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Belizán JM, Miller S, Williams C, Pingray V. Every woman in the world must have respectful care during childbirth: a reflection. Reprod Health 2020; 17:7. [PMID: 31964394 PMCID: PMC6975084 DOI: 10.1186/s12978-020-0855-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- José M Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina.
| | - Suellen Miller
- Safe Motherhood Program, University of California, San Francisco, USA
| | - Caitlin Williams
- Department of Maternal & Child Health Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Verónica Pingray
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
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Zethof S, Bakker W, Nansongole F, Kilowe K, van Roosmalen J, van den Akker T. Pre-post implementation survey of a multicomponent intervention to improve informed consent for caesarean section in Southern Malawi. BMJ Open 2020; 10:e030665. [PMID: 31911511 PMCID: PMC6955547 DOI: 10.1136/bmjopen-2019-030665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Surgical informed consent is essential prior to caesarean section, but potentially compromised by insufficient communication. We assessed the association between a multicomponent intervention and women's recollection of information pertaining to informed consent for caesarean section in a low-resource setting, thereby contributing to respectful maternity care. DESIGN Pre-post implementation survey, conducted from January to June 2018, surveying women prior to discharge. SETTING Rural 150-bed mission hospital in Southern Malawi. PARTICIPANTS A total of 160 postoperative women were included: 80 preimplementation and 80 postimplementation. INTERVENTION Based on observed deficiencies and input from local stakeholders, a multicomponent intervention was developed, consisting of a standardised checklist, wall poster with a six-step guide and on-the-job communication training for health workers. PRIMARY AND SECONDARY OUTCOME MEASURES Individual components of informed consent were: indication, explanation of procedure, common complications, implications for future pregnancies and verbal enquiry of consent, which were compared preintervention and postintervention using χ2 test. Generalised linear models were used to analyse incompleteness scores and recollection of the informed consent process. RESULTS The proportion of women who recollected being informed about procedure-related risks increased from 25/80 to 47/80 (OR 3.13 (95% CI 1.64 to 6.00)). Recollection of an explanation of the procedure changed from 44/80 to 55/80 (OR 1.80 (0.94 to 3.44)), implications for future pregnancy from 25/80 to 47/80 (1.69 (0.89 to 3.20)) and of consent enquiry from 67/80 to 73/80 (OR 2.02 (0.73 to 5.37)). After controlling for other variables, incompleteness scores postintervention were 26% lower (Exp(β)=0.74; 95% CI 0.57 to 0.96). Recollection of common complications increased with 0.25 complications (β=0.25; 95% CI 0.01 to 0.49). Recollection of the correct indication did not differ significantly. CONCLUSION Recollection of informed consent for caesarean section changed significantly in the postintervention group. Obtaining informed consent for caesarean section is one of the essential components of respectful maternity care.
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Affiliation(s)
- Siem Zethof
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
- Clinical Department, St. Luke's Hospital, Zomba, Malawi
| | - Wouter Bakker
- Clinical Department, St. Luke's Hospital, Zomba, Malawi
- Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands
| | | | - Kelvin Kilowe
- Nursing Department, St. Luke's Hospital, Zomba, Malawi
| | - Jos van Roosmalen
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
- Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
- Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands
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Umar N, Wickremasinghe D, Hill Z, Usman UA, Marchant T. Understanding mistreatment during institutional delivery in Northeast Nigeria: a mixed-method study. Reprod Health 2019; 16:174. [PMID: 31791374 PMCID: PMC6889445 DOI: 10.1186/s12978-019-0837-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 11/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving quality of care including the clinical aspects and the experience of care has been advocated for improved coverage and better childbirth outcomes. OBJECTIVE This study aimed to explore the quality of care relating to the prevalence and manifestations of mistreatment during institutional birth in Gombe State, northeast Nigeria, an area of low institutional delivery coverage. METHODS The frequency of dimensions of mistreatment experienced by women delivering in 10 health facilities of Gombe State were quantitatively captured during exit interviews with 342 women in July-August 2017. Manifestations of mistreatment were qualitatively explored through in-depth interviews and focus groups with 63 women living in communities with high and low coverage of institutional deliveries. RESULTS The quantitative data showed that at least one dimension of mistreatment was reported by 66% (95% confidence interval (CI) 45-82%) of women exiting a health facility after delivery. Mistreatment related to health system conditions and constraints were reported in 50% (95% CI 31-70%) of deliveries. In the qualitative data women expressed frustration at being urged to deliver at the health facility only to be physically or verbally mistreated, blamed for poor birth outcomes, discriminated against because of their background, left to deliver without assistance or with inadequate support, travelling long distances to the facility only to find staff unavailable, or being charged unjustified amount of money for delivery. CONCLUSIONS Mistreatment during institutional delivery in Gombe State is highly prevalent and predominantly relates to mistreatment arising from both health system constraints as well as health worker behaviours, limiting efforts to increase coverage of institutional delivery. To address mistreatment during institutional births, strategies that emphasise a broader health systems approach, tackle multiple causes, integrate a detailed understanding of the local context and have buy-in from grassroots-level stakeholders are recommended.
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Affiliation(s)
- Nasir Umar
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Deepthi Wickremasinghe
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Zelee Hill
- Institute for Global Health, University College London, London, UK
| | | | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
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Calvo Aguilar O, Torres Falcón M, Valdez Santiago R. Obstetric violence criminalised in Mexico: a comparative analysis of hospital complaints filed with the Medical Arbitration Commission. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 46:bmjsrh-2018-200224. [PMID: 31690580 DOI: 10.1136/bmjsrh-2018-200224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 08/09/2019] [Accepted: 09/15/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Disrespect and abuse during childbirth have been reported by numerous countries around the world. One of their principal manifestations is the performance of invasive or surgical procedures without the informed consent of women. Non-dignified treatment is the second most common form of this conduct. Five Mexican states have classified obstetric violence as a crime: Aguascalientes, Chiapas, Guerrero, the State of Mexico and Veracruz. The others have not yet done so although it is provided for in their civil and administrative regulations. OBJECTIVE To analyse whether criminalising obstetric violence has been conducive to the recognition and observance of the reproductive rights of women, based on the records of poor health care complaints filed by women with the Medical Arbitration Commissions (CAMs by their Spanish initials) in two Mexican states. MATERIALS AND METHODS We conducted an observational qualitative study using a phenomenological approach. Analysis included two states with similar partner demographic and maternal health indicators but different legal classifications of obstetric violence: the Chiapas has criminalized this form of violence while Oaxaca has not. We reviewed the records of obstetric care complaints filed with CAMs in both states from 2011 to 2015, all of them concluded and including full information. RESULTS Differences were observed regarding the contents of complaints, specifically in the categories of abuse, discrimination and neglect during childbirth. The narratives in the other complaint categories were similar between states. CONCLUSION After analysing the records of malpractice complaints in Chiapas and Oaxaca, we conclude that the differentiated legal status of obstetric violence has not influenced recognition or observance of the reproductive rights of women. Criminalising obstetric violence has not improved care provided by health personnel.
