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Norris G, Hollins Martin CJ, Moylan A, Greig Y. A qualitative descriptive training needs analysis of midwives perceived continuous professional development in providing intranatal respectful maternal care. NURSE EDUCATION TODAY 2024; 136:106144. [PMID: 38471361 DOI: 10.1016/j.nedt.2024.106144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The Vietnam midwifery report acknowledges that while health services are available in Vietnam, there is growing need to increase levels of respectful maternal care provided to women in labour. OBJECTIVE In conjunction with newborns Vietnam charity, our objective was to assess the perceived continuous professional development needs of midwives working in Vietnam to inform development of an intranatal respectful maternal care education resource. METHOD A qualitative exploratory descriptive method was used to conduct a training needs analysis, which identified perceived education requirements of midwives in Vietnam in relation to providing respectful maternal care. PARTICIPANTS A convenience sample of midwives (n = 49) participated in the study. DATA-COLLECTION Eight on-line focus groups were carried out in four hospitals (maternity units) across Vietnam using WebEx, with the interview schedule informed by the World Health Organization guide for delivering intrapartum care for a positive birth experience. DATA-ANALYSIS Data were transcribed into English and analysed using the 6-steps of thematic analysis outlined by Braun and Clark. FINDINGS Three themes and 9 sub-themes were developed from the data. The first theme addressed aspects that contribute towards creating a positive birth experience; the second theme observed barriers to changing practice; and the third theme noted that there are a variety of preferred teaching methods. CONCLUSIONS In response to the training needs analysis, a respectful maternal care education resource has been designed to transform selected areas of intranatal care in Vietnam. Integrating the respectful maternal care educational resource into midwives' continuous professional development in Vietnam is intended to increase women's rights to have safe childbirth, which accommodates choice and control, and promotes a positive birth experience. RECOMMENDATIONS FOR PRACTICE Post-completion and evaluation, we hope that the intranatal respectful maternal care educational resource will be rolled out to all practising midwives in Vietnam.
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Affiliation(s)
- Gail Norris
- School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK.
| | - Caroline J Hollins Martin
- Maternal Health, School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK.
| | - Anne Moylan
- Advanced Neonatal Practitioner, School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK.
| | - Yvonne Greig
- School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK.
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Kasaye H, Scarf V, Sheehy A, Baird K. Health care providers' perspectives on the mistreatment towards women during maternity care: Do perceptions of the working environment and empathy level matter? Women Birth 2024; 37:101601. [PMID: 38518578 DOI: 10.1016/j.wombi.2024.101601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/09/2024] [Accepted: 03/09/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Mistreatment of women in maternity care violates human rights, erodes trust and disrupts the continuity of maternal healthcare services. Investigating Health Care Providers' (HCPs) perspectives is indispensable in uncovering drivers and designing targeted interventions. AIM To identify the roles of HCPs' perceptions of the working environment and levels of empathy on the mistreatment of women during maternity care. METHODS We conducted a self-administered survey among 148 maternal HCPs practising in ten health centres and four hospitals in the East Wollega Zone, Western Ethiopia, from June to September 2022. FINDINGS Most providers reported seeing other HCPs mistreating women (93.2%), while three-fourths (75.7%) admitted it as their actions. Violation of privacy and confidentiality was the most frequently reported category of mistreatment (44.6%), followed by physical abuse (37.1%) and verbal abuse (35.8%). The likelihood of mistreating women was reduced by 65% (AOR=0.35, 95% CI: [0.14, 0.86]) among individuals with positive perceptions of their working environment compared to those with negative perceptions. A unit increase in providers' empathy also led to a five per cent decrease in mistreatment (AOR=0.95, 95% CI: [0.91, 0.98]. CONCLUSIONS HCPs' perceptions of their working environment and enhanced empathy levels were associated with the reduction of the odds of mistreatment of women. While empathic care should be cultivated as a component of HCPs' competencies, efforts should be made to improve the conditions of the demanding health system to realise a resilient, motivated, competent, and compassionate workforce. The interplay between gender, profession, and mistreatment level requires further investigation.
