birth in health facilities when the HDA is well established, when health staff provide respectful care, and when ambulance is available at any time.
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Affiliation(s)
- Ruth Jackson
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Australia
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Shimoda K, Horiuchi S, Leshabari S, Shimpuku Y. Midwives' respect and disrespect of women during facility-based childbirth in urban Tanzania: a qualitative study. Reprod Health 2018; 15:8. [PMID: 29321051 PMCID: PMC5763614 DOI: 10.1186/s12978-017-0447-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 12/20/2017] [Indexed: 11/17/2022] Open
Abstract
Background Over the last two decades, facility-based childbirths in Tanzania have only minimally increased by 10% partly because of healthcare providers’ disrespect and abuse (D&A) of women during childbirth. Although numerous studies have substantiated women’s experience of D&A during childbirth by healthcare providers, few have focused on how D&A occurred during the midwives’ actual care. This study aimed to describe from actual observations the respectful and disrespectful care received by women from midwives during their labor period in two hospitals in urban Tanzania. Methods This descriptive qualitative study involved naturalistic observation of two health facilities in urban Tanzania. Fourteen midwives were purposively recruited for the one-on-one shadowing of their care of 24 women in labor from admission to the fourth stage of labor. Observations of their midwifery care were analyzed using content analysis. Results All the 14 midwives showed both respectful and disrespectful care and some practices that have not been explicated in previous reports of women’s experiences. For respectful care, five categories were identified: 1) positive interactions between midwives and women, 2) respect for women’s privacy, 3) provision of safe and timely midwifery care for delivery, 4) active engagement in women’s labor process, and 5) encouragement of the mother-baby relationship. For disrespectful care, five categories were recognized: 1) physical abuse, 2) psychological abuse, 3) non-confidential care, 4) non-consented care, and 5) abandonment of care. Two additional categories emerged from the unprioritized and disorganized nursing and midwifery management: 1) lack of accountability and 2) unethical clinical practices. Conclusions Both respectful care and disrespectful care of midwives were observed in the two health facilities in urban Tanzania. Several types of physical and psychological abuse that have not been reported were observed. Weak nursing and midwifery management was found to be a contributor to the D&A of women. To promote respectful care of women, pre-service and in-service trainings, improvement of working conditions and environment, empowering pregnant women, and strengthening health policies are crucial.
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Affiliation(s)
- Kana Shimoda
- St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan.
| | - Shigeko Horiuchi
- St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan.,St. Luke's Birth Clinic, 1-24 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Sebalda Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences, P.O. Box 65004, Dar es Salaam, Tanzania
| | - Yoko Shimpuku
- St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
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Sibley LM, Amare Y, Abebe ST, Belew ML, Shiffra K, Barry D. Appropriateness and timeliness of care-seeking for complications of pregnancy and childbirth in rural Ethiopia: a case study of the Maternal and Newborn Health in Ethiopia Partnership. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2017; 36:50. [PMID: 29297394 PMCID: PMC5764048 DOI: 10.1186/s41043-017-0120-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND In 2014, USAID and University Research Co., LLC, initiated a new project under the broader Translating Research into Action portfolio of projects. This new project was entitled Systematic Documentation of Illness Recognition and Appropriate Care Seeking for Maternal and Newborn Complications. This project used a common protocol involving descriptive mixed-methods case studies of community projects in six low- and middle-income countries, including Ethiopia. In this paper, we present the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) case study. METHODS Methods included secondary analysis of data from MaNHEP's 2010 baseline and 2012 end line surveys, health program inventory and facility mapping to contextualize care-seeking, and illness narratives to identify factors influencing illness recognition and care-seeking. Analyses used descriptive statistics, bivariate tests, multivariate logistic regression, and thematic content analysis. RESULTS Maternal illness awareness increased between 2010 and 2012 for major obstetric complications. In 2012, 45% of women who experienced a major complication sought biomedical care. Factors associated with care-seeking were MaNHEP CMNH Family Meetings, health facility birth, birth with a skilled provider, or health extension worker. Between 2012 and 2014, the Ministry of Health introduced nationwide initiatives including performance review, ambulance service, increased posting of midwives, pregnant women's conferences, user-friendly services, and maternal death surveillance. By 2014, most facilities were able to provide emergency obstetric and newborn care. Yet in 2014, biomedical care-seeking for perceived maternal illness occurred more often compared with care-seeking for newborn illness-a difference notable in cases in which the mother or newborn died. Most families sought care within 1 day of illness recognition. Facilitating factors were health extension worker advice and ability to refer upward, and health facility proximity; impeding factors were time of day, weather, road conditions, distance, poor cell phone connectivity (to call for an ambulance), lack of transportation or money for transport, perceived spiritual or physical vulnerability of the mother and newborn and associated culturally determined postnatal restrictions on the mother or newborn's movement outside of the home, and preference for traditional care. Some families sought care despite disrespectful, poor quality care. CONCLUSIONS Improvements in illness recognition and care-seeking observed during MaNHEP have been reinforced since that time and appear to be successful. There is still need for a concerted effort focusing on reducing identified barriers, improve quality of care and provider counseling, and contextualize messaging behavior change communications and provider counseling.