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Affiliation(s)
- Omar Calvo Aguilar
- Dr. Aurelio Valdivieso General Hospital, Oaxaca Health Services, Oaxaca, Mexico
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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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Galle A, Manaharlal H, Cumbane E, Picardo J, Griffin S, Osman N, Roelens K, Degomme O. Disrespect and abuse during facility-based childbirth in southern Mozambique: a cross-sectional study. BMC Pregnancy Childbirth 2019; 19:369. [PMID: 31640603 PMCID: PMC6805678 DOI: 10.1186/s12884-019-2532-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/24/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Evidence suggests that many women experience mistreatment during childbirth in health facilities across the world, but the magnitude of the problem is unknown. The occurrence of disrespect and abuse (D&A) in maternity care services affects the overall quality of care and may undermine women's trust in the health system. Studies about the occurrence of disrespect and abuse in Mozambican health facilities are scarce. The aim of this study was to explore the experience of women giving birth in hospital in different settings in Maputo City and Province, Mozambique. METHODS A cross sectional descriptive survey was conducted between April and June 2018 in the Central Hospital of Maputo (HCM) and district hospitals of Manhiça and Marracuene, Maputo Province, Mozambique. Five hundred seventy-two exit interviews were conducted with women leaving the hospital after delivery. The questionnaire consisted of the following components: socio-demographic characteristics, the occurrence of disrespect and abuse, male involvement during labor and childbirth and intrapartum family planning counselling and provision. RESULTS Prevalence of disrespect and abuse ranged from 24% in the central hospital to 80% in the district hospitals. The main types of D&A reported were lack of confidentiality/privacy, being left alone, being shouted at/scolded, and being given a treatment without permission. While very few women's partners attended the births, the majority of women (73-80%) were in favor of involving their partner as a birth companion. Intrapartum counseling of family planning was very low (9-17%). CONCLUSION The occurrence of disrespect and abuse was much higher in the district hospitals compared to the central hospital, emphasizing the high need for interventions outside Maputo City. Allowing male partners as birth companions should be explored further, as women seem in favor of involving their partners. Investing in intrapartum counselling for family planning is currently a missed opportunity for improving the uptake of contraception in the country.
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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 – Mozambique, Rua das Flores no 34, Impasse 1085, /87 Maputo, Mozambique
| | - Emidio Cumbane
- International Centre for Reproductive Health – Mozambique, Rua das Flores no 34, Impasse 1085, /87 Maputo, Mozambique
| | - Joelma Picardo
- International Centre for Reproductive Health – Mozambique, Rua das Flores no 34, Impasse 1085, /87 Maputo, Mozambique
| | - Sally Griffin
- International Centre for Reproductive Health – Mozambique, Rua das Flores no 34, Impasse 1085, /87 Maputo, Mozambique
| | - Nafissa Osman
- International Centre for Reproductive Health – Mozambique, 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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Afulani PA, Aborigo RA, Walker D, Moyer CA, Cohen S, Williams J. Can an integrated obstetric emergency simulation training improve respectful maternity care? Results from a pilot study in Ghana. Birth 2019; 46:523-532. [PMID: 30680785 DOI: 10.1111/birt.12418] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Few evidence-based interventions exist on how to improve respectful maternity care (RMC) in low-resource settings. We sought to evaluate the effect of an integrated simulation-based training on provision of RMC. METHODS The pilot project was in East Mamprusi District in northern Ghana. We integrated specific components of RMC, emphasizing dignity and respect, communication and autonomy, and supportive care, into a simulation training to improve identification and management of obstetric and neonatal emergencies. Forty-three providers were trained. For evaluation, we conducted surveys at baseline (N = 215) and endline (N = 318) 6 months later, with recently delivered women to assess their experiences of care using the person-centered maternity care scale. Higher scores on the scale represent more respectful care. RESULTS Compared to the baseline, women in the endline reported more respectful care. The average person-centered maternity care score increased from 50 at baseline to 72 at endline, a relative increase of 43%. Scores on the subscales also increased between baseline and endline: 15% increase for dignity and respect, 87% increase for communication and autonomy, and 55% increase for supportive care. These differences remained significant in multivariate analysis controlling for several potential confounders. CONCLUSIONS The findings suggest that integrated provider trainings that give providers the opportunity to learn, practice, and reflect on their provision of RMC in the context of stressful emergency obstetric simulations have the potential to improve women's childbirth experiences in low-resource settings. Incorporating such trainings into preservice and in-service training of providers will help advance global efforts to promote RMC.
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Affiliation(s)
- Patience A Afulani
- School of Medicine, Institute for Global Health Sciences, University of California, San Francisco, California
| | | | - Dilys Walker
- School of Medicine, Institute for Global Health Sciences, University of California, San Francisco, California.,PRONTO International, Seattle, Washington
| | | | - Susanna Cohen
- PRONTO International, Seattle, Washington.,College of Nursing, University of Utah, Salt Lake City, Utah
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Mselle LT, Kohi TW, Dol J. Humanizing birth in Tanzania: a qualitative study on the (mis) treatment of women during childbirth from the perspective of mothers and fathers. BMC Pregnancy Childbirth 2019; 19:231. [PMID: 31277609 PMCID: PMC6612108 DOI: 10.1186/s12884-019-2385-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/27/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While there has been a trend for greater number of women to deliver at health facilities across Tanzania, mothers and their family members continue to face mistreatment with respectful maternity care during childbirth being violated. The objective of this study was to describe the experience of mothers and fathers in relation to (mis) treatment during childbirth in Tanzania. METHODS Using a qualitative descriptive design, 12 semi-structured interviews and four focus group discussions were held with mothers and fathers who were attending a postnatal clinic in the Lake Zone region of Tanzania. Mothers' age ranged from 20 to 45 years whereas fathers' age ranged from 25 to 60 years. Data were analyzed using a priori coding based on Bohren's et al. typology of the mistreatment of women during childbirth. RESULTS Mothers reported facing mistreatment and disrespectful maternity care through verbal abuse (harsh or rude language and judgmental or accusatory comments), failure to meet professional standards of care (refused pain relief, unconsented surgical operations, neglect, abandonment or long delays, and skilled attendant absent at time of delivery), poor rapport between women and providers (poor communication, lack of supportive care, denied husbands presence at birth, denied mobility, denied safe traditional practices, no respect for their preferred birth positions), and health system conditions and constraints (poor physical condition of facilities, supply constraints, bribery and extortion, unclear fee structures). Despite some poor care, some mothers also reported positive birthing experiences and respectful maternity care by having a skilled attendant assistance at delivery, having good communication from nurses, receiving supportive care from nurses and privacy during delivery. CONCLUSION Despite the increasing number of deliveries occurring in the hospital, there continue to be challenges in providing respectful maternity care. Humanizing birth care in Tanzania continues to have a long way to go, however, there is evidence that changes are occurring as mothers notice and report positive changes in delivery care practices.