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Affiliation(s)
- Habtamu Kasaye
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia; Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Vanessa Scarf
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Annabel Sheehy
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Kathleen Baird
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
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Güner S, Gökçe İsbir G, Aydın Beşen M. Midwives' Intercultural Effectiveness Levels and Influencing Factors. J Transcult Nurs 2024; 35:189-198. [PMID: 38380448 DOI: 10.1177/10436596241229479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Due to globalization, countries around the world are starting to notice diversity in their populations. It is crucial that midwives be able to communicate effectively with women from a variety of cultures to provide them with culturally effective health care. METHOD This cross-sectional study was conducted with 394 midwives who work in seven different regions of Türkiye. Data on the intercultural effectiveness and intercultural communication competence of midwives were collected. Data analysis was performed using descriptive statistics, t-tests, analysis of variance, and regression analysis. RESULTS Midwives' intercultural effectiveness was influenced by their foreign language proficiency, experiences abroad, having friends from different cultures, following social media platforms in different languages and cultures, providing care to individuals from diverse cultures, and their willingness to do so. DISCUSSION Findings suggest that exposure to different cultures enhances the level of intercultural effectiveness. Consequently, it is recommended to make plans to support midwives to have positive experiences with different cultures.
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Hameed W, Khan B, Avan BI. Supportive Care-A Missing Piece in the Current Global Efforts of Promoting Respectful Maternity Care. Public Health Rev 2024; 45:1605597. [PMID: 38741751 PMCID: PMC11089184 DOI: 10.3389/phrs.2024.1605597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Sindh, Pakistan
| | - Bilal Iqbal Avan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Pablo MC, Ildefonso HA, Elisa CR. Respectful maternity care interventions to address women mistreatment in childbirth: What has been done? BMC Pregnancy Childbirth 2024; 24:322. [PMID: 38671343 PMCID: PMC11046783 DOI: 10.1186/s12884-024-06524-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Over the last decade, there has been an increasing number of studies regarding experiences of mistreatment, disrespect and abuse (D&A) during facility-based childbirth. These negative experiences during labour have been proven to create a barrier for seeking both facility-based childbirth and postnatal health care, as well as increasing severe postpartum depression among the women who experienced them. This constitutes a serious violation of human rights. However, few studies have carried out specifically designed interventions to reduce these practices. The aim of this scoping review is to synthetise available evidence on this subject, and to identify initiatives that have succeeded in reducing the mistreatment, D&A that women suffer during childbirth in health facilities. METHODS A PubMed search of the published literature was conducted, and all original studies evaluating the efficacy of any type of intervention specifically designed to reduce these negative experiences and promote RMC were selected. RESULTS Ten articles were included in this review. Eight studies were conducted in Africa, one in Mexico, and the other in the U.S. Five carried out a before-and-after study, three used mixed-methods, one was a comparative study between birth centres, and another was a quasi-experimental study. The most common feature was the inclusion of some sort of RMC training for providers at the intervention centre, which led to the conclusion that this training resulted in an improvement in the care received by the women in childbirth. Other strategies explored by a small number of articles were open maternity days, clinical checklists, wall posters and constant user feedback. DISCUSSION These results indicate that there are promising interventions to reduce D&A and promote RMC for women during childbirth in health facilities. RMC training for providers stands as the most proven strategy, and the results suggest that it improves the experiences of care received by women in labour. CONCLUSION The specific types of training and the different initiatives that complement them should be evaluated through further scientific research, and health institutions should implement RMC interventions that apply these strategies to ensure human rights-based maternity care for women giving birth in health facilities around the world.
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Affiliation(s)
- Mira-Catalá Pablo
- Public Health Department, Miguel Hernández University, 03550, Alicante, Spain.
| | - Hernández-Aguado Ildefonso
- Public Health Department, Miguel Hernández University, 03550, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
| | - Chilet-Rosell Elisa
- Public Health Department, Miguel Hernández University, 03550, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
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van der Waal R, van Nistelrooij I. Shroud waving self-determination: A qualitative analysis of the moral and epistemic dimensions of obstetric violence in the Netherlands. PLoS One 2024; 19:e0297968. [PMID: 38648219 PMCID: PMC11034656 DOI: 10.1371/journal.pone.0297968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/15/2024] [Indexed: 04/25/2024] Open
Abstract
Obstetric violence is an urgent global problem. Recently, several studies have appeared on obstetric violence in the Netherlands, indicating that it is a more widespread phenomenon in Dutch maternity care than commonly thought. At the same time, there has been very little public outrage over these studies. The objective of this qualitative research is to gain insight into the working and normalization of obstetric violence by focusing on the moral and epistemic injustices that both facilitate obstetric violence and make it look acceptable. Following the study design of Responsive Evaluation, interviews, homogenous, and heterogenous focus groups were done in three phases, with thirty-one participants, consisting of ten mothers, eleven midwives, five doulas and five midwives in training. All participants were already critically engaged with the topic, which was a selection criterion to be able to bring the existing depth of knowledge on this topic of people in the field to the fore. Data was analyzed through Thematic Analysis. We elaborate on two groups of results. First, we discuss the forms of obstetric violence most commonly mentioned by the participants, which were vaginal examinations, episiotomies, and pelvic floor support. Second, we demonstrate two major themes that concern practices related to moral and epistemic injustice: 1) 'Playing the dead baby card', with the sub-themes 'shroud waving', 'hidden agenda', and 'normalizing obstetric violence'; and 2) 'Troubling consent', with sub-themes 'not being asked for consent', 'saying "yes"', 'saying "no"', and 'giving up resistance'. While epistemic injustice has been analyzed in relation to obstetric violence, moral injustice has not yet been conceptualized as a fundamental part of both the practice and the justification of obstetric violence. This research hence contributes not only to the better understanding of obstetric violence in the Netherlands, but also to a further theorization of this specific form of gender-based violence.
