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Moridi M, Pazandeh F, Hajian S, Potrata B. Development and psychometric properties of Midwives' Knowledge and Practice Scale on Respectful Maternity Care (MKP-RMC). PLoS One 2020; 15:e0241219. [PMID: 33141835 PMCID: PMC7608882 DOI: 10.1371/journal.pone.0241219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To develop a scale for evaluating knowledge and practice of midwives on Respectful Maternity Care (RMC). Methods An exploratory sequential mixed method study was conducted from January 2018 to July 2019 in two non-teaching public hospitals in Tehran, Iran. In the first part of the study, a literature review and qualitative study were carried out in order to develop the preliminary item pool. Then face, content and construct validity and reliability (internal consistency and test-retest) were assessed. Results The MKP-RMC scale has 23-item in knowledge and 23-item in practice section that loaded in three factors: Giving emotional support, providing safe care and preventing mistreatment. Exploratory factor analysis accounted for 43.47% and 58.62% of observed variance in knowledge and practice sections, respectively. The internal consistency and internal correlation coefficient of both section of MKP-RMC indicated acceptable reliability. Conclusion The MKP-RMC is a valid and reliable tool for measuring midwives' knowledge and practice of respectful care during labor and childbirth. The MKP-RMC could be used in maternity services to evaluate and improve quality of childbirth care through development of educational interventions for effective behavioral change. Confirmation of validity and reliability of translated version of the scale in other maternity care providers and different contexts is recommended.
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Affiliation(s)
- Maryam Moridi
- Department of Midwifery and Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Pazandeh
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Sepideh Hajian
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Disrespect and Abuse during Childbirth in Ethiopia: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8186070. [PMID: 33150181 PMCID: PMC7603554 DOI: 10.1155/2020/8186070] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 10/03/2020] [Indexed: 11/22/2022]
Abstract
Background Disrespect and abuse are recognized for the restricting impact of women from seeking maternal care, psychological humiliations, grievances, and unspoken sufferings on women during childbirth. Individual primary studies are limited in explaining of extent of disrespect and abusive care. Hence, this review considers the synthesis of comprehensive evidence on the extent, contributing factors, and consequences of disrespectful and abusive intrapartum care from the women's and providers' perspectives in Ethiopia. Methods Articles had been systematically searched from the databases of PubMed, Cochrane Library, POPLINE, Google Scholar, HINARI, African Journals Online, and WHO Global Health Library. A qualitative and quantitative synthesis was performed using the Bowser and Hill landscape analytical framework. Result Twenty-two studies comprised of the 16 quantitative; 5 qualitative and one mixed studies were included. The most repeatedly dishonored right during facility-based childbirth in Ethiopia was nondignified care, and the least commonly reported abuse was detention in health facilities. These behaviors were contributed by normalization of care, lack of empowerment and education of women, weak health system, and lack of training of providers. Women subjected to disrespectful and abusive behavior distanced themselves from the use of facility-based childbirth-related services and have endured psychological humiliations. Conclusion Disrespectful and abusive care of women during childbirth is repeatedly practiced care in Ethiopia. This result specifically described the contributing factors and their effects as a barrier to the utilization of facility-based childbirth. Therefore, to overcome this alarming problem, health systems and care providers must be responsive to the specific needs of women during childbirth, and implementing policies for standard care of respectful maternity care must be compulsory. In addition, observational, qualitative, and mixed types of studies are required to provide comprehensive evidences on disrespect and abusive behavior during childbirth in Ethiopia.
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Galle A, Manaharlal H, Griffin S, Osman N, Roelens K, Degomme O. A qualitative study on midwives' identity and perspectives on the occurrence of disrespect and abuse in Maputo city. BMC Pregnancy Childbirth 2020; 20:629. [PMID: 33076861 PMCID: PMC7569757 DOI: 10.1186/s12884-020-03320-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/07/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Midwifery care plays a vital role in the reduction of preventable maternal and newborn mortality and morbidity. There is a growing concern about the quality of care during facility based childbirth and the occurrence of disrespect and abuse (D&A) worldwide. While several studies have reported a high prevalence of D&A, evidence about the drivers of D&A is scarce. This study aims to explore midwives' professional identity and perspectives on the occurrence of D&A in urban Mozambique. METHODS A qualitative study took place in the central hospital of Maputo, Mozambique. Nine focus group discussions with midwives were conducted, interviewing 54 midwives. RQDA software was used for analysing the data by open coding and thematic analysis from a grounded theory perspective. RESULTS Midwives felt proud of their profession but felt they were disrespected by the institution and wider society because of their inferior status compared to doctors. Furthermore, they felt blamed for poor health outcomes. The occurrence of D&A seemed more likely in emergency situations but midwives tended to blame this on women being "uncooperative". The involvement of birth companions was a protective factor against D&A together with supervision. CONCLUSION In order to improve quality of care and reduce the occurrence of D&A midwives will need to be treated with more respect within the health system. Furthermore, they should be trained in handling obstetric emergency situations with respect and dignity for the patient. Systematic and constructive supervision might be another promising strategy for preventing D&A.
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Affiliation(s)
- Anna Galle
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, entrance 75, UZP 114, 9000, Ghent, Belgium.
| | - Helma Manaharlal
- International Centre for Reproductive Health, Rua das Flores no 34, Impasse 1085/87, Maputo, Mozambique
| | - Sally Griffin
- International Centre for Reproductive Health, Rua das Flores no 34, Impasse 1085/87, Maputo, Mozambique
| | - Nafissa Osman
- International Centre for Reproductive Health, Rua das Flores no 34, Impasse 1085/87, Maputo, Mozambique.,Faculty of Medicine, Department of Obstetrics/Gynecology, Eduardo Mondlane University, Av. Salvador Allende 57, Maputo, Mozambique
| | - Kristien Roelens
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, entrance 75, UZP 114, 9000, Ghent, Belgium
| | - Olivier Degomme
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, entrance 75, UZP 114, 9000, Ghent, Belgium
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Oluoch-Aridi J, Wafula F, Kokwaro G, Adam MB. 'We just look at the well-being of the baby and not the money required': a qualitative study exploring experiences of quality of maternity care among women in Nairobi's informal settlements in Kenya. BMJ Open 2020; 10:e036966. [PMID: 32895274 PMCID: PMC7478011 DOI: 10.1136/bmjopen-2020-036966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To examine how women living in an informal settlement in Nairobi perceive the quality of maternity care and how it influences their choice of a delivery health facility. DESIGN Qualitative study. SETTINGS Dandora, an informal settlement, Nairobi City in Kenya. PARTICIPANTS Six focus group discussions with 40 purposively selected women aged 18-49 years at six health facilities. RESULTS Four broad themes were identified: (1) perceived quality of the delivery services, (2) financial access to delivery service, (3) physical amenities at the health facility, and (4) the 2017 health workers' strike.The four facilitators that influenced women to choose a private health facility were: (1) interpersonal treatment at health facilities, (2) perceived quality of clinical services, (3) financial access to health services at the facility, and (4) the physical amenities at the health facility. The three barriers to choosing a private facility were: (1) poor quality clinical services at low-cost health facilities, (2) shortage of specialist doctors, and (3) referral to public health facilities during emergencies.The facilitators that influenced women to choose a public facility were: (1) physical amenities for dealing with obstetric emergencies and (2) early referral to public maternity during antenatal care services. Barriers to choosing a public facility were: (1) perception of poor quality clinical services, (2) concerns over security for newborns at tertiary health facilities, (3) fear of mistreatment during delivery, (4) use of unsupervised trainee doctors for deliveries, (5) poor quality of physical amenities, and (6) inadequate staffing. CONCLUSION The study provides insights into decision-making processes for women when choosing a delivery facility by identifying critical attributes that they value and how perceptions of quality influence their choices.