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Affiliation(s)
- Lynn M. Sibley
- Nell Hodgson Woodruff School of Nursing and Rollins School of Public Health, Emory University, Atlanta, GA 30322 USA
| | - Yared Amare
- Consultancy for Social Development, Addis Ababa, Ethiopia
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Bohren MA, Titiloye MA, Kyaddondo D, Hunter EC, Oladapo OT, Tunçalp Ö, Byamugisha J, Olutayo AO, Vogel JP, Gülmezoglu AM, Fawole B, Mugerwa K. Defining quality of care during childbirth from the perspectives of Nigerian and Ugandan women: A qualitative study. Int J Gynaecol Obstet 2017; 139 Suppl 1:4-16. [DOI: 10.1002/ijgo.12378] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Meghan A. Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction Department of Reproductive Health and Research WHO Geneva Switzerland
| | - Musibau A. Titiloye
- Department of Health Promotion and Education Faculty of Public Health College of Medicine University of Ibadan Ibadan Nigeria
| | - David Kyaddondo
- Child Health and Development Centre College of Health Sciences Makerere University Kampala Uganda
| | - Erin C. Hunter
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction Department of Reproductive Health and Research WHO Geneva Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction Department of Reproductive Health and Research WHO Geneva Switzerland
| | | | - Akinpelu O. Olutayo
- Department of Sociology Faculty of the Social Sciences University of Ibadan Ibadan Nigeria
| | - Joshua P. Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction Department of Reproductive Health and Research WHO Geneva Switzerland
| | - A. Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction Department of Reproductive Health and Research WHO Geneva Switzerland
| | - Bukola Fawole
- Department of Obstetrics and Gynecology College of Medicine University of Ibadan Ibadan Nigeria
| | - Kidza Mugerwa
- Department of Obstetrics and Gynecology Makerere University Kampala Uganda
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Vedam S, Stoll K, Rubashkin N, Martin K, Miller-Vedam Z, Hayes-Klein H, Jolicoeur G. The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth. SSM Popul Health 2017; 3:201-210. [PMID: 29349217 PMCID: PMC5768993 DOI: 10.1016/j.ssmph.2017.01.005] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Abuse of human rights in childbirth are documented in low, middle and high resource countries. A systematic review across 34 countries by the WHO Research Group on the Treatment of Women During Childbirth concluded that there is no consensus at a global level on how disrespectful maternity care is measured. In British Columbia, a community-led participatory action research team developed a survey tool that assesses women's experiences with maternity care, including disrespect and discrimination. METHODS A cross-sectional survey was completed by women of childbearing age from diverse communities across British Columbia. Several items (31/130) assessed characteristics of their communication with care providers. We assessed the psychometric properties of two versions of a scale (7 and 14 items), among women who described experiences with a single maternity provider (n=2514 experiences among 1672 women). We also calculated the proportion and selected characteristics of women who scored in the bottom 10th percentile (those who experienced the least respectful care). RESULTS To demonstrate replicability, we report psychometric results separately for three samples of women (S1 and S2) (n=2271), (S3, n=1613). Analysis of item-to-total correlations and factor loadings indicated a single construct 14-item scale, which we named the Mothers on Respect index (MORi). Items in MORi assess the nature of respectful patient-provider interactions and their impact on a person's sense of comfort, behavior, and perceptions of racism or discrimination. The scale exhibited good internal consistency reliability. MORi- scores among these samples differed by socio-demographic profile, health status, experience with interventions and mode of birth, planned and actual place of birth, and type of provider. CONCLUSION The MOR index is a reliable, patient-informed quality and safety indicator that can be applied across jurisdictions to assess the nature of provider-patient relationships, and access to person-centered maternity care.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Research Lab, Division of Midwifery, University of British Columbia, 5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
| | - Kathrin Stoll
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Nicholas Rubashkin
- Department of Global Health Sciences, University of California San Francisco, Mission Hall Building, 550 – 16th Street, 3rd Floor, San Francisco, CA 94158, USA
- Department of Obstetrics and Gynecology, University of California San Francisco, Mission Hall Building, 550 – 16th Street, 3rd Floor, San Francisco, CA 94158, USA
| | - Kelsey Martin
- Birth Place Research Lab, Division of Midwifery, University of British Columbia, 5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
| | - Zoe Miller-Vedam
- Human Rights in Childbirth, 6312 SW Capitol Highway St, 234 Portland, OR 97239, USA
| | - Hermine Hayes-Klein
- Human Rights in Childbirth, 6312 SW Capitol Highway St, 234 Portland, OR 97239, USA
| | - Ganga Jolicoeur
- Midwives Association of British Columbia, 2-175 E. 15th Avenue, Vancouver, BC, Canada V5T 2P6
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Sibley L, Amare Y. Illness recognition and care seeking for maternal complications of pregnancy and birth in rural Amhara and Oromia Regional States of Ethiopia. BMC Pregnancy Childbirth 2017; 17:384. [PMID: 29145815 PMCID: PMC5691869 DOI: 10.1186/s12884-017-1572-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Ethiopia has made steady progress in improving maternal health over the decade, yet mortality remains high. The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) was a 3.5-year project aimed at developing a community-oriented model to improve maternal and newborn survival in rural Ethiopia. Two years after the project ended, we carried out a case study to explore illness recognition and care seeking for complications of pregnancy and childbirth in the project area. This paper describes the results of one component: illness narratives. Methods Sampling involved random selection of 12 health facilities from 6 MaNHEP project districts in Amhara and >Oromia regions, and purposive selection of cases from the facility catchment areas. The purposive sample included 17 cases of perceived excessive bleeding, 5 cases of maternal death from any cause, and witnesses to the illness events. Two-person teams facilitated the narrative interviews. Analysis included thematic content analysis of symptoms, causes, decision makers and decision-making, factors facilitating and impeding care seeking, and delineation of care-seeking steps. Results Most surviving mothers (and witnesses) perceived the symptoms and seriousness of excessive bleeding; a majority (53%) sought timely biomedical care. Three of five families of mothers who died from causes unrelated to bleeding failed to initially perceive symptoms as serious, yet all sought timely appropriate care once they did so. Many of these families took multiple steps to obtain care, leading to delays.. Health worker counseling and proximity to health services facilitated, while certain cultural norms, economic, geographic, and environmental constraints impeded care seeking. Surprisingly, poor quality of care at health facilities was not a barrier. Conclusion Mothers and family caregivers are able to recognize and seek timely biomedical care for abnormal bleeding, and for less obvious symptoms of illness. These achievements can be reinforced through continued and focused health education and counseling, reduction of known barriers to care seeking, and improvements in the capacity of the health system to respond to maternal complications with high quality basic and comprehensive emergency obstetric care.
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Affiliation(s)
- Lynn Sibley
- Nell Hodgson Woodruff School of Nursing and Rollins School of Public Health, Emory University, 1520 Clifton Road NE, Room 268, 30322, Atlanta, Georgia.
| | - Yared Amare
- Consultancy for Social Development, P.O. Box - 70196, Addis Ababa, Ethiopia
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Dey A, Shakya HB, Chandurkar D, Kumar S, Das AK, Anthony J, Shetye M, Krishnan S, Silverman JG, Raj A. Discordance in self-report and observation data on mistreatment of women by providers during childbirth in Uttar Pradesh, India. Reprod Health 2017; 14:149. [PMID: 29141640 PMCID: PMC5688759 DOI: 10.1186/s12978-017-0409-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022] Open
Abstract
Background The study aims to assess the discordance between self-reported and observed measures of mistreatment of women during childbirth in public health facilities in Uttar Pradesh, India, as well as correlates of these measures and their discordance. Methods Cross sectional data were collected through direct observation of deliveries and follow-up interviews with women (n = 875) delivering in 81 public health facilities in Uttar Pradesh. Participants were surveyed on demographics, mistreatment during childbirth, and maternal and newborn complications. Provider characteristics (training, age) were obtained through interviews with providers, and observation data were obtained from checklists completed by trained nurse investigators to document quality of care at delivery. Mistreatment was assessed via self-report and observed measures which included 17 and 6 items respectively. Cohen’s kappas assessed concordance between the 6 items common in the self-report and observed measures. Regression models assessed associations between characteristics of women and providers for each outcome. Results Most participants (77.3%) self-reported mistreatment in at least 1 of the 17-item measure. For the 6 items included in both self-report and observations, 9.1% of women self-reported mistreatment, whereas observers reported 22.4% of women being mistreated. Cohen’s kappas indicated mostly fair to moderate concordance. Regression analyses found that multiparous birth (AOR = 1.50, 95% CI = 1.06–2.13), post-partum maternal complications (AOR = 2.0, 95% CI = 1.34–3.06); new-born complications (AOR = 2.6, 95% CI = 1. 96–4.03) and not having an Skilled Birth Attendant (SBA) trained provider (AOR = 1.47, 95% CI = 1.05–2.04) were associated with increased risk for mistreatment as measured by self-report. In contrast, only provider characteristics like older provider (AOR = 1.03, 95% CI = 1.02–1.05) and provider not trained in SBA (AOR = 1.44, 95% CI = 1.02–2.02) were associated with mistreatment as measured through observations. Younger age at marriage (AOR = 0.86, 95% CI = 0.78–0.95) and provider characteristics (older provider AOR = 1.05, 95% CI = 1.01–1.09; provider not trained in SBA AOR = 0.96, 95% CI = 0.92–0.99) were associated with discordance (based on mistreatment reported by observer but not by women). Conclusion Provider mistreatment during childbirth is prevalent in Uttar Pradesh and may be under-reported by women, particularly when they are younger or when providers are older or less trained. The findings warrant programmatic action as well as more research to better understand the context and drivers of both behavior and reporting. Trial registration CTRI/2015/09/006219. Registered 28 September 2015.