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Affiliation(s)
- Rodante van der Waal
- Care Ethics Department, University for Humanistic Studies, Utrecht, The Netherlands
| | - Inge van Nistelrooij
- Care Ethics Department, University for Humanistic Studies, Utrecht, The Netherlands
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Glover A, Holman C, Boise P. Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice. BMC Pregnancy Childbirth 2024; 24:267. [PMID: 38605316 PMCID: PMC11010273 DOI: 10.1186/s12884-024-06491-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Increasing rates of maternal mortality and morbidity, coupled with ever-widening racial health disparities in maternal health outcomes, indicate that radical improvements need to be made in the delivery of maternity care. This study explored the provision of patient-centered maternity care from the perspective of pregnant and postpartum people; experiences of respect and autonomy were examined through the multi-dimensional contexts of identity, relational trust, and protection of informed choices. METHODS We conducted primary data collection among individuals who experienced a pregnancy in the five years preceding the survey (N = 484) using the validated Mothers on Respect Index (MORi) and Mothers Autonomy in Decision Making (MADM) scale. We conducted an exploratory factor analysis (EFA) which produced three factor variables: trust, informed choice, and identity. Using these factor variables as dependent variables, we conducted bivariate and multivariate analysis to examine the relationship between these factor variables and social marginalization, as measured by race, disability, justice-involvement, and other social risk factors, such as food and housing insecurity. RESULTS Results of our bivariate and multivariate models generally confirmed our hypothesis that increased social marginalization would be associated with decreased experiences of maternity care that was perceived as respectful and protective of individual autonomy. Most notably, AI/AN individuals, individuals who are disabled, and individuals who had at least one social risk factor were more likely to report experiencing identity-related disrespect and violations of their autonomy. CONCLUSIONS In light of the findings that emphasize the importance of patient identity in their experience in the healthcare system, patient-centered and respectful maternity care must be provided within a broader social context that recognizes unequal power dynamics between patient and provider, historical trauma, and marginalization. Provider- and facility-level interventions that improve patient experiences and health outcomes will be more effective if they are contextualized and informed by an understanding of how patients' identities and traumas shape their healthcare experience, health-seeking behaviors, and potential to benefit from clinical interventions and therapies.
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Affiliation(s)
- Annie Glover
- University of Montana Rural Institute for Inclusive Communities, Missoula, US.
- University of Montana School of Public & Community Health Sciences, Missoula, US.
| | - Carly Holman
- University of Montana Rural Institute for Inclusive Communities, Missoula, US
- University of Montana School of Public & Community Health Sciences, Missoula, US
| | - Patrick Boise
- University of Montana Rural Institute for Inclusive Communities, Missoula, US
- University of Montana School of Public & Community Health Sciences, Missoula, US
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MacVicar S, Jordan A, Vu H, Tran HN, Greig Y, Thi Tuyet Nguyen H, Norris G, Martin CR, Hollins Martin CJ. Translation and validation of Vietnamese version of the Birth Satisfaction Scale-Revised (BSS-R). J Reprod Infant Psychol 2024:1-14. [PMID: 38591499 DOI: 10.1080/02646838.2024.2338176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The 10-item Birth Satisfaction Scale-Revised (BSS-R) is a quick and easy survey instrument recommended by the International Consortium for Health Outcome Measures as the tool of choice for measuring women's birth satisfaction. AIM To translate and validate a Vietnamese-language version of the BSS-R. METHOD A quantitative cross-sectional method was used to gather data post translation and back-translation of a Vietnamese version of the BSS-R (VN-BSS-R). Data collected were psychometrically evaluated using key indices of validity and reliability. PARTICIPANTS Vietnamese women who were within one month postpartum of birth (N = 383) took part in the study. RESULTS Findings illustrate that a two-factor model offered excellent psychometric properties. With the two-factor VN-BSS-R, five items loaded onto a subscale 'Positive birth experiences' and the other five onto a second subscale 'Negative birth experiences'. This two-factor model offered a fit to data (root mean square error of approximation [RMSEA] = 0.07, 90% confidence interval [CI] [0.05, 0.09], root square mean residual [RMSE] = 0.04 and comparative fit index [CFI] = 0.97). Mean scores for the exploratory factor analysis [EFA]-derived 'positive' and 'negative' sub-scales were 17.12 (SD 2.34) and 8.40 (SD 4.18) respectively. CONCLUSION The translated and validated VN-BSS-R is a psychometrically robust tool for measuring birth satisfaction in Vietnamese postpartum women.The VN-BSS-R is available for use to measure experiences and perceptions of intrapartum care received by Vietnamese women.