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Affiliation(s)
- Lilian T Mselle
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Thecla W Kohi
- School of Medicine, St. Joseph College of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Justine Dol
- Faculty of Health, Dalhousie University, Halifax, Canada
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Macarayan EK, Ratcliffe HL, Otupiri E, Hirschhorn LR, Miller K, Lipsitz SR, Gawande AA, Bitton A. Facility management associated with improved primary health care outcomes in Ghana. PLoS One 2019; 14:e0218662. [PMID: 31265454 PMCID: PMC6605853 DOI: 10.1371/journal.pone.0218662] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background Strong primary health care (PHC) is essential for achieving universal health coverage, but in many low- and middle-income countries (LMICs) PHC services are of poor quality. Facility management is hypothesized to be critical for improving PHC performance, but evidence about management performance and its associations with PHC in LMICs remains limited. Methods We quantified management performance of PHC facilities in Ghana and assessed the experiences of women who sought care at sampled facilities. Using multi-level models, we examined associations of facility management with five process outcomes and eight experiential outcomes. Findings On a scale of 0 to 1, the average overall management score in Ghana was 0·76 (IQR = 0·68–0·85). Facility management was significantly associated with one process outcome and three experiential outcomes. Controlling for facility characteristics, facilities with management scores at the 90th percentile (management score = 0·90) had 22% more essential drugs compared to facilities with management scores at the 10th percentile (0·60) (p = 0·002). Positive statistically non-significant associations were also seen with three additional process outcomes—integration of family planning services (p = 0·054), family planning types provided (p = 0·067), and essential equipment availability (p = 0·104). Compared to women who sought care at facilities with management scores at the 10th percentile, women who sought care at facilities at the 90th percentile reported 8% higher ratings of trust in providers (p = 0·028), 15% higher ratings of ease of following provider’s advice (p = 0·030), and 16% higher quality rating (p = 0·020). However, women who sought care in the 90th percentile facilities rated their waiting times as worse (22% lower, p = 0·039). Interpretation Higher management scores were associated with higher scores for some process and experiential outcomes. Large variations in management performance indicate the need to strengthen management practices to help realize the full potential of PHC in improving health outcomes.
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Affiliation(s)
- Erlyn K. Macarayan
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Hannah L. Ratcliffe
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Easmon Otupiri
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lisa R. Hirschhorn
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Kate Miller
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Stuart R. Lipsitz
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Atul A. Gawande
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Center for Primary Care, Harvard Medical School, Boston, MA, United States of America
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America
- Division of General Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- * E-mail:
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Tekle Bobo F, Kebebe Kasaye H, Etana B, Woldie M, Feyissa TR. Disrespect and abuse during childbirth in Western Ethiopia: Should women continue to tolerate? PLoS One 2019; 14:e0217126. [PMID: 31173588 PMCID: PMC6555589 DOI: 10.1371/journal.pone.0217126] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/07/2019] [Indexed: 11/24/2022] Open
Abstract
Background Healthcare coverage in Ethiopia has improved dramatically in recent decades. However, facility-based delivery remains persistently low, while maternal mortality remains high. This paper presents the prevalence and associated factors of disrespect and abuse (D&A) during childbirth in public health facilities of western Oromia, Ethiopia. Method A facility-based cross-sectional study was conducted among 612 women from February 2017 to May 2017. Exit interview with the mothers were conducted upon discharge from the maternity ward. We measured D&A during childbirth using seven dimensions. Multivariable logistic regression model was used to assess the association between experience of D&A and client characteristics and institutional factors. Result Three quarters (74.8%) of women reported experiencing at least one form of D&A during their facility childbirth. The types of D&A experienced by the women were; physical abuse (37.1%), non-dignified care (34.6%), non-consented care (54.1%), non-confidential care (40.4%), neglect (25.2%), detention (2.9%), and discrimination (13.2%). Experiences of D&A were 1.6 times more likely to be reported by women delivering at hospitals than health centers (OR: 1.64, 95% CI: 1.01, 2.66). Women without a companion throughout their delivery were almost 10 times more likely than women who had a companion to encounter D&A (OR: 9.94, 95% CI: 5.72, 17.28). On the other hand, women with more than 1,368-birr (USD 57) monthly income were less likely to experience any type of D&A (OR: 0.36, 95% CI: .21, .65). Conclusion Three in four women reported experiencing at least one form of D&A during labor and delivery. This demonstrates a real disconnect between what the health system intends to achieve and what is practiced and calls for fundamental solutions in terms of both improving quality of facility-based delivery and ensuring women’s right to receive health care with dignity.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Wollega University; Nekemte, Oromia, Ethiopia
- * E-mail:
| | | | - Belachew Etana
- Department of Public Health, Wollega University; Nekemte, Oromia, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University; Jimma, Oromia, Ethiopia
- Fenot Project, Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Addis Ababa, Ethiopia
| | - Tesfaye Regassa Feyissa
- Department of Public Health, Wollega University; Nekemte, Oromia, Ethiopia
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
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LeFevre AE, Scott K, Mohan D, Shah N, Bhatnagar A, Labrique A, Dhar D, Chamberlain S, Ved R. Development of a Phone Survey Tool to Measure Respectful Maternity Care During Pregnancy and Childbirth in India: Study Protocol. JMIR Res Protoc 2019; 8:e12173. [PMID: 31021329 PMCID: PMC6658236 DOI: 10.2196/12173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/08/2019] [Accepted: 01/20/2019] [Indexed: 01/19/2023] Open
Abstract
Background Respectful maternity care (RMC) is a key barometer of the underlying quality of care women receive during pregnancy and childbirth. Efforts to measure RMC have largely been qualitative, although validated quantitative tools are emerging. Available tools have been limited to the measurement of RMC during childbirth and confined to observational and face-to-face survey modes. Phone surveys are less invasive, low cost, and rapid alternatives to traditional face-to-face methods, yet little is known about their validity and reliability. Objective The primary objective of this study was to develop validated face-to-face and phone survey tools for measuring RMC during pregnancy and childbirth for use in India and other low resource settings. The secondary objective was to optimize strategies for improving the delivery of phone surveys for use in measuring RMC. Methods To develop face-to-face and phone surveys for measuring RMC, we describe procedures for assessing content, criterion, and construct validity as well as reliability analyses. To optimize the delivery of phone surveys, we outline plans for substudies, which aim to assess the effect of survey modality, and content on survey response, completion, and attrition rates. Results Data collection will be carried out in 4 districts of Madhya Pradesh, India, from July 2018 to March 2019. Conclusions To our knowledge, this is the first RMC phone survey tool developed for India, which may provide an opportunity for the rapid, routine collection of data essential for improving the quality of care during pregnancy and childbirth. Elsewhere, phone survey tools are emerging; however, efforts to develop these surveys are often not inclusive of rigorous pretesting activities essential for ensuring quality data, including cognitive, reliability, and validity testing. In the absence of these activities, emerging data could overestimate or underestimate the burden of disease and health care practices under assessment. In the context of RMC, poor quality data could have adverse consequences including the naming and shaming of providers. By outlining a blueprint of the minimum activities required to generate reliable and valid survey tools, we hope to improve efforts to develop and deploy face-to-face and phone surveys in the health sector. International Registered Report Identifier (IRRID) DERR1-10.2196/12173