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Affiliation(s)
- Arnab Dey
- Sambodhi Research and Communications Pvt. Ltd, C-126, Sector -2, Noida, Uttar Pradesh, - 201301, India.
| | - Holly Baker Shakya
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Dharmendra Chandurkar
- Sambodhi Research and Communications Pvt. Ltd, C-126, Sector -2, Noida, Uttar Pradesh, - 201301, India
| | - Sanjiv Kumar
- India Health Action Trust, No. 13, 1st Floor. 4th Cross, N S Iyengar Street, Sheshadripuram, Bangalore, Karnataka, - 560020, India
| | - Arup Kumar Das
- India Health Action Trust, No. 13, 1st Floor. 4th Cross, N S Iyengar Street, Sheshadripuram, Bangalore, Karnataka, - 560020, India
| | - John Anthony
- India Health Action Trust, No. 13, 1st Floor. 4th Cross, N S Iyengar Street, Sheshadripuram, Bangalore, Karnataka, - 560020, India
| | - Mrunal Shetye
- Bill and Melinda Gates Foundation, 5th Floor, Capital Court, Olof Palme Marg, Munirka, New Delhi, India
| | - Suneeta Krishnan
- Bill and Melinda Gates Foundation, 5th Floor, Capital Court, Olof Palme Marg, Munirka, New Delhi, India
| | - Jay G Silverman
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla, CA, USA
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Montesinos-Segura R, Urrunaga-Pastor D, Mendoza-Chuctaya G, Taype-Rondan A, Helguero-Santin LM, Martinez-Ninanqui FW, Centeno DL, Jiménez-Meza Y, Taminche-Canayo RC, Paucar-Tito L, Villamonte-Calanche W. Disrespect and abuse during childbirth in fourteen hospitals in nine cities of Peru. Int J Gynaecol Obstet 2017; 140:184-190. [PMID: 29044510 DOI: 10.1002/ijgo.12353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/17/2017] [Accepted: 10/17/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the prevalence of disrespect and abuse during childbirth and its associated factors in Peru. METHODS In an observational cross-sectional study, women were surveyed within 48 hours of live delivery at 14 hospitals located in nine Peruvian cities between April and July 2016. The survey was based on seven categories of disrespect and abuse proposed by Bowser and Hill. To evaluate factors associated with each category, prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using adjusted Poisson models with robust variances. RESULTS Among 1528 participants, 1488 (97.4%) had experienced at least one category of disrespect and abuse. Frequency of abandonment of care was increased with cesarean delivery (PR 1.27, 95% CI 1.03-1.57) but decreased in the jungle region (PR 0.27, 0.14-0.53). Discrimination was associated with the jungle region (PR 5.67, 2.32-13.88). Physical abuse was less frequent with cesarean than vaginal delivery (PR 0.23, 0.11-0.49). The prevalences of abandonment of care (PR 0.42, 0.29-0.60), non-consented care (PR 0.70, 0.57-0.85), discrimination (PR 0.40, 0.19-0.85), and non-confidential care (PR 0.71, 0.55-0.93) were decreased among women who had been referred. CONCLUSION Nearly all participants reported having experienced at least one category of disrespect and abuse during childbirth care, which was associated with type of delivery, being referred, and geographic region.
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Affiliation(s)
- Reneé Montesinos-Segura
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
| | - Diego Urrunaga-Pastor
- Sociedad Científica de Estudiantes de Medicina de la Universidad de San Martin de Porres, Facultad de Medicina Humana, Universidad de San Martin de Porres, Lima, Peru
| | - Giuston Mendoza-Chuctaya
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
| | - Alvaro Taype-Rondan
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis M Helguero-Santin
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Piura, Facultad de Medicina Humana, Universidad Nacional de Piura, Piura, Peru
| | | | - Dercy L Centeno
- Sociedad Científica Medico Estudiantil San Cristobal, Escuela Profesional de Medicina Humana, Universidad Nacional de San Cristóbal de Huamanga, Ayacucho, Peru
| | - Yanina Jiménez-Meza
- Sociedad Científica Médico Estudiantil Continental, Facultad de Medicina Humana, Universidad Continental, Junín, Peru
| | - Ruth C Taminche-Canayo
- Sociedad Científica de estudiantes de Medicina de la Amazonía Peruana, Escuela Profesional de Medicina Humana, Universidad Nacional de la Amazonía Peruana, Iquitos, Peru
| | - Liz Paucar-Tito
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
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Savage V, Castro A. Measuring mistreatment of women during childbirth: a review of terminology and methodological approaches. Reprod Health 2017; 14:138. [PMID: 29073914 PMCID: PMC5658997 DOI: 10.1186/s12978-017-0403-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Although mistreatment of women during facility-based childbirth has received increasing recognition as a critical issue throughout the world, there remains a lack of consensus on operational definitions of mistreatment and best practices to assess the issue. Moreover, only minimal research has focused on mistreatment in Latin America and the Caribbean, a region notable for social inequalities and inequitable access to maternal health care. Methods In this article, we discuss the results of a literature review that sought to contribute to the determination of best practices in defining and measuring the mistreatment of women during childbirth, particularly within Latin America and the Caribbean. The review includes a total of 57 English, Spanish, and Portuguese-language research publications and eight legal documents that were published between 2000 and 2017. Results While the typologies of “disrespect and abuse” and “mistreatment during facility-based childbirth” are most frequently employed in global studies, “obstetric violence” remains the most commonly operationalized term in Latin America and the Caribbean in both research and policy contexts. Various researchers have advocated for the use of those three different typologies, yet the terms all share commonalities in highlighting the medicalization of natural processes of childbirth, roots in gender inequalities, parallels with violence against women, the potential for harm, and the threat to women’s rights. For measuring mistreatment, half of the research publications in this review use qualitative methods, such as in-depth interviews and focus groups. After analyzing the strengths and limitations of quantitative, qualitative, and mixed methods approaches to assessing mistreatment, we recommend mixed methods designs as the optimal strategy to evaluate mistreatment and advocate for the inclusion of direct observations that may help bridge the gap between observed measures and participants’ self-reported experiences of mistreatment. Conclusions No matter the conceptual framework used in future investigations, we recommend that studies seek to accomplish three objectives: (1) to measure the perceived and observed frequencies of mistreatment in maternal health settings, (2) to examine the macro and micro level factors that drive mistreatment, and (3) to assess the impact of mistreatment on the health outcomes of women and their newborns.
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Affiliation(s)
- Virginia Savage
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Mail Code #8319, New Orleans, LA, 70112, USA
| | - Arachu Castro
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Mail Code #8319, New Orleans, LA, 70112, USA.