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Affiliation(s)
- Sonya MacVicar
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | - Hien Vu
- Head of Social Work department, Phu San Hanoi Hospital, Hanoi, Vietnam
| | - Hai Ngoc Tran
- Specialist medicine, Tu Du hospital, Ho Chi Minh, Vietnam
| | - Yvonne Greig
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | - Gail Norris
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Colin R Martin
- Institute for Health and Wellbeing, University of Suffolk, UK
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Abebaw WA, Wolde HF, Tilahun WM, Gebreegziabher ZA, Teshome DF. Quality of childbirth care and its determinants along the continuum of care among pregnant women who gave birth vaginally in Gondar town public health facility, Northwest Ethiopia, 2022: generalised structural equation modelling. BMJ Open 2024; 14:e073199. [PMID: 38580371 PMCID: PMC11002431 DOI: 10.1136/bmjopen-2023-073199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/05/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE To assess the quality of childbirth care and its determinants along the continuum of care in Gondar town public health facility in Ethiopia. DESIGN An institution-based, cross-sectional study was employed. Completed data were imported to Stata V.16 for cleaning and analysis. A generalised structural equation model was employed to examine the relationships along the continuum of childbirth care and to determine the factors affecting the quality of childbirth care. SETTING AND PARTICIPANTS This study was conducted among a total of 865 women who delivered in the public health facility of Gondar, Ethiopia, from 19 May to 30 June 2022. RESULTS The study revealed the proportion of good-quality childbirth care during admission, intrapartum and immediate postpartum period was 59% (95% CI 55.7, 62.4), 76.8% (95% CI 73.8, 79.5) and 45% (95% CI 41.7, 48.5), respectively. Postsecondary educational status of mothers (β=0.60, 95% CI 0.16, 1.04) and maternal age of 25-35 (β=0.68, 95% CI 0.33, 1.02) were predictors of quality of care at admission. Referral hospital (β=0.43, 95% CI 0.10, 0.76), presence of guidelines (β=1.36, 95% CI 0.72, 1.99) and provider age of 25-35 (β=0.61, 95% CI 0.12, 1.10) affected the quality of care during the intrapartum period. Urban residence (β=0.52, 95% CI 0.12, 0.93), skilled birth attendant experience (β=0.19, 95% CI 0.11, 0.28) and number of delivery couches (β=-0.29, 95% CI -0.44, -0.13) had significant associations with the quality of childbirth care during the immediate postpartum period. CONCLUSIONS Although our study found improvements in the quality of childbirth care along the continuum compared with previous studies, more workers are needed to alleviate the problem of poor-quality service. Different maternal, provider and facility factors were found to be predictors of the quality of childbirth care.
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Affiliation(s)
| | - Haileab Fekadu Wolde
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | | | - Destaw Fetene Teshome
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Ngarmbatedjimal A, Abdelaziz M, Allambademel VDP, Diarra A, Djerambete V, Kodjimadje T, Luketa S, Madjigoto R, Miangotar Y, Ndingayande A, Tamira S, Varelis T, Vourbane K, Casey SE. Refugee women's and providers' perceptions of person-centered maternity care: a qualitative study in two refugee camps in Chad. BMC Pregnancy Childbirth 2024; 24:225. [PMID: 38561681 PMCID: PMC10983620 DOI: 10.1186/s12884-024-06424-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Globally, mistreatment of women during labor and delivery is a common human rights violation. Person-centered maternity care (PCMC), a critical component of quality of care, is respectful and responsive to an individual's needs and preferences. Factors related to poor PCMC are often exacerbated in humanitarian settings. METHODS We conducted a qualitative study to understand Sudanese refugee women's experiences, including their perceptions of quality of care, during labor and delivery at the maternities in two refugee camps in eastern Chad, as well as maternity health workers' perceptions of PCMC and how they could be better supported to provide this. In-depth interviews were conducted individually with 22 women who delivered in the camp maternities and five trained midwives working in the two maternities; and in six dyads with a total of 11 Sudanese refugee traditional birth attendants and one assistant midwife. In addition, facility assessments were conducted at each maternity to determine their capacity to provide PCMC. RESULTS Overall, women reported positive experiences in the camp maternities during labor and delivery. Providers overwhelmingly defined respectful care as patient-centered and respect as being something fundamental to their role as health workers. While very few reported incidents of disrespect between providers and patients in the maternity, resource constraints, including overwork of the providers and overcrowding, resulted in some women feeling neglected. CONCLUSIONS Despite providers' commitment to offering person-centered care and women's generally positive experiences in this study, one of few that explored PCMC in a refugee camp, conflict and displacement exacerbates the conditions that contribute to mistreatment during labor and delivery. Good PCMC requires organizational emphasis and support, including adequate working conditions and ensuring suitable resources so health workers can effectively perform.