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Affiliation(s)
- Jackline Oluoch-Aridi
- Institute of Healthcare Management, Strathmore University Business School, Strathmore University, Nairobi, Kenya
- The Ford Family Program on Human Development Studies and Solidarity, Kellogg Institute of International Studies, University of Notre Dame, Nairobi, Kenya
| | - Francis Wafula
- Institute of Healthcare Management, Strathmore University Business School, Strathmore University, Nairobi, Kenya
| | - Gilbert Kokwaro
- Institute of Healthcare Management, Strathmore University Business School, Strathmore University, Nairobi, Kenya
| | - Mary B Adam
- Department of Pediatrics, Kijabe Hospital, Kijabe, Kiambu, Kenya
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Siyoum M, Astatkie A, Tenaw Z, Abeje A, Melese T. Respectful family planning service provision in Sidama zone, Southern Ethiopia. PLoS One 2020; 15:e0238653. [PMID: 32886923 PMCID: PMC7473780 DOI: 10.1371/journal.pone.0238653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/20/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Disrespect and abusive care is a violation of women's basic human rights and it is serious global problem that needs urgent intervention. Poor quality client-provider interaction is commonly reported from family planning programmes. In Ethiopia, disrespect and abusive care is very common (21-78%) across health facilities. OBJECTIVE To assess the status of respectful family planning service (client-provider interaction) in Sidama zone, south Ethiopia. METHODOLOGY Health facility-based cross-sectional study was conducted from June to August 2018. Data were collected from 920 family planning clients recruited from 40 randomly selected health facilities. The Mother on Respect index (MORi) questionnaire was used to collect the data through client exit interview. Partial proportional odds ordinal regression was employed to identify determinants of respectful family planning service. RESULT Among family planning clients, the level of respectful family planning service was found to be zero (0%) in the very low respect category, 75(18.5%) in the low respect category, 382(41.52%) in moderate respect category and 463(50.33%) in high respect category. Being a short acting method client (AOR = 0.30, 95%CI [0.12, 0.72]), being an uneducated client (AOR = 0.39, 95%CI [0.25, 0.61]) or a client with elementary education (AOR = 0.41, 95%CI [0.23, 0.73]), client's poverty (AOR = 0.75, 95%CI [0.56, 0.99]), and long waiting time (AOR = 0.46, 95%CI [0.30, 0.69])significantly reduced the odds of moderate and high respect compared to low respect. Conversely, preference of male service providers, service providers' work satisfaction and health workers' prior training on respectful care significantly increased the odds of moderate and high respect. CONCLUSION Considering the current strategy of zero tolerance for disrespect and abuse in Ethiopia, the level of respectful care in this study is sub-optimal. Short term training for service providers on respectful care seems valuable to enhance the level of respectful care for family planning clients irrespective of their socioeconomic background.
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Affiliation(s)
- Melese Siyoum
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- * E-mail:
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Zelalem Tenaw
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Abebaw Abeje
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Teshome Melese
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Habib HH, Torpey K, Maya ET, Ankomah A. Promoting respectful maternity care for adolescents in Ghana: a quasi-experimental study protocol. Reprod Health 2020; 17:129. [PMID: 32831100 PMCID: PMC7444244 DOI: 10.1186/s12978-020-00977-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Intra-partum mistreatment by healthcare providers remains a global public health and human rights challenge. Adolescents, who are typically younger, poorer and less educated have been found to be disproportionately exposed to intra-partum mistreatment. In Ghana, maternal mortality remains a leading cause of death among adolescent females, despite increasing patronage of skilled birth attendance in health facilities. In response to the the World Health Organisation Human Reproduction Programme (WHO-HRP) recommendations to address mistreatment with Respectful Maternity Care (RMC), this study aims to generate evidence on promoting respectful treatment of adolescents using an intervention that trains health providers on the concept of mistreatment, their professional roles in RMC and the rights of adolescents to RMC. METHODS This study will employ a pre-test post-test quasi-experimental design. At pre-test and post-test, quantitative surveys will be conducted among adolescents who deliver at health facilities about their labour experience with mistreatment and RMC. A total target of 392 participants will be recruited across intervention and control facilities. Qualitative interviews will also be conducted with selected adolescents and health professionals for an in-depth understanding of the phenomenon. Following the pre-test, a facility-based training module will be implemented at intervention facilities for the facility midwives. The modules will be co-facilitated by the principal investigator and key resource persons from the district health directorate Quality of Care teams. Training will cover the rights of adolescents to quality healthcare, classifications of mistreatment, RMC as a concept and the role of professionals in providing RMC. No intervention will occur in the control facilities. Descriptive statistics, logistic regressions and difference in differences analyses will be computed. Qualitative data will be transcribed and thematically analysed. DISCUSSION This study is designed to test the success of an intervention in promoting RMC and reducing intra-partum mistreatment towards adolescents. It is expected that the findings of this study will be beneficial in adding to the body of knowledge in improving maternal healthcare and reducing maternal mortality, especially for adolescents. TRIAL REGISTRATION Name of the registry: Pan African Clinical Trials Registry. PACTR202008781392078 .
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Affiliation(s)
- Helen H. Habib
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ernest Tei Maya
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Ocholla IA, Agutu NO, Ouma PO, Gatungu D, Makokha FO, Gitaka J. Geographical accessibility in assessing bypassing behaviour for inpatient neonatal care, Bungoma County-Kenya. BMC Pregnancy Childbirth 2020; 20:287. [PMID: 32397969 PMCID: PMC7216545 DOI: 10.1186/s12884-020-02977-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/30/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Neonatal mortality rate in Kenya continues to be unacceptably high. In reducing newborn deaths, inequality in access to care and quality care have been identified as current barriers. Contributing to these barriers are the bypassing behaviour and geographical access which leads to delay in seeking newborn care. This study (i) measured geographical accessibility of inpatient newborn care, and (ii), characterized bypassing behaviour using the geographical accessibility of the inpatient newborn care seekers. METHODS Geographical accessibility to the inpatient newborn units was modelled based on travel time to the units across Bungoma County. Data was then collected from 8 inpatient newborn units and 395 mothers whose newborns were admitted in the units were interviewed. Their spatial residence locations were geo-referenced and were used against the modelled travel time to define bypassing behaviour. RESULTS Approximately 90% of the sick newborn population have access to nearest newborn units (< 2 h). However, 36% of the mothers bypassed their nearest inpatient newborn facility, with lack of diagnostic services (28%) and distrust of health personnel (37%) being the major determinants for bypassing. Approximately 75% of the care seekers preferred to use the higher tier facilities for both maternal and neonatal care in comparison to sub-county facilities which mostly were bypassed and remained underutilised. CONCLUSION Our findings suggest that though majority of the population have access to care, sub-county inpatient newborn facilities have high risk of being bypassed. There is need to improve quality of care in maternal care, to reduce bypassing behaviour and improving neonatal outcome.
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Affiliation(s)
- Ian A. Ocholla
- Department of Geomatics Engineering and Geospatial Information System, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00100, Nairobi, Kenya
| | - Nathan O. Agutu
- Department of Geomatics Engineering and Geospatial Information System, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00100, Nairobi, Kenya
| | - Paul O. Ouma
- Department of Geomatics Engineering and Geospatial Information System, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00100, Nairobi, Kenya
| | - Daniel Gatungu
- Research and Innovation Directorate, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
| | | | - Jesse Gitaka
- Research and Innovation Directorate, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
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Bayo P, Belaid L, Tahir EO, Ochola E, Dimiti A, Greco D, Zarowsky C. "Midwives do not appreciate pregnant women who come to the maternity with torn and dirty clothing": institutional delivery and postnatal care in Torit County, South Sudan: a mixed method study. BMC Pregnancy Childbirth 2020; 20:250. [PMID: 32345240 PMCID: PMC7189725 DOI: 10.1186/s12884-020-02910-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 03/29/2020] [Indexed: 11/17/2022] Open
Abstract
Background South Sudan has one of the highest maternal mortality ratios in the world, at 789 deaths per 100,000 live births. The majority of these deaths are due to complications during labor and delivery. Institutional delivery under the care of skilled attendants is a proven, effective intervention to avert some deaths. The aim was to determine the prevalence and explore the factors that affect utilization of health facilities for routine delivery and postnatal care in Torit County, South Sudan. Methods A convergent parallel mixed method design combined a community survey among women who had delivered in the previous 12 months selected through a multistage sampling technique (n = 418) with an exploratory descriptive qualitative study. Interviews (n = 19) were conducted with policymakers, staff from non-governmental organizations and health workers. Focus group discussions (n = 12) were conducted among men and women within the communities. Bivariate and multivariate logistic regression were conducted to determine independent factors associated with institutional delivery. Thematic analysis was undertaken for the qualitative data. Results Of 418 participants who had delivered in the previous 12 months, 27.7% had institutional deliveries and 22.5% attended postnatal care at least once within 42 days following delivery. Four or more antenatal care visits increased institutional delivery 5 times (p < 0.001). The participants who had an institutional delivery were younger (mean age 23.3 years old) than those who had home deliveries (mean age 25.6 years). Any previous payments made for delivery in the health facility doubled the risk of home delivery (p = 0.021). Women were more likely to plan and prepare for home delivery than for institutional delivery and sought institutional delivery when complications arose. Perceived poor quality of care due to absence of health staff and lack of supplies was reported as a major barrier to institutional delivery. Women emphasized fear of discrimination based on social and economic status. Unofficial payments such as soap and sweets were reported as routine expectations and another major barrier to institutional delivery. Conclusion Interventions to stop unofficial payments and discrimination based on socio-economic status and to increase access to ANC, delivery services and PNC are needed.