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Burrowes S, Holcombe SJ, Jara D, Carter D, Smith K. Midwives' and patients' perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study. BMC Pregnancy Childbirth 2017; 17:263. [PMID: 28830383 PMCID: PMC5567643 DOI: 10.1186/s12884-017-1442-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 08/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background It is increasingly recognized that disrespect and abuse of women during labor and delivery is a violation of a woman’s rights and a deterrent to the use of life-saving, facility-based labor and delivery services. In Ethiopia, rates of skilled birth attendance are still only 28% despite a recent dramatic national scale up in the numbers of trained providers and facilities. Concerns have been raised that womens’ perceptions of poor quality of care and fear of mistreatment might contribute to this low utilization. This study examines the experiences of disrespect and abuse in maternal care from the perspectives of both providers and patients. Methods We conducted 45 in-depth interviews at four health facilities in Debre Markos, Ethiopia with midwives, midwifery students, and women who had given birth within the past year. Students and providers also took a brief quantitative survey on patients’ rights during labor and delivery and responded to clinical scenarios regarding the provision of stigmatized reproductive health services. Results We find that both health care providers and patients report frequent physical and verbal abuse as well as non-consented care during labor and delivery. Providers report that most abuse is unintended and results from weaknesses in the health system or from medical necessity. We uncovered no evidence of more systematic types of abuse involving detention of patients, bribery, abandonment or ongoing discrimination against particular ethnic groups. Although health care providers showed good basic knowledge of confidentiality, privacy, and consent, training on the principles of responsive and respectful care, and on counseling, is largely absent. Providers indicated that they would welcome related practical instruction. Patient responses suggest that women are aware that their rights are being violated and avoid facilities with reputations for poor care. Conclusions Our results suggest that training on respectful care, offered in the professional ethics modules of the national midwifery curriculum, should be strengthened to include greater focus on counseling skills and rapport-building. Our findings also indicate that addressing structural issues around provider workload should complement all interventions to improve midwives’ interpersonal interactions with women if Ethiopia is to increase provision of respectful, patient-centered maternity care. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1442-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sahai Burrowes
- Public Health Program, College of Education and Health Sciences, Touro University California, 1310 Club Dr. Mare Island, Vallejo, CA, 94592, USA.
| | - Sarah Jane Holcombe
- Bixby Center for Population, Health, and Sustainability, University of California, Berkeley 17 University Hall, Berkeley, CA, 94720-7360, USA
| | - Dube Jara
- Department of Public Health College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Danielle Carter
- Touro University California, 1310 Club Dr. Mare Island, Vallejo, CA, 94592, USA
| | - Katheryn Smith
- Touro University California, 1310 Club Dr. Mare Island, Vallejo, CA, 94592, USA
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86
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Ndwiga C, Warren CE, Ritter J, Sripad P, Abuya T. Exploring provider perspectives on respectful maternity care in Kenya: "Work with what you have". Reprod Health 2017; 14:99. [PMID: 28830492 PMCID: PMC5567891 DOI: 10.1186/s12978-017-0364-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/10/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Promoting respect and dignity is a key component of providing quality care during facility-based childbirth and is becoming a critical indicator of maternal health care. Providing quality care requires essential skills and attitudes from healthcare providers, as their role is central to optimizing interventions in maternity settings. METHODS In 13 facilities in Kenya we conducted a mixed methods, pre-post study design to assess health providers' perspectives of a multi-component intervention (the Heshima project), which aimed to mitigate aspects of disrespect and abuse during facility-based childbirth. Providers working in maternity units at study facilities were interviewed using a two-part quantitative questionnaire: an interviewer-guided section on knowledge and practice, and a self-administered section focusing on intrinsic value systems and perceptions. Eleven distinct composite scores were created on client rights and care, provider emotional wellbeing, and work environments. Bivariate analyses compared pre- and post-scores. Qualitative in-depth interviews focused on underlying factors that affected provider attitudes and behaviors including the complexities of service delivery, and perceptions of the Heshima interventions. RESULTS Composite scales were developed on provider knowledge of client rights (Chronbach α = 0.70), client-centered care (α = 0.80), and HIV care (α = 0.81); providers' emotional health (α = 0.76) and working relationships (α = 0.88); and provider perceptions of management (α = 0.93), job fairness (α = 0.68), supervision (α = 0.84), promotion (α = 0.83), health systems (α = 0.85), and work environment (α = 0.85). Comparison of baseline and endline individual item scores and composite scores showed that provider knowledge of client rights and practice of a rights-based approach, treatment of clients living with HIV, and client-centered care during labor, delivery, and postnatal periods improved (p < 0.001). Changes in emotional health, perceptions of management, job fairness, supervision, and promotion seen in composite scores did not directly align with changes in item-specific responses. Qualitative data reveal health system challenges limit the translation of providers' positive attitudes and behaviors into implementation of a rights-based approach to maternity care. CONCLUSION Behavior change interventions, central to promoting respectful care, are feasible to implement, as seen in the Heshima experience, but require sustained interaction with health systems where providers practice. Provider emotional health has the potential to drive (mis)treatment and affect women's care.
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Affiliation(s)
| | - Charlotte E Warren
- Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC, 20008, USA
| | - Julie Ritter
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pooja Sripad
- Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC, 20008, USA
| | - Timothy Abuya
- Population Council, PO Box 17643-00500, Nairobi, Kenya
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Associations Between Mistreatment by a Provider during Childbirth and Maternal Health Complications in Uttar Pradesh, India. Matern Child Health J 2017; 21:1821-1833. [DOI: 10.1007/s10995-017-2298-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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88
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Kyei-Nimakoh M, Carolan-Olah M, McCann TV. Access barriers to obstetric care at health facilities in sub-Saharan Africa-a systematic review. Syst Rev 2017; 6:110. [PMID: 28587676 PMCID: PMC5461715 DOI: 10.1186/s13643-017-0503-x] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/19/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Since 2000, the United Nations' Millennium Development Goals, which included a goal to improve maternal health by the end of 2015, has facilitated significant reductions in maternal morbidity and mortality worldwide. However, despite more focused efforts made especially by low- and middle-income countries, targets were largely unmet in sub-Saharan Africa, where women are plagued by many challenges in seeking obstetric care. The aim of this review was to synthesise literature on barriers to obstetric care at health institutions in sub-Saharan Africa. METHODS This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were electronically searched to identify studies on barriers to health facility-based obstetric care in sub-Saharan Africa, in English, and dated between 2000 and 2015. Combinations of search terms 'obstetric care', 'access', 'barriers', 'developing countries' and 'sub-Saharan Africa' were used to locate articles. Quantitative, qualitative and mixed-methods studies were considered. A narrative synthesis approach was employed to synthesise the evidence and explore relationships between included studies. RESULTS One hundred and sixty articles met the inclusion criteria. Currently, obstetric care access is hindered by several demand- and supply-side barriers. The principal demand-side barriers identified were limited household resources/income, non-availability of means of transportation, indirect transport costs, a lack of information on health care services/providers, issues related to stigma and women's self-esteem/assertiveness, a lack of birth preparation, cultural beliefs/practices and ignorance about required obstetric health services. On the supply-side, the most significant barriers were cost of services, physical distance between health facilities and service users' residence, long waiting times at health facilities, poor staff knowledge and skills, poor referral practices and poor staff interpersonal relationships. CONCLUSION Despite similarities in obstetric care barriers across sub-Saharan Africa, country-specific strategies are required to tackle the challenges mentioned. Governments need to develop strategies to improve healthcare systems and overall socioeconomic status of women, in order to tackle supply- and demand-side access barriers to obstetric care. It is also important that strategies adopted are supported by research evidence appropriate for local conditions. Finally, more research is needed, particularly, with regard to supply-side interventions that may improve the obstetric care experience of pregnant women. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2014 CRD42014015549.