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Affiliation(s)
- Amnesty E LeFevre
- Division of Epidemiology and Biostatistics , School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Neha Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Diva Dhar
- Bill and Melinda Gates Foundation, New Delhi, India
| | | | - Rajani Ved
- National Health Systems Resource Center, Delhi, India
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Jolly Y, Aminu M, Mgawadere F, van den Broek N. "We are the ones who should make the decision" - knowledge and understanding of the rights-based approach to maternity care among women and healthcare providers. BMC Pregnancy Childbirth 2019; 19:42. [PMID: 30764788 PMCID: PMC6376786 DOI: 10.1186/s12884-019-2189-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Experiences and perceptions of poor quality of care is a powerful determinant of utilisation of maternity services. With many reports of disrespect and abuse in healthcare facilities in low-resource settings, women’s and healthcare providers’ understanding and perception of disrespect and abuse are important in eliminating disrespect and abuse, but these are rarely explored together. Methods This was a qualitative study assessing the continuum of maternity care (antenatal, intrapartum and postnatal care) at the Maternity Unit of Bwaila Hospital in Lilongwe, Malawi. Focus group discussions (FGDs) were conducted separately for mothers attending antenatal clinic and those attending postnatal clinic. For women who accessed intrapartum care services, in-depth interviews were used. Participants were recruited purposively. Key informant interviews were conducted with healthcare providers involved in the delivery of maternal and newborn health services. Topic guides were developed based on the seven domains of the Respectful Maternity Care (RMC) Charter. Data was transcribed verbatim, coded and analysed using the thematic framework approach. Results A total of 8 focus group discussions and 9 in-depth interviews involving 64 women and 9 key informant interviews with health care providers were conducted. Important themes that emerged included: the importance of a valued patient-provider relationship as determined by a good attitude and method of communication, the need for more education of women regarding the stages of pregnancy and labour, what happens at each stage and which complications could occur, the importance of a woman’s involvement in decision-making, the need to maintain confidentiality when required and the problem of insufficient human resources. Prompt and timely service was considered a priority. Neither women accessing maternity care nor trained healthcare providers providing this care were aware of the RMC Charter. Conclusions This study has highlighted the most essential aspects of respectful maternity care from the viewpoint of both women accessing maternity care and healthcare providers. Although RMC components are in place, healthcare providers were not aware of them. There is the need to promote the RMC Charter among both women who seek care and healthcare providers. Electronic supplementary material The online version of this article (10.1186/s12884-019-2189-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yasmin Jolly
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Mamuda Aminu
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Florence Mgawadere
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Colley S, Kao CH, Gau M, Cheng SF. Women's perception of support and control during childbirth in The Gambia, a quantitative study on dignified facility-based intrapartum care. BMC Pregnancy Childbirth 2018; 18:413. [PMID: 30352577 PMCID: PMC6199796 DOI: 10.1186/s12884-018-2025-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 09/25/2018] [Indexed: 12/05/2022] Open
Abstract
Background In The Gambia, a woman faces 1 in 24-lifetime risk of maternal death due to pregnancy and childbirth, yet, only 57% of deliveries are conducted by skilled birth attendants. However, poor provider attitude has been identified as one of the contributing factors hampering the efforts of the government in improving access to skilled care during childbirth. This study, therefore, explored women’s perception of support and control during childbirth in The Gambia. Methods A descriptive cross-sectional study was employed. A convenience sampling method was used to select participants in two regions in The Gambia. A sample size of 200 women who met the eligibility criteria was recruited after informed consent. The demographic-obstetric information sheet and the Support and Control in Birth scale (SCIB) were used to collect data. Data analysis was done using SPSS software version 23.0. Results Women’s perceptions of support and control were low. External control 1.85 (SD ± 0.43) recorded the least perception compared to internal control 2.41 (SD ± 0.65) and perception of support 2.52 (SD ± 0.61). Participants reported the lowest perceptions in pain control, involvement in decision making, information sharing and the utilization of different position during birth. Women’s age (p < .001) and mode of delivery (p = .01), significantly predicted women’s perception of internal control. Educational status (p = .02), mode of delivery (p = .04), place of delivery (p < .001) and perception of support (p < .001) significantly predicted women’s perception of external control, whilst birth plan (p = .001), mode of delivery (p = .04), and perception of external control (p < .001) significantly predicted women’s perception of support. Conclusion This study concluded that an environment that promotes women feeling a sense of control and support during childbirth should be created in order to ensure a dignified intrapartum care in The Gambia. This can be achieved through effective training of skilled birth attendants on non-pharmacological pain management, effective communication with clients and promoting women’s participation in decision-making regarding their care throughout the process of childbirth. Electronic supplementary material The online version of this article (10.1186/s12884-018-2025-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saffie Colley
- Ministry of Health & Social Welfare, West Africa, Banjul, The Gambia
| | - Chien-Huei Kao
- Graduate Institute of Nurse-Midwifery National Taipei University and Health Sciences, 365 Ming-Te Road, Taipei, 112, Taiwan.
| | - Meeiling Gau
- Graduate Institute of Nurse-Midwifery National Taipei University and Health Sciences, 365 Ming-Te Road, Taipei, 112, Taiwan
| | - Su-Fen Cheng
- Graduate Institute of Nursing, National Taipei University and Health Sciences, 365 Ming-Te Road, Taipei, 112, Taiwan
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Wilson-Mitchell K, Eustace L, Robinson J, Shemdoe A, Simba S. Overview of literature on RMC and applications to Tanzania. Reprod Health 2018; 15:167. [PMID: 30285782 PMCID: PMC6171292 DOI: 10.1186/s12978-018-0599-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 09/03/2018] [Indexed: 11/25/2022] Open
Abstract
Respectful maternity care research in Tanzania continues to increase. This is an overview of the literature summarizing research based on the domains which comprise this quality of care indicator, ranging from exploratory and descriptive to quantitative measurements of birth perinatal outcomes when respectful interventions are made. The domains of respectful care are reflected in the seven Universal Rights of Childbearing Women but go further to implicate facility administrators and policy makers to provide supportive infrastructure to allay disrespect and abuse.The research methodologies continue to be problematic and several ethical cautions restrict how much control is possible. Similarly, the barriers to collecting accurate accounts in qualitative studies of disrespect require astute interviewing and observation techniques. The participatory community-based and the critical sociology and human rights frameworks appear to provide a good basis for both researcher and participants to identify problems and determine possible solutions to the multiple factors that contribute to disrespect and abuse. The work-life conditions of midwives in the Global South are plagued with poor infrastructure and significantly low resources which deters respectful care while decreasing retention of workers. Researchers and policy-makers have addressed disrespectful care by building human resource capacity, by strengthening professional organizations and by educating midwives in low-resource countries. Furthermore, researchers encourage midwives not only to acquire attitudinal change and to adopt respectful maternity care skills, but also to emerge as leaders and change agents.Safe methods for conducting care while addressing low resources, skilled management of conflict and creative innovations to engage the community are all interventions that are being considered for quality improvement research. Tanzania is poised to evaluate the outcomes of education workshops that address all seven domains of respectful care.