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Affiliation(s)
- Alexis Ngarmbatedjimal
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Mahamat Abdelaziz
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Vincent de Paul Allambademel
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Aminata Diarra
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, NY, 10032, USA
| | - Valentin Djerambete
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Thérèse Kodjimadje
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Samy Luketa
- International Rescue Committee Chad, BP 5208, N'Djaména, Chad
| | - Robert Madjigoto
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Yodé Miangotar
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | | | - Salomon Tamira
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Theodora Varelis
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, NY, 10032, USA
| | | | - Sara E Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, NY, 10032, USA.
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Benyamini Y, Delicate A, Ayers S, Dikmen-Yildiz P, Gouni O, Jonsdottir SS, Karlsdottir SI, Kömürcü Akik B, Leinweber J, Murphy-Tighe S, Pajalic Z, Riklikiene O, Limmer CM. Key dimensions of women's and their partners' experiences of childbirth: A systematic review of reviews of qualitative studies. PLoS One 2024; 19:e0299151. [PMID: 38551936 PMCID: PMC10980232 DOI: 10.1371/journal.pone.0299151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/06/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND The World Health Organization 2018 intrapartum guideline for a positive birth experience emphasized the importance of maternal emotional and psychological well-being during pregnancy and the need for safe childbirth. Today, in many countries birth is safe, yet many women report negative and traumatic birth experiences, with adverse effects on their and their families' well-being. Many reviews have attempted to understand the complexity of women's and their partners' birth experience; however, it remains unclear what the key dimensions of the birth experience are. OBJECTIVE To synthesize the information from reviews of qualitative studies on the experience of childbirth in order to identify key dimensions of women's and their partners' childbirth experience. METHODS Systematic database searches yielded 40 reviews, focusing either on general samples or on specific modes of birth or populations, altogether covering primary studies from over 35,000 women (and >1000 partners) in 81 countries. We appraised the reviews' quality, extracted data and analysed it using thematic analysis. FINDINGS Four key dimensions of women's and partners' birth experience (covering ten subthemes), were identified: 1) Perceptions, including attitudes and beliefs; 2) Physical aspects, including birth environment and pain; 3) Emotional challenges; and 4) Relationships, with birth companions and interactions with healthcare professionals. In contrast with the comprehensive picture that arises from our synthesis, most reviews attended to only one or two of these dimensions. CONCLUSIONS The identified key dimensions bring to light the complexity and multidimensionality of the birth experience. Within each dimension, pathways leading towards negative and traumatic birth experiences as well as pathways leading to positive experiences become tangible. Identifying key dimensions of the birth experience may help inform education and research in the field of birth experiences and gives guidance to practitioners and policy makers on how to promote positive birth experiences for women and their partners.