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Affiliation(s)
- Minerva Kyei-Nimakoh
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Mary Carolan-Olah
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Terence V. McCann
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
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89
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Akachi Y, Kruk ME. Quality of care: measuring a neglected driver of improved health. Bull World Health Organ 2017; 95:465-472. [PMID: 28603313 PMCID: PMC5463815 DOI: 10.2471/blt.16.180190] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 11/27/2022] Open
Abstract
The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact.
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Affiliation(s)
- Yoko Akachi
- United Nations University World Institute for Development, Katajanokanlaituri 6B, FI-00160, Helsinki, Finland
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, United States of America
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90
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Defining disrespect and abuse of newborns: a review of the evidence and an expanded typology of respectful maternity care. Reprod Health 2017; 14:66. [PMID: 28545473 PMCID: PMC5445465 DOI: 10.1186/s12978-017-0326-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/12/2017] [Indexed: 11/26/2022] Open
Abstract
Amid increased attention to quality of obstetric care and respectful maternity care globally, insufficient focus has been given to quality of care and respectful care for newborns in the postnatal period. Especially in low and middle income countries, where low utilisation of obstetric and neonatal services is of concern, it is plausible that poor quality of care or mistreatment of newborns or stillborn infants will influence future care seeking, both for the health care needs of the growing infant and for subsequent pregnancies. Preliminary evidence indicates that mistreatment of newborns exists, both in the immediate and later postnatal periods. Definitions have been developed for instances of mistreatment of women during labour and delivery, but how newborns fit into the categorisations and critical questions around how to conceptualise dignified care for newborns have not been well addressed. The WHO recently published “Standards for improving quality of maternal and newborn care in health facilities”, which provides a series of clinical and experiential standards that health facilities should strive to provide for all patients. Presented here are a number of the experiential measures, as well as health system requirements, which could be further developed to encompass the explicit needs of newborns and stillborn infants, and their families. Specific WHO Standards that require more attention for newborns are those related to effective communication, informed consent and emotional support (including for bereaved families). Using seven categories previously developed for respectful maternity care generally, a literature review was conducted on mistreatment of newborns. The review revealed examples of mistreatment of newborns in six of the seven categories. Common occurrences were failure to meet a professional standard of care, stigma and discrimination, and health system constraints. Many instances of mistreatment of newborns related to neglect and non-consented care rather than outright physical or verbal abuse. Two additional categories were also identified for newborns related to legal accountability and bereavement care. More research is needed into the prevalence of disrespect, abuse, and stigmatisation of newborns and further discussions are needed about how to provide quality care for all patients, including the smallest and most vulnerable.
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91
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Warren CE, Njue R, Ndwiga C, Abuya T. Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions. BMC Pregnancy Childbirth 2017; 17:102. [PMID: 28351350 PMCID: PMC5371243 DOI: 10.1186/s12884-017-1288-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 03/23/2017] [Indexed: 12/02/2022] Open
Abstract
Background Disrespect and abuse or mistreatment of women by health care providers in maternity settings has been identified as a key deterrent to women seeking delivery care. Mistreatment includes physical and verbal abuse, stigma and discrimination, a poor relationship between women and providers and policy and health systems challenges. This paper uses qualitative data to describe mistreatment of women in Kenya. Methods Data are drawn from implementation research conducted in 13 facilities and communities. Researchers conducted a range of in-depth interviews with women (n-50) who had given birth in a facility policy makers health managers and providers (n-63); and focus group discussions (19) with women and men living around study facilities. Data were captured on paper and audio tapes, transcribed and translated and exported into Nvivo for analysis. Subsequently we applied a typology of mistreatment which includes first order descriptive themes, second and third-order analytical themes. Final analysis was organized around description of the nature, manifestations and experiences, and factors contributing to mistreatment. Results Women describe: their negative experiences of childbirth; frustration with lack of confidentiality and autonomy; abandonment by the providers, and dirty maternity units. Providers admit to challenges but describe reasons for apparent abuse (slapped on thighs to encourage women to focus on birthing process) and ‘detention’ is because relatives have abandoned them. Men try to overcome challenges by paying providers to ensure they look after their wives. Drivers of mistreatment are perpetuated by social and gender norms at family and community levels. At facility level, poor managerial oversight, provider demotivation, and lack of equipment and supplies, contribute to a poor experience of care. Weak or non-existent legal redress perpetuate the problem. Conclusion This paper builds on the expanding literature on mistreatment during labour and childbirth –outlining drivers from an individual, family, community, facility and policy level. New frameworks to group the manifestations into themes or components makes it increasingly more focused on specific interventions to promote respectful maternity care. The Kenya findings resonate with budding literature – demonstrating that this is indeed a global issue that needs a global solution.
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Affiliation(s)
- Charlotte E Warren
- Population Council, 4301 Connecticut Avenue NW Suite 280, Washington DC, USA
| | - Rebecca Njue
- Population Council, PO Box 17643 - 00500, Nairobi, Kenya
| | - Charity Ndwiga
- Population Council, PO Box 17643 - 00500, Nairobi, Kenya
| | - Timothy Abuya
- Population Council, PO Box 17643 - 00500, Nairobi, Kenya.