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Affiliation(s)
- Pontius Bayo
- Department of Obstetrics and Gynecology, Torit State Hospital, Torit, South Sudan.
| | - Loubna Belaid
- Department of family medicine, McGill University, Montreal, Canada
| | | | - Emmanuel Ochola
- Department of public health, St, Mary's Hospital Lacor, Gulu, Uganda
| | | | - Donato Greco
- School of public health, University of Rome, Rome, Italy
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Risk Factors for Positive Appraisal of Mistreatment during Childbirth among Ethiopian Midwifery Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082682. [PMID: 32295137 PMCID: PMC7216170 DOI: 10.3390/ijerph17082682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022]
Abstract
The maternal mortality ratio and neonatal mortality rate remain high in Ethiopia, where few births are attended by qualified healthcare staff. This is partly due to care providers’ mistreatment of women during childbirth, which creates a culture of anxiety that decreases the use of healthcare services. This study employed a cross-sectional design to identify risk factors for positive appraisal of mistreatment during childbirth. We asked 391 Ethiopian final year midwifery students to complete a paper-and-pen questionnaire assessing background characteristics, prior observation of mistreatment during education, self-esteem, stress, and mistreatment appraisal. A multivariable linear regression analysis indicated age (p = 0.005), stress (p = 0.019), and previous observation of mistreatment during education (p < 0.001) to be significantly associated with mistreatment appraisal. Younger students, stressed students, and students that had observed more mistreatment during their education reported more positive mistreatment appraisal. No significant association was observed for origin (p = 0.373) and self-esteem (p = 0.445). Findings can be utilized to develop educational interventions that counteract mistreatment during childbirth in the Ethiopian context.
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Thommesen T, Kismul H, Kaplan I, Safi K, Van den Bergh G. "The midwife helped me ... otherwise I could have died": women's experience of professional midwifery services in rural Afghanistan - a qualitative study in the provinces Kunar and Laghman. BMC Pregnancy Childbirth 2020; 20:140. [PMID: 32138695 PMCID: PMC7059669 DOI: 10.1186/s12884-020-2818-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/18/2020] [Indexed: 11/11/2022] Open
Abstract
Background Afghanistan has one of the world’s highest maternal mortality ratios, with more than 60% of women having no access to a skilled birth attendant in some areas. The main challenges for childbearing Afghan women are access to skilled birth attendance, emergency obstetric care and reliable contraception. The NGO-based project Advancing Maternal and Newborn Health in Afghanistan has supported education of midwives since 2002, in accordance with the national plan for midwifery education. The aim of this study is to explore women’s experiences of professional midwifery care in four villages in Afghanistan covered by the project, so as to reveal challenges and improve services in rural and conflict-affected areas of the country. Methods An exploratory case-study approach was adopted. Fourteen in-depth interviews and four focus-group discussions were conducted. A total of 39 women participated – 25 who had given birth during the last six months, 11 mothers-in-law and three community midwives in the provinces of Kunar and Laghman. Data generated by the interviews and observations was analysed using thematic content analysis. Findings Many of the women greatly valued the trained midwives’ life-saving experience, skills and care, and the latter were important reasons for choosing to give birth in a clinic. Women further appreciated midwives’ promotion of immediate skin-to-skin contact and breastfeeding. However, some women experienced rudeness, discrimination and negligence on the part of the midwives. Moreover, relatives’ disapproval, shame and problems with transport and security were important obstacles to women giving birth in the clinics. Conclusions Local recruitment and professional education of midwives as promoted by Afghan authorities and applied in the project seem successful in promoting utilisation and satisfaction with maternal and neonatal health services in rural Afghanistan. Nevertheless, the quality of the services is still lacking, with some women complaining of disrespectful care. There seems to be a need to focus more on communication issues during the education of midwives. An increased focus on in-service training and factors promoting quality care and respectful communication is necessary and should be prioritised.
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Affiliation(s)
- Trude Thommesen
- Centre for International Health, Department for Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
| | - Hallgeir Kismul
- Centre for International Health, Department for Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Ian Kaplan
- Norwegian Afghanistan Committee, Kabul, Afghanistan
| | - Khadija Safi
- Norwegian Afghanistan Committee, Kabul, Afghanistan
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Lalla AT, Ginsbach KF, Penney N, Shamsudin A, Oka R. Exploring sources of insecurity for Ethiopian Oromo and Somali women who have given birth in Kakuma Refugee Camp: A Qualitative Study. PLoS Med 2020; 17:e1003066. [PMID: 32208416 PMCID: PMC7092956 DOI: 10.1371/journal.pmed.1003066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND According to the United Nations High Commissioner for Refugees, 44,000 people are forced to flee their homes every day due to conflict or persecution. Although refugee camps are designed to provide a safe temporary location for displaced persons, increasing evidence demonstrates that the camps themselves have become stressful and dangerous long-term places-especially for women. However, there is limited literature focused on refugee women's perspectives on their insecurity. This qualitative study sought to better understand the ways in which women experienced insecurity at a refugee camp in Kenya. METHODS AND FINDINGS Between May 2017 and June 2017, ethnographic semi-structured interviews accompanied by observation were conducted with a snowball sampling of 20 Somali (n = 10) and Ethiopian Oromo (n = 10) women, 18 years and older, who had had at least 1 pregnancy while living in Kakuma Refugee Camp. The interviews were orally translated, transcribed, entered into Dedoose software for coding, and analyzed utilizing an ethnographic approach. Four sources of insecurity became evident: tension between refugees and the host community, intra- or intercultural conflicts, direct abuse and/or neglect by camp staff and security personnel, and unsafe situations in accessing healthcare-both in traveling to healthcare facilities and in the facilities themselves. Potential limitations include nonrandom sampling, the focus on a specific population, the inability to record interviews, and possible subtle errors in translation. CONCLUSIONS In this study, we observed that women felt insecure in almost every area of the camp, with there being no place in the camp where the women felt safe. As it is well documented that insecure and stressful settings may have deleterious effects on health, understanding the sources of insecurity for women in refugee camps can help to guide services for healthcare in displaced settings. By creating a safer environment for these women in private, in public, and in the process of accessing care in refugee camps, we can improve health for them and their babies.
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Affiliation(s)
- Amber Trujillo Lalla
- University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America.,Eck Institute of Global Health, University of Notre Dame, Notre Dame, Indiana, United States of America
| | | | - Naomi Penney
- Indiana University-Purdue University, Indianapolis, Indiana, United States of America
| | | | - Rahul Oka
- Anthropology Department, University of Notre Dame, Notre Dame, Indiana, United States of America
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Afulani PA, Dyer J, Calkins K, Aborigo RA, Mcnally B, Cohen SR. Provider knowledge and perceptions following an integrated simulation training on emergency obstetric and neonatal care and respectful maternity care: A mixed-methods study in Ghana. Midwifery 2020; 85:102667. [PMID: 32114318 DOI: 10.1016/j.midw.2020.102667] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/23/2019] [Accepted: 02/11/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Little is known about the effect of integrating respectful maternity care into clinical training programs. We sought to examine the effectiveness of an integrated simulation training on emergency obstetric and neonatal care and respectful maternity care on providers' knowledge and self-efficacy, and to asess providers' perceptions of the integrated training. METHODS The project was piloted in East Mamprusi district in Northern Ghana. Forty-three maternity providers were trained, with six participants trained as Simulation Facilitators. Data are from self-administered evaluation forms (with structured and open-ended questions) from all 43 providers and in-depth interviews with 17 providers. We conducted descriptive quantitative analysis and framework qualitative analysis. RESULTS Provider knowledge increased from an average of 61.6% at pre-test to 74.5% at post-test. Self-efficacy also increased from an average of 5.8/10 at pretest to 9.2/10 at post-test. Process evaluation data showed that providers valued the training. Over 95% of participants agreed that the training was useful to them and that they will use the tools learned in the training in their practice. Overall, providers had positive perceptions of the training. They noted improvements in their knowledge and confidence to manage obstetric and neonatal emergencies, as well as in patient-provider communication and teamwork. Many listed respectful maternity care elements as what was most impactful to them from the training. CONCLUSIONS Simulation and team-training on emergency obstetric and neonatal care, combined with respectful maternity care content, can enable health care providers to improve both their clinical and interpersonal knowledge and skills in a training setting that reflects their complex and stressful work environments. Our findings suggest this type of training is feasible, acceptable, and effective in limited-resource settings. Uptake of such trainings could drive efforts towards providing high quality safe, responsive, and respectful obstetric and neonatal care.