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Affiliation(s)
- Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Amy Delicate
- Centre for Maternal and Child Health Research, City, University of London, London United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City, University of London, London United Kingdom
| | - Pelin Dikmen-Yildiz
- Department of Psychology, Fen—Edebiyat Fakültesi, Cumhuriyet Mahallesi, Kirklareli University, Kırklareli, Turkey
| | - Olga Gouni
- Cosmoanelixis, Prenatal & Life Sciences Educational Organization, Nea Ionia, Athens, Greece
| | | | | | - Burcu Kömürcü Akik
- Department of Psychology, Faculty of Languages and History-Geography, Ankara University, Ankara, Turkey
| | - Julia Leinweber
- Institute of Midwifery, Charité University of Medicine, Berlin, Germany
| | - Sylvia Murphy-Tighe
- Department of Nursing & Midwifery, Health Sciences Building, University of Limerick, Ireland
| | | | - Olga Riklikiene
- Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Claudia Maria Limmer
- Department of Nursing and Management, Faculty of Business and Social Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
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Fullaondo A, Erreguerena I, Keenoy EDM. Transforming health care systems towards high-performance organizations: qualitative study based on learning from COVID-19 pandemic in the Basque Country (Spain). BMC Health Serv Res 2024; 24:364. [PMID: 38515068 PMCID: PMC10958960 DOI: 10.1186/s12913-024-10810-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic is one of the worst health catastrophes of the last century, which caused severe economic, political, and social consequences worldwide. Despite these devastating consequences, lessons learned provide a great opportunity that can drive the reform of health systems to become high-performing, effective, equitable, accessible, and sustainable organisations. This work identifies areas in which changes must be encouraged that will enable health systems to deal effectively with current and future challenges, beyond COVID-19. METHODS A realist design was chosen, based on qualitative data collection techniques, content analysis and triangulation to identify key domains of organizational interventions behind the changes implemented to react to the COVID-19 pandemic in the Basque Country. Twenty key informants were used as an expert source of information. Thematic analysis was done using the Framework Method. RESULTS The analysis of the interviews resulted in the identification of 116 codes, which were reviewed and agreed upon by the researchers. Following the process of methodological analysis, these codes were grouped into domains: seven themes and 23 sub-themes. Specifically, the themes are: responsiveness, telehealth, integration, knowledge management, professional roles, digitisation, and organisational communication. The detailed description of each theme and subtheme is presented. CONCLUSIONS The findings of this work pretend to guide the transformation of health systems into organisations that can improve the health of their populations and provide high quality care. Such a multidimensional and comprehensive reform encompasses both strategic and operational actions in diverse areas and requires a broad and sustained political, technical, and financial commitment.
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Affiliation(s)
- Ane Fullaondo
- Kronikgune Institute for Health Services Research, Barakaldo, Spain.
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Udho S, Clow SE. Experiences, prevalence and drivers of disrespect and abuse of adolescents during facility-based childbirth in sub-Saharan Africa: a scoping review protocol. BMJ Open 2024; 14:e078912. [PMID: 38490663 PMCID: PMC10946369 DOI: 10.1136/bmjopen-2023-078912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Adolescents are more likely to experience disrespect and abuse (D&A) by skilled health personnel during facility-based childbirth. However, research evidence on the experiences, prevalence and drivers of D&A of adolescents in childbirth is limited. We aim to establish research evidence on the experiences, prevalence and drivers of D&A of adolescents during facility-based childbirth in sub-Saharan Africa and identify gaps in the literature to inform future research. METHODS AND ANALYSIS The protocol is designed using Arksey and O'Malley's methodological framework and will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We will systematically search to retrieve peer-reviewed articles published in English from 2011 to date in PubMed/Medline, EBSCOhost (Africa Wide Information, CINAHL, PsycINFO and SocINDEX), Web of Science (SciELO Citation Index and Web of Science Core Collection) and Scopus. Two independent reviewers will screen the references by titles, abstracts and full texts. Discrepancies in screening results will be resolved through discussions. Key elements of included studies will be charted using a predetermined tool. We will perform numerical analysis and synthesis of narrative accounts of the extent, nature and distribution of review studies. ETHICS AND DISSEMINATION No ethical approval is required since the scoping review will use openly available public data and information. Review findings will be disseminated at conferences and published in peer-reviewed journals. No protocol registration is required.
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Affiliation(s)
- Samson Udho
- Department of Midwifery, Lira University, Lira, Uganda
- Department of Health and Rehabilitation Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Sheila Elizabeth Clow
- Department of Health and Rehabilitation Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
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Suarez A, Yakupova V. Childbirth experiences of women with a history of physical, sexual, and child abuse: a cross-sectional study of 2,575 Russian women. BMC Pregnancy Childbirth 2024; 24:186. [PMID: 38459457 PMCID: PMC10921683 DOI: 10.1186/s12884-024-06369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/24/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND A substantial number of women who subsequently become pregnant and give birth have a history of physical, sexual, and/or child abuse. This study investigated the associations of these types of traumas and their cumulative effect with childbirth experiences, namely, mode of birth, maternal and child complications during pregnancy/childbirth, preterm birth, medical procedures, and obstetric violence during labour. METHODS A group of Russian women (n = 2,575) who gave birth within the previous 12 months, completed a web-based survey, where they provided demographic information, details about their childbirth experiences, and a history of trauma. RESULTS Women with any type of past abuse were at higher risk for maternal complications during pregnancy/childbirth (exp(β) < 0.73, p < 0.010 for all). More specific to the type of trauma were associations of physical abuse with caesarean birth, child abuse with complications during pregnancy/childbirth for the baby, and physical and child abuse with obstetric violence (exp(β) < 0.54, p < 0.022 for all). There was a cumulative effect of trauma for all the outcomes except for medical procedures during childbirth and preterm birth. CONCLUSION This study provides insights into potential different individual effects of physical, sexual, and/or child abuse as well as their cumulative impact on the childbirth experiences. The robust findings about maternal complications during pregnancy/childbirth and obstetric violence highlight the importance of trauma-informed care, supportive policies, and interventions to create safe and empowering birthing environments that prioritise patient autonomy, dignity, and respectful communication.