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92
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Amroussia N, Hernandez A, Vives-Cases C, Goicolea I. "Is the doctor God to punish me?!" An intersectional examination of disrespectful and abusive care during childbirth against single mothers in Tunisia. Reprod Health 2017; 14:32. [PMID: 28259180 PMCID: PMC5336668 DOI: 10.1186/s12978-017-0290-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background Disrespectful and abusive treatment during childbirth is a violation of women’s right to dignified, respectful healthcare throughout pregnancy and childbirth. Although reports point out that marginalized groups in society such as single mothers are particularly vulnerable to abusive and disrespectful care, there is a lack of in-depth research exploring single mothers’ encounters at the maternal healthcare facilities, especially in Tunisia. In Tunisia, single mothers are particularly vulnerable due to their social stigmatization and socio-economic marginalization. This study examines the self-perceptions and childbirth experiences of single mothers at the public healthcare facilities in Tunisia. Methods This study follows a qualitative design. Eleven single mothers were interviewed in regard to their experiences with maternal healthcare services and their perceptions of the attitudes of the health workers towards them. The interviews also addressed the barriers faced by the participants in accessing adequate maternal healthcare services, and their self-perceptions as single mothers. The data were analyzed using an inductive thematic approach guided by the feminist intersectional approach. Emergent codes were grouped into three final themes. Results Three themes emerged during the data analysis: 1) Experiencing disrespect and abuse, 2) Perceptions of regret and shame attributed to being a single mother, and 3) The triad of vulnerability: stigma, social challenges, and health system challenges. The study highlights that the childbirth experiences of single mothers are shaped by intersectional factors that go beyond the health system. Gender plays a major role in constructing these experiences while intersecting with other social structures. The participants had experienced disrespectful and discriminatory practices and even violence when they sought maternal healthcare services at the public healthcare facilities in Tunisia. Those experiences reflect not only the poor quality of maternal health services but also how health system practices translate the stigma culturally associated with single motherhood in this setting. Social stigma did not only affect how single mothers were treated during the childbirth, but also how they perceived themselves and how they perceived their care. Conclusion Ensuring women’s right to dignified, respectful healthcare during childbirth requires tackling the underlying causes of social inequalities leading to women’s marginalization and discrimination. Electronic supplementary material The online version of this article (doi:10.1186/s12978-017-0290-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nada Amroussia
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Alison Hernandez
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Carmen Vives-Cases
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science Alicante University, Alicante, Spain.,CIBER of Epidemiology and Public Health, Barcelona, Spain
| | - Isabel Goicolea
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
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Baker U, Hassan F, Hanson C, Manzi F, Marchant T, Swartling Peterson S, Hylander I. Unpredictability dictates quality of maternal and newborn care provision in rural Tanzania-A qualitative study of health workers' perspectives. BMC Pregnancy Childbirth 2017; 17:55. [PMID: 28166745 PMCID: PMC5294891 DOI: 10.1186/s12884-017-1230-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 01/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Health workers are the key to realising the potential of improved quality of care for mothers and newborns in the weak health systems of Sub Saharan Africa. Their perspectives are fundamental to understand the effectiveness of existing improvement programs and to identify ways to strengthen future initiatives. The objective of this study was therefore to examine health worker perspectives of the conditions for maternal and newborn care provision and their perceptions of what constitutes good quality of care in rural Tanzanian health facilities. Methods In February 2014, we conducted 17 in-depth interviews with different cadres of health workers providing maternal and newborn care in 14 rural health facilities in Tandahimba district, south-eastern Tanzania. These facilities included one district hospital, three health centres and ten dispensaries. Interviews were conducted in Swahili, transcribed verbatim and translated into English. A grounded theory approach was used to guide the analysis, the output of which was one core category, four main categories and several sub-categories. Results ‘It is like rain’ was identified as the core category, delineating unpredictability as the common denominator for all aspects of maternal and newborn care provision. It implies that conditions such as mothers’ access to and utilisation of health care are unreliable; that availability of resources is uncertain and that health workers have to help and try to balance the situation. Quality of care was perceived to vary as a consequence of these conditions. Health workers stressed the importance of predictability, of ‘things going as intended’, as a sign of good quality care. Conclusions Unpredictability emerged as a fundamental condition for maternal and newborn care provision, an important determinant and characteristic of quality in this study. We believe that this finding is also relevant for other areas of care in the same setting and may be an important defining factor of a weak health system. Increasing predictability within health services, and focusing on the experience of health workers within these, should be prioritised in order to achieve better quality of care for mothers and newborns. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1230-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulrika Baker
- Department of Public Health sciences, Global health - Health Systems and Policy Research, Widerströmska huset, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden. .,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Nobels allé 12, 141 83, Huddinge, Sweden.
| | - Farida Hassan
- Ifakara Health Institute, Plot 463 Kiko Avenue, Mikocheni, Dar es Salaam, P.O. Box 78 373, Tanzania
| | - Claudia Hanson
- Department of Public Health sciences, Global health - Health Systems and Policy Research, Widerströmska huset, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.,Department for Disease Control, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Fatuma Manzi
- Ifakara Health Institute, Plot 463 Kiko Avenue, Mikocheni, Dar es Salaam, P.O. Box 78 373, Tanzania
| | - Tanya Marchant
- Department for Disease Control, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Stefan Swartling Peterson
- Department of Public Health sciences, Global health - Health Systems and Policy Research, Widerströmska huset, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.,International Maternal and Child Health, Uppsala University, Drottninggatan 4, 751 85, Uppsala, Sweden.,Makerere School of Public Health, Kampala, Uganda
| | - Ingrid Hylander
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Nobels allé 12, 141 83, Huddinge, Sweden
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Smith ER, Bergelson I, Constantian S, Valsangkar B, Chan GJ. Barriers and enablers of health system adoption of kangaroo mother care: a systematic review of caregiver perspectives. BMC Pediatr 2017; 17:35. [PMID: 28122592 PMCID: PMC5267363 DOI: 10.1186/s12887-016-0769-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Despite improvements in child survival in the past four decades, an estimated 6.3 million children under the age of five die each year, and more than 40% of these deaths occur in the neonatal period. Interventions to reduce neonatal mortality are needed. Kangaroo mother care (KMC) is one such life-saving intervention; however it has not yet been fully integrated into health systems around the world. Utilizing a conceptual framework for integration of targeted health interventions into health systems, we hypothesize that caregivers play a critical role in the adoption, diffusion, and assimilation of KMC. The objective of this research was to identify barriers and enablers of implementation and scale up of KMC from caregivers’ perspective. Methods We searched Pubmed, Embase, Web of Science, Scopus, and WHO regional databases using search terms ‘kangaroo mother care’ or ‘kangaroo care’ or ‘skin to skin care’. Studies published between January 1, 1960 and August 19, 2015 were included. To be eligible, published work had to be based on primary data collection regarding barriers or enablers of KMC implementation from the family perspective. Abstracted data were linked to the conceptual framework using a deductive approach, and themes were identified within each of the five framework areas using Nvivo software. Results We identified a total of 2875 abstracts. After removing duplicates and ineligible studies, 98 were included in the analysis. The majority of publications were published within the past 5 years, had a sample size less than 50, and recruited participants from health facilities. Approximately one-third of the studies were conducted in the Americas, and 26.5% were conducted in Africa. We identified four themes surrounding the interaction between families and the KMC intervention: buy in and bonding (i.e. benefits of KMC to mothers and infants and perceptions of bonding between mother and infant), social support (i.e. assistance from other people to perform KMC), sufficient time to perform KMC, and medical concerns about mother or newborn health. Furthermore, we identified barriers and enablers of KMC adoption by caregivers within the context of the health system regarding financing and service delivery. Embedded within the broad social context, barriers to KMC adoption by caregivers included adherence to traditional newborn practices, stigma surrounding having a preterm infant, and gender roles regarding childcare. Conclusion Efforts to scale up and integrate KMC into health systems must reduce barriers in order to promote the uptake of the intervention by caregivers.
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Affiliation(s)
- Emily R Smith
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave., Building 1, Boston, MA, 02115, USA.