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Affiliation(s)
- Karline Wilson-Mitchell
- Midwifery Education Program, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - Lucia Eustace
- Tanzanian Midwives Association, P.O. Box 65524, Muhimbili Dar Es Salaam, Tanzania
| | - Jamie Robinson
- Canadian Association of Midwives, 2330 Notre-Dame W., Suite 300, Montreal,, Quebec H3J 1N4 Canada
| | - Aloisia Shemdoe
- Tanzanian Midwives Association, P.O. Box 65524, Muhimbili Dar Es Salaam, Tanzania
| | - Stephano Simba
- Tanzanian Midwives Association, P.O. Box 65524, Muhimbili Dar Es Salaam, Tanzania
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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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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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Bhattacharya S, Sundari Ravindran TK. Silent voices: institutional disrespect and abuse during delivery among women of Varanasi district, northern India. BMC Pregnancy Childbirth 2018; 18:338. [PMID: 30126357 PMCID: PMC6102865 DOI: 10.1186/s12884-018-1970-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A considerable amount of qualitative evidence reporting abusive treatment of women during delivery by health providers is available. However, there is a dearth of information regarding the actual prevalence and nature of such abuse, which this study aimed to explore. METHODS We conducted a community based cross-sectional study using a contextually adapted version of the Staha (meaning 'respect' in Swahili) project questionnaire among 410 rural women who delivered between June, 2014 to August 2015 at any health facility of Varanasi district, northern India. We selected the women through multi-stage cluster random sampling from two rural blocks of Varanasi, which recorded the highest number of institutional deliveries in 2014-15. RESULTS The frequency of any abusive behavior (excluding inappropriate demands of money due to its high prevalence-90.5%) was 28.8%. The reported abuses were non-dignified care including verbal abuse and derogatory insults related to the woman's sexual behavior (19.3%); physical abuse (13.4%); neglect or abandonment (8.5%); non-confidential care (5.6%); and feeling humiliation due to lack of cleanliness bordering on filth (4.9%). Women were abused during labor or delivery irrespective of their socio-demographic background. Bivariate analysis using Chi-square tests showed statistically significant associations between abuse and provider type, facility type, and presence of complications during delivery. Binary logistic regression indicated that the odds of being abused was four times higher in those women who experienced complications during delivery. Though statistically insignificant, and contrary to expectations, women also seemed to be abused in private institutions; but with a lower frequency and of lesser severity. CONCLUSIONS The prevalence of disrespect and abuse during labor or delivery was high among women irrespective of their socio-demographic background or delivery conditions in government as well as private health facilities. If the problem of disrespect and abuse is not addressed, it can be assumed that such harsh practices might promote home deliveries, which despite being more unsafe provide an empathetic environment in lieu of safe facility-based birthing options.
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Affiliation(s)
| | - T. K. Sundari Ravindran
- Achutha Menon Centre For Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011 India
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Mselle LT, Kohi TW, Dol J. Barriers and facilitators to humanizing birth care in Tanzania: findings from semi-structured interviews with midwives and obstetricians. Reprod Health 2018; 15:137. [PMID: 30107840 PMCID: PMC6092851 DOI: 10.1186/s12978-018-0583-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/05/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In Tanzania, the provision of humanized care is increasingly being emphasized in midwifery practice, yet studies regarding perceptions and practices of skilled health personnel towards the humanization of birth care are scare. Previous reviews have identified that abuse and disrespect is not limited to individuals but reflects systematic failures and deeply embedded provider attitudes and beliefs. Therefore, the current study aims to explore the perceptions and practices of skilled health personnel on humanizing birth care in Tanzania by identifying current barriers and facilitators. METHODS Semi-structured interviews were held with skilled health personnel including midwives (n = 6) and obstetricians (n = 2) working in the two district hospitals of Tanzania. Data were analyzed using thematic coding. RESULTS Skilled health personnel identified systematic barriers to providing humanizing birth care. Systematic barriers included lack of space and limited facilities. Institutional norms and practices prohibited family involvement during the birth process,including beliefs that limited choice of birth position as well as disrespected beliefs, traditions, and culture. Participants also acknowledged four facilitators that improve the likelihood of humanized care during childbirth in Tanzania: ongoing education of skilled health personnel on respectful maternal care, institutional norms designed for continuous clinic support during childbirth, belief in the benefit of having family become active participants, and respecting maternal wishes when appropriate. CONCLUSION To move forward with humanizing the birth process in Tanzania, it will be essential that systematic barriers are addressed as well as changing the mindset of personnel towards respectful maternal care. It will be essential for the government and private hospitals to revalue their labour wards to increase the space and staff allocated to each mother to enhance family-integrated care. Additionally, in-service training as well as incorporation of respectful maternal care during pre-service training is key to changing the culture in the labour ward.
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Affiliation(s)
- Lilian T. Mselle
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Thecla W. Kohi
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Justine Dol
- Faculty of Health, Dalhousie University, Halifax, Canada
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Banks KP, Karim AM, Ratcliffe HL, Betemariam W, Langer A. Jeopardizing quality at the frontline of healthcare: prevalence and risk factors for disrespect and abuse during facility-based childbirth in Ethiopia. Health Policy Plan 2018; 33:317-327. [PMID: 29309598 PMCID: PMC5886294 DOI: 10.1093/heapol/czx180] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/13/2022] Open
Abstract
Disrespect and abuse (D&A) experienced by women during facility-based childbirth has gained global recognition as a threat to eliminating preventable maternal mortality and morbidity. This study explored the frequency and associated factors of D&A in four rural health centres in Ethiopia. Experiences of women who delivered in these facilities were captured by direct observation of client-provider interaction (N = 193) and exit interview at time of discharge (N = 204). Incidence of D&A was observed in each facility, with failure to ask woman for preferred birth position most commonly observed [n = 162, 83.9%, 95% confidence interval (95% CI) 78.0-88.5%]. During exit interviews, 21.1% (n = 43, 95% CI 15.4-26.7%) of respondents reported at least one occurrence of D&A. Bivariate models using client characteristics and index birth experience showed that women's reporting of D&A was significantly associated with childbirth complications [odds ratio (OR) = 7.98, 95% CI 3.70, 17.22], weekend delivery (OR = 0.17, 95% CI 0.05, 0.63) and no previous delivery at the facility (OR = 3.20, 95% CI 1.27, 8.05). Facility-level fixed-effect models found that experience of complications (OR = 15.51, 95% CI 4.38, 54.94) and weekend delivery (OR = 0.05, 95% CI 0.01-0.32) remained significantly and most strongly associated with self-reported D&A. These data suggest that addressing D&A in health centres in Ethiopia will require a sustained effort to improve infrastructure, support the health workforce in rural settings, enforce professional standards and target interventions to improve women's experiences as part of quality of care initiatives.