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Affiliation(s)
- Patience A Afulani
- Institute for Global Health Sciences, School of Medicine, University of California, San Francisco, California.
| | | | | | | | - Brienne Mcnally
- Institute for Global Health Sciences, School of Medicine, University of California, San Francisco, California
| | - Susanna R Cohen
- PRONTO International, Seattle, WA, USA; University of Utah, College of Nursing, Salt Lake City, Utah, USA
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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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Silveira MF, Mesenburg MA, Bertoldi AD, De Mola CL, Bassani DG, Domingues MR, Stein A, Coll CVN. The association between disrespect and abuse of women during childbirth and postpartum depression: Findings from the 2015 Pelotas birth cohort study. J Affect Disord 2019; 256:441-447. [PMID: 31252237 PMCID: PMC6880287 DOI: 10.1016/j.jad.2019.06.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/23/2019] [Accepted: 06/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study examined the association between disrespect and abuse of women during facility-based childbirth and postpartum depression (PD) occurrence. METHODS We used data from the 2015 Pelotas (Brazil) Birth Cohort, a population-based cohort of all live births in the city. We assessed 3065 mothers at pregnancy and 3-months after birth. Self-reported disrespect and abuse experiences included physical abuse, verbal abuse, denial of care, and undesired procedures. We estimate the occurrence of each disrespect and abuse type, one or more types and disrespect and abuse score. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PD. EPDS scores ≥13 and ≥15 indicated at least moderate PD and marked/severe. Odds ratios (OR) were calculated by logistic regression. RESULTS The prevalence of at least moderate PD and marked/severe PD was 9.4% and 5.7%, respectively. 18% of the women experienced at least one type of disrespect and abuse. Verbal abuse increased the odds of having at least moderate PD (OR = 1.58; 95%CI 1.06-2.33) and marked/severe PD (OR = 1.69; 95%CI 1.06-2.70) and the effect among women who did not experience antenatal depressive symptoms was greater in comparison to those who did (OR = 2.51; 95%CI 1.26-5.04 and OR = 4.27; 95%CI 1.80-10.12). Physical abuse increased the odds of having marked/severe PD (OR = 2.28; 95%CI 1.26-4.12). Having experienced three or more mistreatment types increased the odds of at least moderate PD (OR = 2.90; 95%CI 1.30 - 35.74) and marked/severe PD (OR=3.86; 95%CI 1.58-9.42). LIMITATIONS Disrespect and abuse experiences during childbirth were self-reported. CONCLUSIONS Disrespect and abuse during childbirth increased the odds of PD three months after birth. Strategies to promote high quality and respectful maternal health care are needed to prevent mother-child adverse outcomes.
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Affiliation(s)
- Mariangela Freitas Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160, 3° andar, Pelotas CEP 96020-220, Brazil
| | - Marilia Arndt Mesenburg
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160, 3° andar, Pelotas CEP 96020-220, Brazil.
| | - Andrea Damaso Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160, 3° andar, Pelotas CEP 96020-220, Brazil
| | - Christian Loret De Mola
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160, 3° andar, Pelotas CEP 96020-220, Brazil,Postgraduate Program in Public Health, Federal University of Rio Grande, Brazil
| | - Diego Garcia Bassani
- Centre for Global Child Health, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto ON M5G 1×8, Canada
| | - Marlos Rodrigues Domingues
- Postgraduate Program in Physical Education, Federal University of Pelotas, Rua Luiz de Camões, n° 625, Pelotas CEP 96055-630, Brazil
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Oxford OX3 7JX, UK
| | - Carolina V N Coll
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160, 3° andar, Pelotas CEP 96020-220, Brazil,International Center for Equity in Health, Federal University of Pelotas, Brazil
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Villains or victims? An ethnography of Afghan maternity staff and the challenge of high quality respectful care. BMC Pregnancy Childbirth 2019; 19:307. [PMID: 31443691 PMCID: PMC6708168 DOI: 10.1186/s12884-019-2420-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background Healthcare providers are the vital link between evidence-based policies and women receiving high quality maternity care. Explanations for suboptimal care often include poor working conditions for staff and a lack of essential supplies. Other explanations suggest that doctors, midwives and care assistants might lack essential skills or be unaware of the rights of the women for whom they care. This ethnography examined the everyday lives of maternal healthcare providers working in a tertiary maternity hospital in Kabul, Afghanistan between 2010 and 2012. The aim was to understand their notions of care, varying levels of commitment, and the obstacles and dilemmas that affected standards. Methods The culture of care was explored through six weeks of observation, 41 background interviews, 23 semi-structured interviews with doctors, midwives and care assistants. Focus groups were held with two diverse groups of women in community settings to understand their experiences and desires regarding care in maternity hospitals. Data were analysed thematically. Results Women related many instances of neglect, verbal abuse and demands for bribes from staff. Doctors and midwives concurred that they did not provide care as they had been taught and blamed the workload, lack of a shift system, insufficient supplies and inadequate support from management. Closer inspection revealed a complex reality where care was impeded by low levels of supplies and medicines but theft reduced them further; where staff were unfairly blamed by management but others flouted rules with impunity; and where motivated staff tried hard to work well but, when overwhelmed with the workload, admitted that they lost patience and shouted at women in childbirth. In addition there were extreme examples of both abusive and vulnerable staff. Conclusions Providing respectful quality maternity care for women in Afghanistan requires multifaceted initiatives because the factors leading to suboptimal care or mistreatment are complex and interrelated. Standards need enforcing and abusive practices confronting to provide a supportive, facilitating environment for both staff and childbearing women. Polarized perspectives such as ‘villain’ or ‘victim’ are unhelpful as they exclude the complex realities of human behaviour and consequently limit the scope of problem solving.
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George A, LeFevre AE, Jacobs T, Kinney M, Buse K, Chopra M, Daelmans B, Haakenstad A, Huicho L, Khosla R, Rasanathan K, Sanders D, Singh NS, Tiffin N, Ved R, Zaidi SA, Schneider H. Lenses and levels: the why, what and how of measuring health system drivers of women's, children's and adolescents' health with a governance focus. BMJ Glob Health 2019; 4:e001316. [PMID: 31297255 PMCID: PMC6590975 DOI: 10.1136/bmjgh-2018-001316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/16/2019] [Accepted: 02/15/2019] [Indexed: 11/18/2022] Open
Abstract
Health systems are critical for health outcomes as they underpin intervention coverage and quality, promote users’ rights and intervene on the social determinants of health. Governance is essential for health system endeavours as it mobilises and coordinates a multiplicity of actors and interests to realise common goals. The inherently social, political and contextualised nature of governance, and health systems more broadly, has implications for measurement, including how the health of women, children and adolescents health is viewed and assessed, and for whom. Three common lenses, each with their own views of power dynamics in policy and programme implementation, include a service delivery lens aimed at scaling effective interventions, a societal lens oriented to empowering people with rights to effect change and a systems lens concerned with creating enabling environments for adaptive learning. We illustrate the implications of each lens for the why, what and how of measuring health system drivers across micro, meso and macro health systems levels, through three examples (digital health, maternal and perinatal death surveillance and review, and multisectoral action for adolescent health). Appreciating these underpinnings of measuring health systems and governance drivers of the health of women, children and adolescents is essential for a holistic learning and action agenda that engages a wider range of stakeholders, which includes, but also goes beyond, indicator-based measurement. Without a broadening of approaches to measurement and the types of research partnerships involved, continued investments in the health of women, children and adolescents will fall short.