| | - Ilana Bergelson
- Division of Medicine Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Stacie Constantian
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave., Building 1, Boston, MA, 02115, USA
| | - Bina Valsangkar
- Saving Newborn Lives, Save the Children, Washington, D.C., USA
| | - Grace J Chan
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave., Building 1, Boston, MA, 02115, USA.,Division of Medicine Critical Care, Boston Children's Hospital, Boston, MA, USA
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Balde MD, Bangoura A, Diallo BA, Sall O, Balde H, Niakate AS, Vogel JP, Bohren MA. A qualitative study of women's and health providers' attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea. Reprod Health 2017; 14:4. [PMID: 28086975 PMCID: PMC5237275 DOI: 10.1186/s12978-016-0262-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/07/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Reducing maternal morbidity and mortality remains a key health challenge in Guinea. Anecdotal evidence suggests that women in Guinea are subjected to mistreatment during childbirth in health facilities, but limited research exists on this topic. This study was conducted to better understand the social norms and the acceptability of four scenarios of mistreatment during childbirth, from the perspectives of women and service providers. METHODS This study used qualitative methods including in-depth interviews (IDIs) and focus group discussions (FGDs) with women of reproductive age, midwives, nurses and doctors. This study was conducted in one urban area (Mamou) and one peri-urban area (Pita) in Guinea. Participants were presented with four scenarios of mistreatment during childbirth, including a provider: (1) slapping a woman; (2) verbally abusing a woman; (3) refusing to help a woman; and (4) forcing a woman to give birth on the floor. Data were collected in local languages (Pular and Malinké) and French, and transcribed and analyzed in French. We used a thematic analysis approach and manually coded the data using a codebook developed for the project. RESULTS A total of 40 IDIs and eight FGDs were conducted with women of reproductive age, 5 IDIs with doctors, and 13 IDIs with midwives. Most women were not accepting of any of the scenarios, unless the action was perceived to be used to save the life of the mother or child. However, they perceived a woman's disobedience and uncooperativeness to contribute to her poor treatment. Women reacted to this mistreatment by accepting poor treatment, refusal to use the same hospital, revenge against the provider or complaints to hospital management. Service providers were accepting of mistreatment when women were disobedient, uncooperative, or to save the life of the baby. CONCLUSIONS This is the first known study on mistreatment of women during childbirth to be conducted in Guinea. Both women and service providers were accepting of mistreatment during childbirth under certain conditions. Any approach to preventing and eliminating mistreatment during childbirth must consider these important contextual and social norms and develop a comprehensive intervention that addresses root causes. Further research is needed on how to measure mistreatment during childbirth in Guinea.
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Affiliation(s)
- Mamadou Diouldé Balde
- Cellule de recherche en santé de la reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea
- Faculté de médecine, pharmacie et odontostomatologie, Université G.A. Nasser de Conakry, Conakry, Guinea
| | - Abou Bangoura
- Cellule de recherche en santé de la reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea
- Département de sociologie, Université Sonfonia, Conakry, Guinea
| | - Boubacar Alpha Diallo
- Cellule de recherche en santé de la reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea
- Faculté de médecine, pharmacie et odontostomatologie, Université G.A. Nasser de Conakry, Conakry, Guinea
| | - Oumar Sall
- Cellule de recherche en santé de la reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea
| | - Habibata Balde
- Cellule de recherche en santé de la reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea
- Département de sociologie, Université Sonfonia, Conakry, Guinea
| | - Aïssatou Sona Niakate
- Cellule de recherche en santé de la reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea
| | - Joshua P. Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Meghan A. Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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96
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Balde MD, Diallo BA, Bangoura A, Sall O, Soumah AM, Vogel JP, Bohren MA. Perceptions and experiences of the mistreatment of women during childbirth in health facilities in Guinea: a qualitative study with women and service providers. Reprod Health 2017; 14:3. [PMID: 28077145 PMCID: PMC5225581 DOI: 10.1186/s12978-016-0266-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/08/2016] [Indexed: 11/24/2022] Open
Abstract
Background Every woman is entitled to respectful care during childbirth; so it is concerning to hear of informal reports of mistreatment during childbirth in Guinea. This study sought to explore the perceptions and experiences of mistreatment during childbirth, from the perspectives of women and service providers, and the analysis presents findings according to a typology of mistreatment during childbirth. Methods This study used qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) and was conducted with four groups of participants: women of reproductive age, midwives, doctors, and administrators. The study took place in two sites in Guinea, an urban area (Mamou) and peri-urban (Pita). Data collection was conducted in two health facilities for providers and administrators, and in the health facility catchment area for women. Data were collected in local languages (Pular and Malinké), then transcribed and analyzed in French. We used a thematic analysis approach and coded transcripts manually. Results A total of 64 IDIs and eight FGDs were conducted and are included in this analysis, including 40 IDIs and eight FGDs with women of reproductive age, 5 IDIs with doctors, 13 IDIs with midwives, and 6 IDIs with administrators. Participants described their own personal experiences, experiences of women in their communities and perceptions regarding mistreatment during childbirth. Results were organized according to a typology of mistreatment during childbirth, and included instances of physical abuse, verbal abuse, abandonment and neglect. Women described being slapped by providers, yelled at for noncompliance with provider requests, giving birth on the floor and without skilled attendance in the health facility. Poor physical conditions of health facilities and health workforce constraints contributed to experiences of mistreatment. Conclusions These results are important because they demonstrate that the mistreatment of women during childbirth exists in Guinea and occurs in multiple forms. These data should be used by the Ministry of Health and other stakeholders to develop strategies to reduce and prevent the mistreatment of women during childbirth.
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Affiliation(s)
- Mamadou Diouldé Balde
- Cellule de recherche en santé de la reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea.,Faculté de Médecine, Pharmacie et Odontostomatologie, Université G.A.Nasser de Conakry, Conakry, Guinea
| | - Boubacar Alpha Diallo
- Cellule de recherche en santé de la reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea.,Faculté de Médecine, Pharmacie et Odontostomatologie, Université G.A.Nasser de Conakry, Conakry, Guinea
| | - Abou Bangoura
- Cellule de recherche en santé de la reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea.,Département de sociologie, Université Sonfonia, Conakry, Guinea
| | - Oumar Sall
- Cellule de recherche en santé de la reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea
| | - Anne Marie Soumah
- Cellule de recherche en santé de la reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea
| | - Joshua P Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Meghan A Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
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Topp SM, Chipukuma JM. How did rapid scale-up of HIV services impact on workplace and interpersonal trust in Zambian primary health centres: a case-based health systems analysis. BMJ Glob Health 2016; 1:e000179. [PMID: 28588985 PMCID: PMC5321392 DOI: 10.1136/bmjgh-2016-000179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/07/2016] [Accepted: 11/24/2016] [Indexed: 11/09/2022] Open
Abstract
Background In sub-Saharan Africa, large amounts of funding continue to be directed towards HIV-specific care and treatment, often with claims of ‘health system strengthening’ effect. Such claims rarely account for the impact on human relationships and decisions that are core to functional health systems. This research examined how establishment of externally funded HIV services influenced trusting relationships in Zambian health centres. Methods An in-depth, multicase study included four health centres selected for urban, peri-urban and rural characteristics. Case data included healthcare worker (HCW) interviews (60); patient interviews (180); direct observation of facility operations (2 weeks/centre) and key informant interviews (14) which were recorded and transcribed verbatim. Thematic analysis adopted inductive and deductive coding guided by a framework incorporating concepts of workplace trust, patient–provider trust, intrinsic and extrinsic motivation. Results HIV service scale-up impacted trust in positive and negative ways. Investment in HIV-specific infrastructure, supplies and quality assurance mechanisms strengthened workplace trust, HCW motivation and patient–provider trust in HIV departments in the short-term. In the health centres more broadly and over time, however, non-governmental organisation-led investment and support of HIV departments reinforced HCW's perceptions of the government as uninterested or unable to provide a quality work environment. Exacerbating existing perceptions of systemic workplace inequity and nepotism, uneven distribution of personal and professional opportunities related to HIV service establishment contributed to interdepartmental antagonism and reinforced workplace practices designed to protect individual HCW's interests. Conclusions Findings illustrate long-term negative effects of the vertical HIV resourcing and support structures which failed to address and sometimes exacerbated HCW (dis)trust with their own government and supervisors. The short-term and long-term effects of weakened workplace trust on HCWs' motivation and performance signal the importance of understanding how such relationships play a role in generating virtuous or perverse cycles of actor interactions, with implications for service outcomes.