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Affiliation(s)
- Kathleen P Banks
- Department of Global Health and Population, Women and Health Initiative, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB 7th Floor, Boston, MA 02115, USA
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown Building, 3rd Floor, Boston, MA 02118, USA
| | - Ali M Karim
- JSI Research & Training Institute Inc., The Last Ten Kilometers Project, 44 Farnsworth St, Boston, MA 02210, USA, and
| | - Hannah L Ratcliffe
- Department of Global Health and Population, Women and Health Initiative, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB 7th Floor, Boston, MA 02115, USA
- Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA 02215, USA
| | - Wuleta Betemariam
- JSI Research & Training Institute Inc., The Last Ten Kilometers Project, 44 Farnsworth St, Boston, MA 02210, USA, and
| | - Ana Langer
- Department of Global Health and Population, Women and Health Initiative, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB 7th Floor, Boston, MA 02115, USA
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Hameed W, Avan BI. Women's experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan. PLoS One 2018; 13:e0194601. [PMID: 29547632 PMCID: PMC5856402 DOI: 10.1371/journal.pone.0194601] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/16/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Respectful and dignified healthcare is a fundamental right for every woman. However, many women seeking childbirth services, especially those in low-income countries such as Pakistan, are mistreated by their birth attendants. The aim of this epidemiological study was to estimate the prevalence of mistreatment and types of mistreatment among women giving birth in facility- and home-based settings in Pakistan in order to address the lack of empirical evidence on this topic. The study also examined the association between demographics (socio-demographic, reproductive history and empowerment status) and mistreatment, both in general and according to birth setting (whether home- or facility-based). MATERIAL AND METHODS In phase one, we identified 24 mistreatment indicators through an extensive literature review. We then pre-tested these indicators and classified them into seven behavioural types. During phase two, the survey was conducted (April-May 2013) in 14 districts across Pakistan. A total of 1,334 women who had given birth at home or in a healthcare facility over the past 12 months were interviewed. Linear regression analysis was employed for the full data set, and for facility- and home-based births separately, using Stata version 14.1. RESULTS There were no significant differences in manifestations of mistreatment between facility- and home-based childbirths. Approximately 97% of women reported experiencing at least one disrespectful and abusive behaviour. Experiences of mistreatment by type were as follows: non-consented care (81%); right to information (72%); non-confidential care (69%); verbal abuse (35%); abandonment of care (32%); discriminatory care (15%); and physical abuse (15%). In overall analysis, experience of mistreatment was lower among women who were unemployed (β = -1.17, 95% CI -1.81, -0.53); and higher among less empowered women (β = 0.11, 95% CI 0.06, 0.16); and those assisted by a traditional birth attendant as opposed to a general physician (β = 0.94, 95% CI 0.13, 1.75). Sub-group analyses for home-based births identified the same significant associations with mistreatment, with ethnicity included. In facility-based births, there was a significant relationship between women's employment and empowerment status and mistreatment. Women with prior education on birth preparedness were less likely to experience mistreatment compared to those who had received no previous birth preparedness education. CONCLUSION In order to promote care that is woman-centred and provided in a respectful and culturally appropriate manner, service providers should be cognisant of the current situation and ensure provision of quality antenatal care. At the community level, women should seek antenatal care for improved birth preparedness, while at the interpersonal level strategies should be devised to leverage women's ability to participate in key household decisions.
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Affiliation(s)
- Waqas Hameed
- Research Scholar, Department of Statistics, University of Karachi, Sindh, Pakistan
| | - Bilal Iqbal Avan
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Downe S, Lawrie TA, Finlayson K, Oladapo OT. Effectiveness of respectful care policies for women using routine intrapartum services: a systematic review. Reprod Health 2018; 15:23. [PMID: 29409519 PMCID: PMC5801845 DOI: 10.1186/s12978-018-0466-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 01/24/2018] [Indexed: 01/17/2023] Open
Abstract
Background Several studies have identified how mistreatment during labour and childbirth can act as a barrier to the use of health facilities. Despite general agreement that respectful maternity care (RMC) is a fundamental human right, and an important component of quality intrapartum care that every pregnant woman should receive, the effectiveness of proposed policies remains uncertain. We performed a systematic review to assess the effectiveness of introducing RMC policies into health facilities providing intrapartum services. Methods We included randomized and non-randomized controlled studies evaluating the effectiveness of introducing RMC policies into health facilities. We searched PubMed, CINAHL, LILACS, AJOL, WHO RHL, and Popline, along with ongoing trials registers (ISRCT register, ICTRP register), and the White Ribbon Respectful Maternity Care Repository. Included studies were assessed for risk of bias. Certainty of evidence was assessed using GRADE criteria. Findings Five studies were included. All were undertaken in Africa (Kenya, Tanzania, Sudan, South Africa), and involved a range of components. Two were cluster RCTs, and three were before/after studies. In total, over 8000 women were included at baseline and over 7500 at the endpoints. Moderate certainty evidence suggested that RMC interventions increases women’s experiences of respectful care (one cRCT, approx. 3000 participants; adjusted odds ratio (aOR) 3.44, 95% CI 2.45–4.84); two observational studies also reported positive changes. Reports of good quality care increased. Experiences of disrespectful or abusive care, and, specifically, physical abuse, were reduced. Low certainty evidence indicated fewer accounts of non-dignified care, lack of privacy, verbal abuse, neglect and abandonment with RMC interventions, but no difference in satisfaction rates. Other than low certainty evidence of reduced episiotomy rates, there were no data on the pre-specified clinical outcomes. Conclusion Multi-component RMC policies appear to reduce women’s overall experiences of disrespect and abuse, and some components of this experience. However, the sustainability of the demonstrated effect over time is unclear, and the elements of the programmes that have most effect have not been examined. While the tested RMC policies show promising results, there is a need for rigorous research to refine the optimum approach to deliver and achieve RMC in all settings.