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Affiliation(s)
- Asha George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | - Tanya Jacobs
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Mary Kinney
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Kent Buse
- Political Affairs and Strategy, UNAIDS, Geneva, Switzerland
| | | | | | - Annie Haakenstad
- School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Luis Huicho
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rajat Khosla
- United Nations High Commission for Human Rights, Geneva, Switzerland
| | | | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Neha S Singh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicki Tiffin
- Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa.,Computational Biology, University of Cape Town, Cape Town, South Africa
| | - Rajani Ved
- National Health Systems Resource Centre, New Delhi, India
| | - Shehla Abbas Zaidi
- Community Health Sciences, Aga Khan University Faculty of Health Sciences, Karachi, Pakistan
| | - Helen Schneider
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, McLemore M, Cadena M, Nethery E, Rushton E, Schummers L, Declercq E. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health 2019. [PMID: 31182118 DOI: 10.1186/s12978-019-0729-2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)-US study. METHODS Our multi-stakeholder team distributed an online cross-sectional survey to capture lived experiences of maternity care in diverse populations. Patient-designed items included indicators of verbal and physical abuse, autonomy, discrimination, failure to meet professional standards of care, poor rapport with providers, and poor conditions in the health system. We quantified the prevalence of mistreatment by race, socio-demographics, mode of birth, place of birth, and context of care, and describe the intersectional relationships between these variables. RESULTS Of eligible participants (n = 2700), 2138 completed all sections of the survey. One in six women (17.3%) reported experiencing one or more types of mistreatment such as: loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help. Context of care (e.g. mode of birth; transfer; difference of opinion) correlated with increased reports of mistreatment. Experiences of mistreatment differed significantly by place of birth: 5.1% of women who gave birth at home versus 28.1% of women who gave birth at the hospital. Factors associated with a lower likelihood of mistreatment included having a vaginal birth, a community birth, a midwife, and being white, multiparous, and older than 30 years. Rates of mistreatment for women of colour were consistently higher even when examining interactions between race and other maternal characteristics. For example, 27.2% of women of colour with low SES reported any mistreatment versus 18.7% of white women with low SES. Regardless of maternal race, having a partner who was Black also increased reported mistreatment. CONCLUSION This is the first study to use indicators developed by service users to describe mistreatment in childbirth in the US. Our findings suggest that mistreatment is experienced more frequently by women of colour, when birth occurs in hospitals, and among those with social, economic or health challenges. Mistreatment is exacerbated by unexpected obstetric interventions, and by patient-provider disagreements.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Tanya Khemet Taiwo
- University of California Davis School of Medicine, Sacramento, California, USA.,Department of Midwifery, Bastyr University, Seattle, WA, USA
| | - Nicholas Rubashkin
- Department of Obstetrics and Gynecology, University of California San Francisco and the Institute for Global Health Sciences, California, USA
| | - Melissa Cheyney
- Department of Anthropology, Oregon State University, Corvallis, Oregon, USA
| | | | - Monica McLemore
- Department of Family Health Care Nursing and ANSIRH Bixby Center for Global Reproductive Health, University of California, San Francisco, USA
| | | | - Elizabeth Nethery
- School of Population & Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eleanor Rushton
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Laura Schummers
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eugene Declercq
- School of Public Health, Boston University, Massachusetts, Boston, USA
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Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, McLemore M, Cadena M, Nethery E, Rushton E, Schummers L, Declercq E. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health 2019; 16:77. [PMID: 31182118 PMCID: PMC6558766 DOI: 10.1186/s12978-019-0729-2] [Citation(s) in RCA: 351] [Impact Index Per Article: 70.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/30/2019] [Indexed: 12/19/2022] Open
Abstract
Background Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)–US study. Methods Our multi-stakeholder team distributed an online cross-sectional survey to capture lived experiences of maternity care in diverse populations. Patient-designed items included indicators of verbal and physical abuse, autonomy, discrimination, failure to meet professional standards of care, poor rapport with providers, and poor conditions in the health system. We quantified the prevalence of mistreatment by race, socio-demographics, mode of birth, place of birth, and context of care, and describe the intersectional relationships between these variables. Results Of eligible participants (n = 2700), 2138 completed all sections of the survey. One in six women (17.3%) reported experiencing one or more types of mistreatment such as: loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help. Context of care (e.g. mode of birth; transfer; difference of opinion) correlated with increased reports of mistreatment. Experiences of mistreatment differed significantly by place of birth: 5.1% of women who gave birth at home versus 28.1% of women who gave birth at the hospital. Factors associated with a lower likelihood of mistreatment included having a vaginal birth, a community birth, a midwife, and being white, multiparous, and older than 30 years. Rates of mistreatment for women of colour were consistently higher even when examining interactions between race and other maternal characteristics. For example, 27.2% of women of colour with low SES reported any mistreatment versus 18.7% of white women with low SES. Regardless of maternal race, having a partner who was Black also increased reported mistreatment. Conclusion This is the first study to use indicators developed by service users to describe mistreatment in childbirth in the US. Our findings suggest that mistreatment is experienced more frequently by women of colour, when birth occurs in hospitals, and among those with social, economic or health challenges. Mistreatment is exacerbated by unexpected obstetric interventions, and by patient-provider disagreements. Electronic supplementary material The online version of this article (10.1186/s12978-019-0729-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Tanya Khemet Taiwo
- University of California Davis School of Medicine, Sacramento, California, USA.,Department of Midwifery, Bastyr University, Seattle, WA, USA
| | - Nicholas Rubashkin
- Department of Obstetrics and Gynecology, University of California San Francisco and the Institute for Global Health Sciences, California, USA
| | - Melissa Cheyney
- Department of Anthropology, Oregon State University, Corvallis, Oregon, USA
| | | | - Monica McLemore
- Department of Family Health Care Nursing and ANSIRH Bixby Center for Global Reproductive Health, University of California, San Francisco, USA
| | | | - Elizabeth Nethery
- School of Population & Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eleanor Rushton
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Laura Schummers
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eugene Declercq
- School of Public Health, Boston University, Massachusetts, Boston, USA
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Sudhinaraset M, Giessler K, Golub G, Afulani P. Providers and women's perspectives on person-centered maternity care: a mixed methods study in Kenya. Int J Equity Health 2019; 18:83. [PMID: 31182105 PMCID: PMC6558853 DOI: 10.1186/s12939-019-0980-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/08/2019] [Indexed: 11/24/2022] Open
Abstract
Background Globally, there has been increasing attention to women’s experiences of care and calls for a person-centered care approach. At the heart of this approach is the patient-provider relationship. It is necessary to examine the extent to which providers and women agree on the care that is provided and received. Studies have found that incongruence between women’s and providers’ perceptions may negatively impact women’s compliance, satisfaction, and future use of health facilities. However, there are no studies that examine patient and provider perspectives on person-centered care. Methods To fill this gap in the literature, we use cross-sectional data of 531 women and 33 providers in seven government health facilities in Kenya to assess concordance and discordance in person-centered care measures. Additionally, we analyze 41 in-depth interviews with providers from three of these facilities to examine why differences in reporting may occur. Descriptive statistical methods were used to measure the magnitude of differences between reports of women and reports of providers. Thematic analyses were conducted for provider surveys. Results Our findings suggest high discordance between women and providers’ perspectives in regard to person-centered care experiences. On average, women reported lower levels of person-centered care compared to providers, including low respectful and dignified care, communication and autonomy, and supportive care. Providers were more likely to report higher rates of poor health facility environment such as having sufficient staff. We summarize the overarching reasons for the divergence in women and provider reports as: 1) different understanding or interpretation of person-centered care behaviors, and 2) different expectations, norms or values of provider behaviors. Providers rationalized abuse towards women, did not allow a companion of choice, and blamed women for poor patient-provider communication. Women lacked assurance in privacy and confidentiality, and faced challenges related to the health facility environment. Providers attributed poor person-centered care to both individual and facility/systemic factors. Conclusions Implications of this study suggests that providers should be trained on person-centered care approaches and women should be counseled on understanding patient rights and how to communicate with health professionals.
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Affiliation(s)
- May Sudhinaraset
- University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, USA. .,School of Medicine, University of California, San Francisco, USA.
| | - Katie Giessler
- School of Medicine, University of California, San Francisco, USA
| | | | - Patience Afulani
- School of Medicine, University of California, San Francisco, USA
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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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Oluoch-Aridi J, Smith-Oka V, Milan E, Dowd R. Exploring mistreatment of women during childbirth in a peri-urban setting in Kenya: experiences and perceptions of women and healthcare providers. Reprod Health 2018; 15:209. [PMID: 30558618 PMCID: PMC6296108 DOI: 10.1186/s12978-018-0643-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/23/2018] [Indexed: 11/23/2022] Open
Abstract
Background In Kenya, indirectly caused maternal deaths form a significant portion of all maternal deaths within the health system. Many of these deaths are avoidable and occur during delivery and labor. Poor quality health service has been a recurring concern among women in Kenya, with women reporting interactions with healthcare workers that are often demeaning and abusive. This paper explores the experiences and perceptions of both female patients and healthcare workers regarding mistreatment during childbirth. This study aims to provide recommendations on how dignified care can be made the norm, specifically focusing on a peri-urban setting in Kenya. Methods The research was accomplished using qualitative research methods with focus group discussions and in depth interviews with women and healthcare workers. The aim was to gain a deeper understanding of the manifestations of mistreatment within the context of a peri-urban setting in Kenya. Results Female patients reported different forms of mistreatment, such as verbal abuse, physical abuse, neglect, discrimination, abandonment, poor rapport and failure of the health system to uphold professional standards. The healthcare workers described a health system that was weak and fragmented with poor policy support particularly for the new free maternity services policy leading to the mistreatment of women. Conclusion Newly formed County Governments need to provide resources for a functioning health system to ensure an enabling environment for the provision of high quality maternal health services. This process can include feedback loops with maternity clients to ensure woman-centered services. Policy makers need to strengthen oversight for the implementation of the free maternity services Community health volunteers can be trained to provide this information. Professional associations that govern the standards of quality care for healthcare workers need to address the mistreatment through retraining and norms transformation. Electronic supplementary material The online version of this article (10.1186/s12978-018-0643-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jackline Oluoch-Aridi
- Regional Research Programs Manager, The Ford Program in Human Development Studies and Solidarity, University of Notre Dame, Regional Office, East Africa, P.O. Box 49675-00100, Nairobi, Kenya.
| | - Vania Smith-Oka
- Department of Anthropology, University of Notre Dame, 248 Corbett Family Hall, Notre Dame, IN, 46556, USA
| | - Ellyn Milan
- Eck Institute for Global Health, University of Notre Dame, 120 Brownson Hall, Notre Dame, IN, 46556, USA
| | - Robert Dowd
- The Ford Program in Human Development Studies and Solidarity, Kellogg Institute of International Affairs, University of Notre Dame, 2167 Nanovic-Jenkins Hall, Notre Dame, IN, 46556, USA
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Mordal E, Vatne S, Agafari HG, Tsegaye M, Ulvund I. Women's childbearing location preferences in South Ethiopia: a qualitative study. Health Care Women Int 2018; 40:138-157. [PMID: 30526416 DOI: 10.1080/07399332.2018.1526287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Maternal mortality is unacceptably high in developing countries, and maternal health care service utilization is associated with improved maternal outcomes. We shed light on conditions that influence women's preferences for childbirth location. Based on a qualitative descriptive design, 25 interviews were conducted with women of childbearing age in Southern Ethiopia in 2015. Previous experience of complications was the most common reason for using skilled attendants at the next childbirth. In addition, women's limited decision-making authority and knowledge, as well as the quality of health care services and infrastructure, influenced childbirth location preferences. Home birth is still the norm, but there is growing interest in using health facilities and skilled attendants.