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Affiliation(s)
- Anna Suarez
- Department of Psychology, Lomonosov Moscow State University, Mokhovaya St, 11/9, Moscow, 125009, Russia.
| | - Vera Yakupova
- Department of Psychology, Lomonosov Moscow State University, Mokhovaya St, 11/9, Moscow, 125009, Russia
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Širvinskienė G, Forray AI, König-Bachmann M, Blaga OM, Grincevičienė Š, Luegmair K, Pranskevičiūtė-Amoson R, Zenzmaier C. Experiences of childbirth care in Lithuania and Romania: Insights from the European Babies Born Better survey. Birth 2024; 51:121-133. [PMID: 37798932 DOI: 10.1111/birt.12771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 06/14/2023] [Accepted: 08/11/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Data on experience and satisfaction of users are essential for improvement of health care, especially in the field of childbirth. The aim of this study was to compare childbirth care experiences in Lithuania and Romania. METHODS Data derived from the EU Babies Born Better online survey were analyzed. Parturients from Lithuania (N = 373) and Romania (N = 359) who had given birth within the last 5 years were included. Participants were asked to (1) describe the best things in childbirth care and (2) suggest changes in the care received at their birthplace. Qualitative data were analyzed using a previously developed deductive coding framework. RESULTS In agreement with previous findings from Austria, positive experiences mainly addressed care experienced at an individual level (in particular healthcare practitioners' competence and personality traits) and suggested changes mainly addressed services at birthplace (issues related to infrastructure, information and counseling, and empowerment). Responses not initially included in the coding framework addressed aspects such as informal payment (in both countries), desire for home birth (particularly in Lithuania), or mistreatment of parturients (particularly in Romania). CONCLUSIONS We conclude that similar trends in childbirth care exist in Lithuania and Romania with regard to parturients' personal experiences and psychosocial needs and that addressing the needs of parturients is important for improving service provision.
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Affiliation(s)
- Giedrė Širvinskienė
- Department of Health Psychology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Health Research Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alina Ioana Forray
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
- Department of Community Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Oana Maria Blaga
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Švitrigailė Grincevičienė
- Department of Biothermodynamics and Drug Design, Institute of Biotechnology, Life Sciences Centre, Vilnius University, Vilnius, Lithuania
| | - Karolina Luegmair
- Midwifery Department, Health University of Applied Sciences Tyrol, Innsbruck, Austria
- KSH Munich, University of Applied Sciences, Munich, Germany
| | | | - Christoph Zenzmaier
- Midwifery Department, Health University of Applied Sciences Tyrol, Innsbruck, Austria
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Calys-Tagoe BNL, Brownson K, Nsaful J, Dedey F, Tetteh J, Coleman N, Laryea RY, Clegg-Lamptey JN. Satisfaction levels and associated influencing factors among inpatients and outpatients with breast cancer at a tertiary health facility in Ghana. Ghana Med J 2024; 58:7-16. [PMID: 38957283 PMCID: PMC11215237 DOI: 10.4314/gmj.v58i1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Objectives To uncover variables linked to breast cancer patient satisfaction in order to improve policy choices and actions for breast cancer care in Ghana. Design We employed a cross-sectional design using a quantitative approach. Setting The Radiotherapy, Oncology and Surgery Departments of the Korle Bu Teaching Hospital, Accra. Participants Inpatient and outpatient breast cancer patients. Main outcome measures The level of inpatient and outpatient satisfaction was measured using descriptive and inferential statistical analyses. The Shapiro-Wilk test was employed to assess normality, while the Heckman selection model assessed significance with outcomes of interest. Results A total of 636 participants, with a mean age of 52.64±14.07 years, were recruited. The measured inpatient and outpatient levels of satisfaction out of 100 were 74.06±7.41 and 49.99±1.00 respectively, while the self-reported satisfaction levels out of 5 were 4.22±0.63 and 4.11±0.85 respectively. The level of inpatient satisfaction was significantly influenced by age, marital status, income level, and number of previous facilities visited (p<0.05). Outpatient satisfaction level was significantly associated with place of residence and income level (p<0.05). Conclusions The study offers insight into the satisfaction levels of breast cancer patients receiving inpatient and outpatient services at the largest tertiary referral centre and teaching hospital in Ghana, as well as the factors influencing attendance and satisfaction levels. Understanding and improving breast cancer patients' levels of satisfaction is a way that providers can safeguard their emotional well-being. Improvement in patient satisfaction at our institution among outpatients is an area for future growth. Funding Gardner-Holt Women's Health Grant program, Centre for Global Surgery 2021.