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Affiliation(s)
- Soo Downe
- Brook Building, University of Central Lancashire, Preston, UK.
| | - Theresa A Lawrie
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Kenny Finlayson
- Brook Building, University of Central Lancashire, Preston, UK
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
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73
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Factors influencing the capacity of women to voice their concerns about maternal health services in the Muanda and Bolenge Health Zones, Democratic Republic of the Congo: a multi-method study. BMC Health Serv Res 2018; 18:37. [PMID: 29368601 PMCID: PMC5784705 DOI: 10.1186/s12913-018-2842-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/15/2018] [Indexed: 11/13/2022] Open
Abstract
Background This paper aims to identify factors that influence the capacity of women to voice their concerns regarding maternal health services at the local level. Methods A secondary analysis was conducted of the data from three studies carried out between 2013 and 2015 in the Democratic Republic of the Congo (DRC) in the context of a WOTRO initiative to improve maternal health services through social accountability mechanisms in the DRC. The data processing and analysis focused on data related to factors that influence the capacity of women to voice their concerns and on the characteristics of women that influence their ability to identify, and address specific problems. Data from 21 interviews and 12 focus group discussions (n = 92) were analysed using an inductive content analysis, and those from one household survey (n = 517) were summarized. Results The women living in the rural setting were mostly farmers/fisher-women (39.7%) or worked at odd jobs (20.3%). They had not completed secondary school (94.6%). Around one-fifth was younger than 20 years old (21.9%). The majority of women could describe the health service they received but were not able to describe what they should receive as care. They had insufficient knowledge of the health services before their first visit. They were not able to explain the mandate of the health providers. The information they received concerned the types of healthcare they could receive but not the real content of those services, nor their rights and entitlements. They were unaware of their entitlements and rights. They believed that they were laypersons and therefore unable to judge health providers, but when provided with some tools such as a checklist, they reported some abusive and disrespectful treatments. However, community members asserted that the reported actions were not reprehensible acts but actions to encourage a woman and to make her understand the risk of delivery. Conclusions Factors influencing the capacity of women to voice their concerns in DRC rural settings are mainly associated with insufficient knowledge and socio-cultural context. These findings suggest that initiatives to implement social accountability have to address community capacity-building, health providers’ responsiveness and the socio-cultural norms issues. Electronic supplementary material The online version of this article (10.1186/s12913-018-2842-2) contains supplementary material, which is available to authorized users.
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Asefa A, Bekele D, Morgan A, Kermode M. Service providers' experiences of disrespectful and abusive behavior towards women during facility based childbirth in Addis Ababa, Ethiopia. Reprod Health 2018; 15:4. [PMID: 29304814 PMCID: PMC5756390 DOI: 10.1186/s12978-017-0449-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background Disrespect and abuse (D&A) of women during childbirth by the attending staff in health facilities has been widely reported in many countries. Although D&A in labor rooms is recognized as a deterrent to maternal health service utilization, approaches to defining, classifying, and measuring D&A are still at an early stage of development. This study aims to enhance understanding of service providers’ experiences of D&A during facility based childbirth in health facilities in Addis Ababa. Methods A facility based cross-sectional study was conducted in August 2013 in one hospital and three health centers. A total of 57 health professionals who had assisted with childbirth during the study period completed a self-administered questionnaire. Service providers’ personal observations of mistreatment during childbirth and their perceptions of respectful maternity care (RMC) were assessed. Data were entered into and analyzed using SPSS version 16 software. Results The majority (83.7%) of participants were aged <30 years (mean = 27.25 ± 5.45). Almost half (43.9%) were midwives, and 77.2% had less than five years experience as a health professional. Work load was reported to be very high by 31.6% of participants, and 28% rated their working environment as poor or very poor. Almost half (50.3%) of participants reported that service providers do not generally obtain women’s consent prior to procedures. One-quarter (25.9%) reported having ever witnessed physical abuse (physical force, slapping, or hitting) in their health facility. They also reported observing privacy violations (34.5%), and women being detained against their will (18%). Violations of women’s rights were self-reported by 14.5% of participants. More than half (57.1%) felt that they had been disrespected and abused in their work place. The majority of participants (79.6%) believed that lack of respectful care discourages pregnant women from coming to health facilities for delivery. Conclusions The study findings indicate that most service providers from these facilities had witnessed disrespectful practices during childbirth, and recognized that such practices have negative consequences for service utilization. These findings can help decision makers plan for interventions to improve RMC taking account of the provider perspective.
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Affiliation(s)
- Anteneh Asefa
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, P.O.Box 70, Hawassa, Ethiopia. .,Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, 3000, Australia.
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, P.O.Box 143079, Addis Ababa, Ethiopia
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, 3000, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, 3000, Australia
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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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76
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Mukamurigo J, Dencker A, Ntaganira J, Berg M. The meaning of a poor childbirth experience - A qualitative phenomenological study with women in Rwanda. PLoS One 2017; 12:e0189371. [PMID: 29220391 PMCID: PMC5722369 DOI: 10.1371/journal.pone.0189371] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 11/26/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Being pregnant and giving birth is a pivotal life event and one that a woman ordinarily remembers for most of her life. A negative childbirth experience can affect a woman's health well beyond the episode of the labour and birth itself. This study explored the meaning of a poor childbirth experience, as expressed by women who had given birth in Rwanda. METHODS In a cross-sectional household study conducted in Northern Province and in Kigali City, the capital of Rwanda, a structured questionnaire was answered by women who had given birth one to 13 months earlier. One question, answered by 898 women, asked them to rate their overall experience of childbirth from 0 (very bad) to 10 (very good). Of these, 28 women (3.1%) who had rated their childbirth experience as bad (≤ 4) were contacted for individual interviews. Seventeen of these women agreed to participate in individual in-depth interviews. The texts were analysed with a reflective lifeworld approach. RESULTS The essential meaning of a "poor" childbirth experience was that the women had been exposed to disrespectful care, constituted by neglect, verbal or physical abuse, insufficient information, and denial of their husband as a companion. The actions of carers included abandonment, humiliation, shaming and insult, creating feelings of insecurity, fear and distrust in the women. Two of the women did not report any experience of poor care; their low rating was related to having suffered from medical complications. CONCLUSION It is challenging that the main finding is that women are exposed to disrespectful care. In an effort to provide an equitable and high quality maternal health care system in Rwanda, there is a need to focus on activities to implement respectful, evidence-based care for all. One such activity is to develop and provide education programmes for midwives and nurses about professional behaviour when caring for and working with women during labour and birth.