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Affiliation(s)
- Elin Mordal
- a Molde University College - Specialized University in Logistics , Molde , Norway
| | - Solfrid Vatne
- a Molde University College - Specialized University in Logistics , Molde , Norway
| | | | | | - Ingeborg Ulvund
- a Molde University College - Specialized University in Logistics , Molde , Norway
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Begley C, Sedlicka N, Daly D. Respectful and disrespectful care in the Czech Republic: an online survey. Reprod Health 2018; 15:198. [PMID: 30514394 PMCID: PMC6280471 DOI: 10.1186/s12978-018-0648-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/26/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Respectful maternity care includes treating women with dignity, consulting them about preferences, gaining consent for treatment, respecting their wishes, and giving care based on evidence, not routines. In the absence of any documented evidence, this study aimed to ascertain maternity care-givers' perceptions of respectful care provided for childbearing women in Czech Republic. METHODS Following ethical approval, an online quantitative survey with qualitative comments was completed by 52 respondents recruited from workshops on promoting normal birth, followed by snowball sampling. The majority were midwives (50%) or doulas (46%) working in one of 51 hospitals, or with homebirths. Chi-square analysis was used for comparisons. RESULTS Non-evidenced-based interventions, described as 'always' or 'frequently' used in hospitals, included application of electronic fetal monitoring in normal labour (n = 40, 91%), shaving the perineum (n = 10, 29%), and closed-glottal pushing (n = 32, 94%). Positions stated as most often used for spontaneous vaginal births were semi-recumbent (n = 31, 65%) or lying flat (n = 15, 31%) in hospital, and upright at home (n = 27, 100%). Average episiotomy and induction of labour rates were estimated at 40 and 26%, respectively, higher than accepted norms. Eighteen respondents (46%) said reasons for performing vaginal examinations were not explained to women in hospitals, and 21 (51%) said consent was 'never' sought. At home, 25 (89%) said reasons were explained, and permission 'always' sought (n = 22, 81%). Thirteen (32%) said hospital clinicians explained why artificial rupture of membranes was necessary, but only ten (25%) said they 'always' sought permission. The majority said that hospital clinicians 'never'/'almost never' explained reasons for performing an episiotomy (13 = 34%), gained permission (n = 20, 54%) or gave local anaesthetic (n = 19, 51%). Contrastingly, 17 (100%) said midwives at home explained the reasons for episiotomy and asked permission. When clinicians disagreed with women's decisions, 13 (35%) respondents said women might be told to 'face the consequences', six (16%) stated that the 'psychological pressure' experienced caused women to 'give up and give their permission', and four (11%) said the intervention would be performed 'against her will.' CONCLUSIONS Findings reveal considerable levels of disrespectful, non-evidenced-based, non-consensual and abusive practices that may leave women with life-long trauma.
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Affiliation(s)
- Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, DO2 T283 Ireland
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Natalie Sedlicka
- Association for Birth Houses & Centers (APODAC), Masarykovo nábřeží 234/26, 11000 Prague 1, Czech Republic
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, DO2 T283 Ireland
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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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Rubashkin N, Warnock R, Diamond-Smith N. A systematic review of person-centered care interventions to improve quality of facility-based delivery. Reprod Health 2018; 15:169. [PMID: 30305129 PMCID: PMC6180507 DOI: 10.1186/s12978-018-0588-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION We conducted a systematic review to summarize the global evidence on person-centered care (PCC) interventions in delivery facilities in order to: (1) map the PCC objectives of past interventions (2) to explore the impact of PCC objectives on PCC and clinical outcomes. METHODS We developed a search strategy based on a current definition of PCC. We searched for English-language, peer-reviewed and original research articles in multiple databases from 1990 to 2016 and conducted hand searches of the Cochrane library and gray literature. We used systematic review methodology that enabled us to extract and synthesize quantitative and qualitative data. We categorized interventions according to their primary and secondary PCC objectives. We categorized outcomes into person-centered and clinical (labor and delivery, perinatal, maternal mental health). RESULTS Our initial search strategy yielded 9378 abstracts; we conducted full-text reviews of 32 quantitative, 6 qualitative, 2 mixed-methods studies, and 7 systematic reviews (N = 47). Past interventions pursued these primary PCC objectives: autonomy, supportive care, social support, the health facility environment, and dignity. An intervention's primary and secondary PCC objectives frequently did not align with the measured person-centered outcomes. Generally, PCC interventions either improved or made no difference to person-centered outcomes. There was no clear relationship between PCC objectives and clinical outcomes. CONCLUSIONS This systematic review presents a comprehensive analysis of facility-based delivery interventions using a current definition of person-centered care. Current definitions of PCC propose new domains of inquiry but may leave out previous domains.
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Affiliation(s)
- Nicholas Rubashkin
- Institute for Global Health Sciences, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA
| | - Ruby Warnock
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, Zuckerberg San Francisco General, University of California, San Francisco, 1001 Potrero Avenue, 6D, San Francisco, CA 94110 USA
| | - Nadia Diamond-Smith
- Institute for Global Health Sciences, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
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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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McMahon SA, Mnzava RJ, Tibaijuka G, Currie S. The "hot potato" topic: challenges and facilitators to promoting respectful maternal care within a broader health intervention in Tanzania. Reprod Health 2018; 15:153. [PMID: 30208916 PMCID: PMC6134753 DOI: 10.1186/s12978-018-0589-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
In recent years, mistreatment during childbirth has captured the public health and maternal health consciousness as not only an affront to women's rights but also a formidable deterrent to the uptake of facility-based childbirth - and thus to reductions in maternal mortality. The challenge ahead is to determine what can be done to address this public health problem. A modest but growing body of research has demonstrated that interventions to foster Respectful Maternity Care (RMC) can enact change, albeit in the relatively controlled context of a trial or study. Herein we describe our experiences in weaving elements of RMC across tiers of an existing maternal and newborn health program. As a commentary, this document does not outline program results, but instead highlights challenges and facilitators to promoting RMC within a large-scale, multi-district health platform. We conclude with lessons learned during the process and urge that others share their program learning experiences in an effort to strengthen the knowledge base on what works and what does not work in terms of addressing this complex, context-sensitive issue.
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Affiliation(s)
- Shannon A. McMahon
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Rose John Mnzava
- Jhpiego/Tanzania, an affiliate of Johns Hopkins University, PO Box 9170, Dar es Salaam, Tanzania
| | - Gaudiosa Tibaijuka
- Jhpiego/Tanzania, an affiliate of Johns Hopkins University, PO Box 9170, Dar es Salaam, Tanzania
| | - Sheena Currie
- Jhpiego/USA, an affiliate of Johns Hopkins University, 1615 Thames St., Baltimore, 21231 MD USA
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Afulani PA, Diamond-Smith N, Phillips B, Singhal S, Sudhinaraset M. Validation of the person-centered maternity care scale in India. Reprod Health 2018; 15:147. [PMID: 30157877 PMCID: PMC6114501 DOI: 10.1186/s12978-018-0591-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/15/2018] [Indexed: 11/25/2022] Open
Abstract
Background Person-centered care during childbirth is recognized as a critical component of quality of maternity care. But there are few validated tools to measure person-centered maternity care (PCMC). This paper aims to fill this measurement gap. We present the results of the psychometric analysis of the PCMC tool that was previously validated in Kenya using data from India. We aim to assess the validity and reliability of the PCMC scale in India, and to compare the results to those found in the Kenya validation. Methods We use data from a cross-sectional survey conducted from August to October 2017 with recently delivered women at 40 government facilities in Uttar Pradesh, India (N = 2018). The PCMC measure used is a previously validated scale with subscales for dignity and respect, communication and autonomy, and supportive care. We performed psychometric analyses, including iterative exploratory and confirmatory factor analysis, to assess construct and criterion validity and reliability. Results The results provide support for a 27-item PCMC scale in India with a possible score range from 0 to 81, compared to the 30-item PCMC scale in Kenya with a 0 to 90 possible score range. The overall PCMC scale has good reliability (Cronbach alpha = 0.85). Similar to Kenya, we are able to group the items in to three conceptual domains representing subscales for “Dignity and Respect,” “Communication and Autonomy,” and “Supportive Care.” The sub-scales also have relatively good reliability (Cronbach alphas range from 0.67 to 0.73). In addition, increasing scores on the scale is associated with future intentions to deliver in the same facility, suggesting good criterion validity. Conclusions This research extends the PCMC literature by presenting results of validating the PCMC scale in a new context. The psychometric analysis using data from Uttar Pradesh, India corroborates the Kenya analysis showing the scale had good content, construct, and criterion validity, as well as high reliability. The overlap in items suggests that this scale can be used across different contexts to compare women’s experiences of care, and to inform and evaluate quality improvement efforts to promote comprehensive PCMC.