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Affiliation(s)
- Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Sudhinaraset M, Treleaven E, Melo J, Singh K, Diamond-Smith N. Women's status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory. BMC Pregnancy Childbirth 2016; 16:332. [PMID: 27793115 PMCID: PMC5084395 DOI: 10.1186/s12884-016-1124-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 10/22/2016] [Indexed: 11/20/2022] Open
Abstract
Background Mistreatment of women in healthcare settings during childbirth has been gaining attention globally. Mistreatment during childbirth directly and indirectly affects health outcomes, patient satisfaction, and the likelihood of delivering in a facility currently or in the future. It is important that we study patients’ reports of mistreatment and abuse to develop a deeper understanding of how it is perpetrated, its consequences, and to identify potential points of intervention. Patients’ perception of the quality of care is dependent, not only on the content of care, but importantly, on women’s expectations of care. Methods This study uses rich, mixed-methods data to explore women’s characteristics and experiences of mistreatment during childbirth among slum-resident women in Uttar Pradesh, India. To understand the ways in which women’s social and cultural factors influence their expectations of care and consequently their perceptions of respectful care, we adopt a Cultural Health Capital (CHC) framework. The quantitative sample includes 392 women, and the qualitative sample includes 26 women. Results Quantitative results suggest high levels of mistreatment (over 57 % of women reported any form of mistreatment). Qualitative findings suggest that lack of cultural health capital disadvantages patients in their patient-provider relationships, and that women use resources to improve care they receive. Participants articulated how providers set expectations and norms regarding behaviors in facilities; patients with lower social standing may not always understand standard practices and are likely to suffer poor health outcomes as a result. Of importance, however, patients also blame themselves for their own lack of knowledge. Conclusions Lack of cultural health capital disadvantages women during delivery care in India. Providers set expectations and norms around behaviors during delivery, while women are often misinformed and may have low expectations of care.
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Affiliation(s)
- May Sudhinaraset
- Department of Epidemiology and Biostatistics and Global Health Sciences, University of California, San Francisco. 550 16th Street, Box 1224, San Francisco, CA, 94158, USA.
| | - Emily Treleaven
- Department of Social and Behavioral Sciences, University of California, San Francisco. 3333 California St., San Francisco, CA, 94143, USA
| | - Jason Melo
- Division of Global Public Health, Department of Medicine, University of California, San Diego. 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Kanksha Singh
- Foundation for Research in Health Systems, 214, Sydicate House, Inderlok, Delhi, India
| | - Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics and Global Health Sciences, University of California, San Francisco. 550 16th Street, Box 1224, San Francisco, CA, 94158, USA
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Ratcliffe HL, Sando D, Lyatuu GW, Emil F, Mwanyika-Sando M, Chalamilla G, Langer A, McDonald KP. Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital. Reprod Health 2016; 13:79. [PMID: 27424608 PMCID: PMC4948096 DOI: 10.1186/s12978-016-0187-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/19/2016] [Indexed: 11/25/2022] Open
Abstract
Background There is emerging evidence that disrespect and abuse (D&A) during facility-based childbirth is prevalent in countries throughout the world and a barrier to achieving good maternal health outcomes. However, much work remains in the identification of effective interventions to prevent and eliminate D&A during facility-based childbirth. This paper describes an exploratory study conducted in a large referral hospital in Dar es Salaam, Tanzania that sought to measure D&A, introduce a package of interventions to reduce its incidence, and evaluate their effectiveness. Methods After extensive consultation with critical constituencies, two discrete interventions were implemented: (1) Open Birth Days (OBD), a birth preparedness and antenatal care education program, and (2) a workshop for healthcare providers based on the Health Workers for Change curriculum. Each intervention was designed to increase knowledge of patient rights and birth preparedness; increase and improve patient-provider and provider-administrator communication; and improve women’s experience and provider attitudes. The effects of the interventions were assessed using a pre-post design and a range of tools: pre-post questionnaires for OBD participants and pre-post questionnaires for workshop participants; structured interviews with healthcare providers and administrators; structured interviews with women who gave birth at the study facility; and direct observations of patient-provider interactions during labor and delivery. Results Comparisons before and after the interventions showed an increase in patient and provider knowledge of user rights across multiple dimensions, as well as women’s knowledge of the labor and delivery process. Women reported feeling better prepared for delivery and provider attitudes towards them improved, with providers reporting higher levels of empathy for the women they serve and better interpersonal relationships. Patients and providers reported improved communication, which direct observations confirmed. Additionally, women reported feeling more empowered and confident during delivery. Provider job satisfaction increased substantially from baseline levels, as did user reports of satisfaction and perceptions of care quality. Conclusions Collectively, the outcomes of this study indicate that the tested interventions have the potential to be successful in promoting outcomes that are prerequisite to reducing disrespect and abuse. However, a more rigorous evaluation is needed to determine the full impact of these interventions.
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Affiliation(s)
- Hannah L Ratcliffe
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA. .,Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - David Sando
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA.,Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Faida Emil
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Guerino Chalamilla
- Management and Development for Health, Dar es Salaam, Tanzania.,Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Kathleen P McDonald
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA
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Solnes Miltenburg A, Lambermon F, Hamelink C, Meguid T. Maternity care and Human Rights: what do women think? BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:17. [PMID: 27368988 PMCID: PMC4930607 DOI: 10.1186/s12914-016-0091-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/16/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND A human rights approach to maternal health is considered as a useful framework in international efforts to reduce maternal mortality. Although fundamental human rights principles are incorporated into legal and medical frameworks, human rights have to be translated into measurable actions and outcomes. So far, their substantive applications remain unclear. The aim of this study is to explore women's perspectives and experiences of maternal health services through a human rights perspective in Magu District, Tanzania. METHODS This study is a qualitative exploration of perspectives and experiences of women regarding maternity services in government health facilities. The point of departure is a Human Rights perspective. A total of 36 semi-structured interviews were held with 17 women, between the age of 31 and 63, supplemented with one focus group discussion of a selection of the interviewed women, in three rural villages and the town centre in Magu District. Data analysis was performed using a coding scheme based on four human rights principles: dignity, autonomy, equality and safety. RESULTS Women's experiences of maternal health services reflect several sub-standard care factors relating to violations of multiple human rights principles. Women were aware that substandard care was present and described a range of ways how the services could be delivered that would venerate human rights principles. Prominent themes included: 'being treated well and equal', 'being respected' and 'being given the appropriate information and medical treatment'. CONCLUSION Women in this rural Tanzanian setting are aware that their experiences of maternity care reflect violations of their basic rights and are able to voice what basic human rights principles mean to them as well as their desired applications in maternal health service provision.
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Affiliation(s)
- Andrea Solnes Miltenburg
- Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Fleur Lambermon
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam, Zanzibar Town, The Netherlands
| | - Cees Hamelink
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam, Zanzibar Town, The Netherlands
| | - Tarek Meguid
- Department of Obstetrics & Gynaecology, Mnazi Mmoja Hospital, Stone Town Zanzibar, Tanzania
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