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Affiliation(s)
- Judith Mukamurigo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda
- * E-mail:
| | - Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joseph Ntaganira
- College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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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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Okonofua FE, Ntoimo LFC, Ogu RN. Women's perceptions of reasons for maternal deaths: Implications for policies and programs for preventing maternal deaths in low-income countries. Health Care Women Int 2017; 39:95-109. [DOI: 10.1080/07399332.2017.1365868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- F. E. Okonofua
- Vice Chancellors Office, University of Medical Sciences, Ondo City, Ondo State, Nigeria
- Women's Health and Action Research Centre/WHO MNCH Implementation Research Group, Benin City, Edo State, Nigeria
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
| | - L. F. C. Ntoimo
- Women's Health and Action Research Centre/WHO MNCH Implementation Research Group, Benin City, Edo State, Nigeria
- Department of Demography and Social Statistics, Federal University Oye-Ekiti, Ekiti State, Nigeria
| | - R. N. Ogu
- Women's Health and Action Research Centre/WHO MNCH Implementation Research Group, Benin City, Edo State, Nigeria
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
- Department of Obstetrics and Gynaecology, University of Port Harcourt, Rivers State, Nigeria
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Savage V, Castro A. Measuring mistreatment of women during childbirth: a review of terminology and methodological approaches. Reprod Health 2017; 14:138. [PMID: 29073914 PMCID: PMC5658997 DOI: 10.1186/s12978-017-0403-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Although mistreatment of women during facility-based childbirth has received increasing recognition as a critical issue throughout the world, there remains a lack of consensus on operational definitions of mistreatment and best practices to assess the issue. Moreover, only minimal research has focused on mistreatment in Latin America and the Caribbean, a region notable for social inequalities and inequitable access to maternal health care. Methods In this article, we discuss the results of a literature review that sought to contribute to the determination of best practices in defining and measuring the mistreatment of women during childbirth, particularly within Latin America and the Caribbean. The review includes a total of 57 English, Spanish, and Portuguese-language research publications and eight legal documents that were published between 2000 and 2017. Results While the typologies of “disrespect and abuse” and “mistreatment during facility-based childbirth” are most frequently employed in global studies, “obstetric violence” remains the most commonly operationalized term in Latin America and the Caribbean in both research and policy contexts. Various researchers have advocated for the use of those three different typologies, yet the terms all share commonalities in highlighting the medicalization of natural processes of childbirth, roots in gender inequalities, parallels with violence against women, the potential for harm, and the threat to women’s rights. For measuring mistreatment, half of the research publications in this review use qualitative methods, such as in-depth interviews and focus groups. After analyzing the strengths and limitations of quantitative, qualitative, and mixed methods approaches to assessing mistreatment, we recommend mixed methods designs as the optimal strategy to evaluate mistreatment and advocate for the inclusion of direct observations that may help bridge the gap between observed measures and participants’ self-reported experiences of mistreatment. Conclusions No matter the conceptual framework used in future investigations, we recommend that studies seek to accomplish three objectives: (1) to measure the perceived and observed frequencies of mistreatment in maternal health settings, (2) to examine the macro and micro level factors that drive mistreatment, and (3) to assess the impact of mistreatment on the health outcomes of women and their newborns.
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Affiliation(s)
- Virginia Savage
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Mail Code #8319, New Orleans, LA, 70112, USA
| | - Arachu Castro
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Mail Code #8319, New Orleans, LA, 70112, USA.
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Associations Between Mistreatment by a Provider during Childbirth and Maternal Health Complications in Uttar Pradesh, India. Matern Child Health J 2017; 21:1821-1833. [DOI: 10.1007/s10995-017-2298-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kujawski SA, Freedman LP, Ramsey K, Mbaruku G, Mbuyita S, Moyo W, Kruk ME. Community and health system intervention to reduce disrespect and abuse during childbirth in Tanga Region, Tanzania: A comparative before-and-after study. PLoS Med 2017; 14:e1002341. [PMID: 28700587 PMCID: PMC5507413 DOI: 10.1371/journal.pmed.1002341] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 06/01/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Abusive treatment of women during childbirth has been documented in low-resource countries and is a deterrent to facility utilization for delivery. Evidence for interventions to address women's poor experience is scant. We assessed a participatory community and health system intervention to reduce the prevalence of disrespect and abuse during childbirth in Tanzania. METHODS AND FINDINGS We used a comparative before-and-after evaluation design to test the combined intervention to reduce disrespect and abuse. Two hospitals in Tanga Region, Tanzania were included in the study, 1 randomly assigned to receive the intervention. Women who delivered at the study facilities were eligible to participate and were recruited upon discharge. Surveys were conducted at baseline (December 2011 through May 2012) and after the intervention (March through September 2015). The intervention consisted of a client service charter and a facility-based, quality-improvement process aimed to redefine norms and practices for respectful maternity care. The primary outcome was any self-reported experiences of disrespect and abuse during childbirth. We used multivariable logistic regression to estimate a difference-in-difference model. At baseline, 2,085 women at the 2 study hospitals who had been discharged from the maternity ward after delivery were invited to participate in the survey. Of these, 1,388 (66.57%) agreed to participate. At endline, 1,680 women participated in the survey (72.29% of those approached). The intervention was associated with a 66% reduced odds of a woman experiencing disrespect and abuse during childbirth (odds ratio [OR]: 0.34, 95% CI: 0.21-0.58, p < 0.0001). The biggest reductions were for physical abuse (OR: 0.22, 95% CI: 0.05-0.97, p = 0.045) and neglect (OR: 0.36, 95% CI: 0.19-0.71, p = 0.003). The study involved only 2 hospitals in Tanzania and is thus a proof-of-concept study. Future, larger-scale research should be undertaken to evaluate the applicability of this approach to other settings. CONCLUSIONS After implementation of the combined intervention, the likelihood of women's reports of disrespectful treatment during childbirth was substantially reduced. These results were observed nearly 1 year after the end of the project's facilitation of implementation, indicating the potential for sustainability. The results indicate that a participatory community and health system intervention designed to tackle disrespect and abuse by changing the norms and standards of care is a potential strategy to improve the treatment of women during childbirth at health facilities. The trial is registered on the ISRCTN Registry, ISRCTN 48258486. TRIAL REGISTRATION ISRCTN Registry, ISRCTN 48258486.
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Affiliation(s)
- Stephanie A. Kujawski
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Lynn P. Freedman
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Kate Ramsey
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | | | | | - Wema Moyo
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Fujita W, Leshabari S, Mlay ED, Ohashi K. Tanzanian women’s coping and understanding of labour: A qualitative study at the Amtulabhai Antenatal Clinic. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2017. [DOI: 10.1016/j.ijans.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ratcliffe HL, Sando D, Mwanyika-Sando M, Chalamilla G, Langer A, McDonald KP. Applying a participatory approach to the promotion of a culture of respect during childbirth. Reprod Health 2016; 13:80. [PMID: 27424514 PMCID: PMC4948103 DOI: 10.1186/s12978-016-0186-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/19/2016] [Indexed: 11/10/2022] Open
Abstract
Disrespect and abuse (D&A) during facility-based childbirth is a topic of growing concern and attention globally. Several recent studies have sought to quantify the prevalence of D&A, however little evidence exists about effective interventions to mitigate disrespect and abuse, and promote respectful maternity care. In an accompanying article, we describe the process of selecting, implementing, and evaluating a package of interventions designed to prevent and reduce disrespect and abuse in a large urban hospital in Tanzania. Though that study was not powered to detect a definitive impact on reducing D&A, the results showed important changes in intermediate outcomes associated with this goal. In this commentary, we describe the factors that enabled this effect, especially the participatory approach we adopted to engage key stakeholders throughout the planning and implementation of the program. Based on our experience and findings, we conclude that a visible, sustained, and participatory intervention process; committed facility leadership; management support; and staff engagement throughout the project contributed to a marked change in the culture of the hospital to one that values and promotes respectful maternity care. For these changes to translate into dignified care during childbirth for all women in a sustainable fashion, institutional commitment to providing the necessary resources and staff will be needed.
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Affiliation(s)
- Hannah L Ratcliffe
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA.
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - David Sando
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Guerino Chalamilla
- Management and Development for Health, Dar es Salaam, Tanzania
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Kathleen P McDonald
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
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