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Affiliation(s)
- Patience A Afulani
- School of Medicine, Institute for Global Health Sciences, University of California, San Francisco, USA.
| | - Nadia Diamond-Smith
- School of Medicine, Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Beth Phillips
- School of Medicine, Institute for Global Health Sciences, University of California, San Francisco, USA
| | | | - May Sudhinaraset
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, USA
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Betron ML, McClair TL, Currie S, Banerjee J. Expanding the agenda for addressing mistreatment in maternity care: a mapping review and gender analysis. Reprod Health 2018; 15:143. [PMID: 30153848 PMCID: PMC6114528 DOI: 10.1186/s12978-018-0584-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper responds to the global call to action for respectful maternity care (RMC) by examining whether and how gender inequalities and unequal power dynamics in the health system undermine quality of care or obstruct women's capacities to exercise their rights as both users and providers of maternity care. METHODS We conducted a mapping review of peer-reviewed and gray literature to examine whether gender inequality is a determinant of mistreatment during childbirth. A search for peer-reviewed articles published between January 1995 and September 2017 in PubMed, Embase, SCOPUS, and Web of Science databases, supplemented by an appeal to experts in the field, yielded 127 unique articles. We reviewed these articles using a gender analysis framework that categorizes gender inequalities into four key domains: access to assets, beliefs and perceptions, practices and participation, and institutions, laws, and policies. A total of 37 articles referred to gender inequalities in the four domains and were included in the analysis. RESULTS The mapping indicates that there have been important advances in documenting mistreatment at the health facility, but less attention has been paid to addressing the associated structural gender inequalities. The limited evidence available shows that pregnant and laboring women lack information and financial assets, voice, and agency to exercise their rights to RMC. Women who defy traditional feminine stereotypes of chastity and serenity often experience mistreatment by providers as a result. At the same time, mistreatment of women inside and outside of the health facility is normalized and accepted, including by women themselves. As for health care providers, gender discrimination is manifested through degrading working conditions, lack of respect for their abilities, violence and harassment,, lack of mobility in the community, lack of voice within their work setting, and limited training opportunities and professionalization. All of these inequalities erode their ability to deliver high quality care. CONCLUSION While the evidence base is limited, the literature clearly shows that gender inequality-for both clients and providers-contributes to mistreatment and abuse in maternity care. Researchers, advocates, and practitioners need to further investigate and build upon lessons from the broader gender equality, violence prevention, and rights-based health movements to expand the agenda on mistreatment in childbirth and develop effective interventions.
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Affiliation(s)
- Myra L. Betron
- USAID’s Maternal and Child Survival Program/Jhpiego, 1776 Massachusetts Avenue, NW Washington DC, 20036 USA
| | - Tracy L. McClair
- Jhpiego, 1776 Massachusetts Avenue, NW Washington, DC, 20036 USA
| | - Sheena Currie
- USAID’s Maternal and Child Survival Program/Jhpiego, 1776 Massachusetts Avenue, NW Washington DC, 20036 USA
| | - Joya Banerjee
- USAID’s Maternal and Child Survival Program/Jhpiego, 1776 Massachusetts Avenue, NW Washington DC, 20036 USA
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Webber G, Chirangi B, Magatti N. Promoting respectful maternity care in rural Tanzania: nurses' experiences of the "Health Workers for Change" program. BMC Health Serv Res 2018; 18:658. [PMID: 30134890 PMCID: PMC6106895 DOI: 10.1186/s12913-018-3463-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 08/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background Disrespectful and abusive care of women during their pregnancies has been shown to be a barrier for women accessing health care services for antenatal care and delivery. As part of an implementation research study to improve women’s access to health care services in Rorya District, Mara, Tanzania, we conducted a pilot study training reproductive health care nurses to be more sensitive to women’s needs based on the “Health Workers for Change” curriculum. Methods Six series of workshops were held with a total of 60 reproductive health care nurses working at the hospitals, health centres and dispensaries in the district. The participants provided comments on a survey and participated in focus groups at the conclusion of the workshop series. These qualitative data were analyzed for common themes. Results The participants appreciated the training and reflected on the poor quality of health care services they were providing, recognizing their attitudes towards their women patients were problematic. They emphasized the need for future training to include more staff and to sustain positive changes. Finally, they made several suggestions for improving women’s experiences in the future. Conclusions The qualitative findings demonstrate the success of the workshops in assisting the health care providers to become aware of their negative attitudes towards women. Future research should examine the impact of the workshops both on sustaining attitudinal changes of the providers and on the experiences of pregnant women receiving health care services.
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Affiliation(s)
- Gail Webber
- Bruyere Research Institute, 85 Primrose Ave, Ottawa, ON, K1R 6M1, Canada.
| | - Bwire Chirangi
- Shirati KMT District Hospital, Rorya, Mara, Shirati, Tanzania
| | - Nyamusi Magatti
- Shirati KMT District Hospital, Rorya, Mara, Shirati, Tanzania
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Madhiwalla N, Ghoshal R, Mavani P, Roy N. Identifying disrespect and abuse in organisational culture: a study of two hospitals in Mumbai, India. REPRODUCTIVE HEALTH MATTERS 2018; 26:36-47. [PMID: 30102132 PMCID: PMC6178091 DOI: 10.1080/09688080.2018.1502021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This paper draws on findings from a qualitative study of two government hospitals in Mumbai, India, which aimed to provide a better understanding of the institutional drivers of disrespect and abuse (D&A) in childbirth. The paper describes the structural context, in which government hospital providers can exercise considerable power over patients, yet may be themselves vulnerable to violence and external influence. Decisions that affect care are made by a bureaucracy, which does not perceive problems with the same intensity as providers who are directly attending to patients. Within this context, while contrasting organisational cultures had evolved at the two hospitals, both were characterised by social/professional inequality and hierarchical functioning, and marginalising women. This context generates invisible pressures on subordinate staff, and creates interpersonal conflicts and ambiguity in the division of roles and responsibilities that manifest in individual actions of D&A. Services are organised around the internal logic of the institution, rather than being centred on women. This results in conditions that violate women's privacy, and disregards their choice and consent. The structural environment of resource constraints, poor management and bureaucratic decision-making leads to precarious situations, endangering women’s safety. With the institution's functioning based on hierarchies and authority, rather than adherence to universal standards or established protocols, irrational, harmful practices endorsed by senior staff are institutionalised and reproduced. A deeper focus on organisational culture, embedded in the discourse of D&A, would help to evolve effective strategies to address D&A as systemic problems.
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Affiliation(s)
- Neha Madhiwalla
- a Co-ordinator, Centre for Studies in Ethics and Rights , Anusandhan Trust , Mumbai , India
| | - Rakhi Ghoshal
- b Senior Programme Officer, Centre for Studies in Ethics and Rights , Anusandhan Trust , Mumbai , India
| | - Padmaja Mavani
- c Associate Professor, Department of Obstetrics and Gynaecology , Seth G.S. Medical College and K.E.M. Hospital , Mumbai , India
| | - Nobhojit Roy
- d Head, WHO Collaborating Centre for Research on Surgical Care Delivery in LMICS, Surgical Unit , BARC Hospital , Mumbai , India
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Kalisa R, Smeele P, van Elteren M, van den Akker T, van Roosmalen J. Facilitators and barriers to birth preparedness and complication readiness in rural Rwanda among community health workers and community members: a qualitative study. Matern Health Neonatol Perinatol 2018; 4:11. [PMID: 29992035 PMCID: PMC5989363 DOI: 10.1186/s40748-018-0080-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/26/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Birth preparedness and complication readiness (BP/CR) comprise a strategy to make women plan for birth and encourage them to seek professional care in order to reduce poor pregnancy outcome. We aimed to understand the facilitators and barriers to BP/CR among community health workers (CHWs) and community members in rural Rwanda. METHODS Eight focus group discussions were conducted with 88 participants comprising of CHWs, elderly women aged 45-68 and men aged 18-59, as well as two key informant interviews in Musanze district, Rwanda, between November and December 2015. Qualitative data were digitally recorded, transcribed verbatim and analysed using content analysis. RESULTS Participants perceived the importance of family assistance, medical insurance and attending antenatal care (ANC) to facilitate BP/CR and enhance professional care at birth. CHWs reinforced BP/CR messages by SMS alerts and during community gatherings. 'Ubudehe (collective action to combat poverty)' was known as a tool to identify the poorest families in need of government aid to pay for medical care. Disrespect and abuse of women during labor by health workers were perceived as important barriers to access professional care, as well as conflicting health policies such as user fees for ANC and family planning services, and imposing fines on women giving birth outside health facilities. CONCLUSION CHWs, ANC and medical insurance are perceived to be important facilitators of BP/CR. Respectful care is paramount for improved maternal health. There is a need for addressing inconsistent health policies hindering the intention to access professional care.
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Affiliation(s)
- Richard Kalisa
- Department of Obstetrics and Gynecology, Ruhengeri Hospital, Musanze, Rwanda
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - Patrick Smeele
- Department of Medical Humanities, VU University Medical Center, Amsterdam, The Netherlands
| | - Marianne van Elteren
- Department of Medical Humanities, VU University Medical Center, Amsterdam, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, The Netherlands
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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83
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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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84
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Alzyoud F, Khoshnood K, Alnatour A, Oweis A. Exposure to verbal abuse and neglect during childbirth among Jordanian women. Midwifery 2018; 58:71-76. [DOI: 10.1016/j.midw.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 11/20/2017] [Accepted: 12/06/2017] [Indexed: 11/25/2022]
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85
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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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86
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Afulani PA, Kirumbi L, Lyndon A. What makes or mars the facility-based childbirth experience: thematic analysis of women's childbirth experiences in western Kenya. Reprod Health 2017; 14:180. [PMID: 29284490 PMCID: PMC5747138 DOI: 10.1186/s12978-017-0446-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa accounts for approximately 66% of global maternal deaths. Poor person-centered maternity care, which emphasizes the quality of patient experience, contributes both directly and indirectly to these poor outcomes. Yet, few studies in low resource settings have examined what is important to women during childbirth from their perspective. The aim of this study is to examine women's facility-based childbirth experiences in a rural county in Kenya, to identify aspects of care that contribute to a positive or negative birth experience. METHODS Data are from eight focus group discussions conducted in a rural county in western Kenya in October and November 2016, with 58 mothers aged 15 to 49 years who gave birth in the preceding nine weeks. We recorded and transcribed the discussions and used a thematic approach for data analysis. RESULTS The findings suggest four factors influence women's perceptions of quality of care: responsiveness, supportive care, dignified care, and effective communication. Women had a positive experience when they were received well at the health facility, treated with kindness and respect, and given sufficient information about their care. The reverse led to a negative experience. These experiences were influenced by the behavior of both clinical and support staff and the facility environment. CONCLUSIONS This study extends the literature on person-centered maternity care in low resource settings. To improve person-centered maternity care, interventions need to address the responsiveness of health facilities, ensure women receive supportive and dignified care, and promote effective patient-provider communication.
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Affiliation(s)
| | - Leah Kirumbi
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Audrey Lyndon
- School of Nursing, University of California, San Francisco, USA
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87
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Austad K, Chary A, Martinez B, Juarez M, Martin YJ, Ixen EC, Rohloff P. Obstetric care navigation: a new approach to promote respectful maternity care and overcome barriers to safe motherhood. Reprod Health 2017; 14:148. [PMID: 29132431 PMCID: PMC5683321 DOI: 10.1186/s12978-017-0410-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/02/2017] [Indexed: 11/23/2022] Open
Abstract
Background Disrespectful and abusive maternity care is a common and pervasive problem that disproportionately impacts marginalized women. By making mothers less likely to agree to facility-based delivery, it contributes to the unacceptably high rates of maternal mortality in low- and middle-income countries. Few programmatic approaches have been proposed to address disrespectful and abusive maternity care. Obstetric care navigation Care navigation was pioneered by the field of oncology to improve health outcomes of vulnerable populations and promote patient autonomy by providing linkages across a fragmented care continuum. Here we describe the novel application of the care navigation model to emergency obstetric referrals to hospitals for complicated home births in rural Guatemala. Care navigators offer women accompaniment and labor support intended to improve the care experience—for both patients and providers—and to decrease opposition to hospital-level obstetric care. Specific roles include deflecting mistreatment from hospital staff, improving provider communication through language and cultural interpretation, advocating for patients’ right to informed consent, and protecting patients' dignity during the birthing process. Care navigators are specifically chosen and trained to gain the trust and respect of patients, traditional midwives, and biomedical providers. We describe an ongoing obstetric care navigator pilot program employing rapid-cycle quality improvement methods to quickly identify implementation successes and failures. This approach empowers frontline health workers to problem solve in real time and ensures the program is highly adaptable to local needs. Conclusion Care navigation is a promising strategy to overcome the “humanistic barrier” to hospital delivery by mitigating disrespectful and abusive care. It offers a demand-side approach to undignified obstetric care that empowers the communities most impacted by the problem to lead the response. Results from an ongoing pilot program of obstetric care navigation will provide valuable feedback from patients on the impact of this approach and implementation lessons to facilitate replication in other settings.
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Affiliation(s)
- Kirsten Austad
- Wuqu' Kawoq
- Maya Health Alliance 2 Calle 5-43, Zona 1, Santiago Sacatepéquez, Guatemala.,Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Anita Chary
- Wuqu' Kawoq
- Maya Health Alliance 2 Calle 5-43, Zona 1, Santiago Sacatepéquez, Guatemala.,Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Boris Martinez
- Wuqu' Kawoq
- Maya Health Alliance 2 Calle 5-43, Zona 1, Santiago Sacatepéquez, Guatemala
| | - Michel Juarez
- Wuqu' Kawoq
- Maya Health Alliance 2 Calle 5-43, Zona 1, Santiago Sacatepéquez, Guatemala
| | - Yolanda Juarez Martin
- Wuqu' Kawoq
- Maya Health Alliance 2 Calle 5-43, Zona 1, Santiago Sacatepéquez, Guatemala
| | - Enma Coyote Ixen
- Wuqu' Kawoq
- Maya Health Alliance 2 Calle 5-43, Zona 1, Santiago Sacatepéquez, Guatemala
| | - Peter Rohloff
- Wuqu' Kawoq
- Maya Health Alliance 2 Calle 5-43, Zona 1, Santiago Sacatepéquez, Guatemala. .,Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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88
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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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89
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Hastings-Tolsma M, Nolte AGW, Temane A. Birth stories from South Africa: Voices unheard. Women Birth 2017; 31:e42-e50. [PMID: 28711397 DOI: 10.1016/j.wombi.2017.06.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/28/2017] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The manner that birth events unfold can have a lasting impact on women. Giving voice to women's experiences is key in the creation of care that embodies humanistic, family-centred service. AIM The aim of this research was to describe the experiences of women receiving care during childbirth. METHODS The design was qualitative and descriptive using thematic analysis to analyse women's birth stories. A purposive sample of women (N=12) who had recently given birth in South Africa was selected. Participants were recruited who had delivered across a variety of settings: public, private, and maternity hospital, as well as at home. Data were collected using in-depth interviews and field notes. FINDINGS Four themes were noted: cocoon of compassionate care, personal regard for shared decision-making, beliefs about birth, and protection. Themes demonstrated both caring and non-caring behaviours including feelings of sadness, loneliness and being unwanted, being scared and uncertain, and overall dissatisfaction with the birth experience. Irrespective of setting, patients felt the absence of shared decision-making; the exception was where care was with midwives in an independent maternity hospital or at home. DISCUSSION A period of high vulnerability, birth is often met with care perceived as non-caring and lacking in compassion. Many women reported failure to be included as a partner in decision-making where birth occurred in private or public hospital settings. Where a midwifery model of care was in place, experiences were uniformly positive. CONCLUSIONS Fundamental change is needed in midwifery education and scope of practice, with overhaul of health system resourcing.
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Affiliation(s)
- Marie Hastings-Tolsma
- Louise Herrington School of Nursing, Baylor University, 3700 Worth Street, Dallas, TX 75246, USA; Visiting Professor, Department of Nursing Science, University of Johannesburg, Johannesburg, South Africa.
| | - Anna G W Nolte
- Department of Nursing Science, University of Johannesburg, Johannesburg, South Africa.
| | - Annie Temane
- Department of Nursing Science, University of Johannesburg, Johannesburg, South Africa.
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