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Affiliation(s)
| | - Kirstyn Brownson
- Huntsman Cancer Institute, University of Utah School of Medicine, Utah, USA
| | - Josephine Nsaful
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, Korle Bu, Accra
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, Korle Bu, Accra
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, Korle Bu, Accra
| | - Nathaniel Coleman
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle Bu, Accra
| | - Ruth Y Laryea
- Department of Medicine and Therapeutics, University of Ghana Medical School, Korle Bu, Accra
| | - Joe-Nat Clegg-Lamptey
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, Korle Bu, Accra
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
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Haseli A, Khosravi S, Hajimirzaie SS, Feli R, Rasoal D. Midwifery students' experiences: Violations of dignity during childbirth. Nurs Ethics 2024; 31:296-310. [PMID: 37650382 PMCID: PMC11181724 DOI: 10.1177/09697330231197703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND The principle of human dignity is woven into the ethical principles of the midwifery profession, noted as both an obligation and a human right. RESEARCH OBJECTIVES The aim of this study is to explore the experiences of midwifery students regarding threats to women's dignity during childbirth. RESEARCH DESIGN This is a qualitative study with explorative design. Participants and Research Context: The research was carried out in 2022 at Kermanshah University of Medical Sciences, involving 32 midwifery students in individual interviews that lasted between 30 and 90 minutes. These participants aged 21 to 28 years, with an average age of 23.5 years, provided their perspectives on the matter. RESULTS Four key themes described the threats to women's dignity during childbirth: 1) professional incompetence, 2) abuse of power imbalance, 3) caring only for physical and not mental health, and 4) structural issues within the healthcare system. Professional incompetence was characterized by outdated practices and lack of adherence to evidence-based medicine. Abuse of power imbalance was demonstrated in instances where the authoritative position of healthcare providers was misused, thereby disrupting the respectful care that women are entitled to receive. The disproportionate emphasis on physical health over mental health was evidenced by the disregard for mothers' psychological well-being during childbirth. Lastly, systemic structural issues emerged as significant impediments, revealing the need for system-wide changes. Ethical considerations: This study was approved by the Ethics Committee of the Research Deputy at Kermanshah University. Participation was voluntary and the confidentiality were maintained. CONCLUSION The findings underscore the role that unprofessional behavior, ethical lapses in medical practices, and systemic challenges play in undermining maternal dignity during childbirth. These threats necessitate urgent attention and must be adequately addressed in policy development and program implementation to safeguard the dignity of mothers during childbirth.
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Affiliation(s)
| | | | | | | | - Dara Rasoal
- School of Health and Welfare, Dalarna University, Sweden
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Ayers S, Horsch A, Garthus-Niegel S, Nieuwenhuijze M, Bogaerts A, Hartmann K, Karlsdottir SI, Oosterman M, Tecirli G, Turner JD, Lalor J. Traumatic birth and childbirth-related post-traumatic stress disorder: International expert consensus recommendations for practice, policy, and research. Women Birth 2024; 37:362-367. [PMID: 38071102 DOI: 10.1016/j.wombi.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Research suggests 1 in 3 births are experienced as psychologically traumatic and about 4% of women and 1% of their partners develop post-traumatic stress disorder (PTSD) as a result. AIM To provide expert consensus recommendations for practice, policy, and research and theory. METHOD Two consultations (n = 65 and n = 43) with an international group of expert researchers and clinicians from 33 countries involved in COST Action CA18211; three meetings with CA18211 group leaders and stakeholders; followed by review and feedback from people with lived experience and CA18211 members (n = 238). FINDINGS Recommendations for practice include that care for women and birth partners must be given in ways that minimise negative birth experiences. This includes respecting women's rights before, during, and after childbirth; and preventing maltreatment and obstetric violence. Principles of trauma-informed care need to be integrated across maternity settings. Recommendations for policy include that national and international guidelines are needed to increase awareness of perinatal mental health problems, including traumatic birth and childbirth-related PTSD, and outline evidence-based, practical strategies for detection, prevention, and treatment. Recommendations for research and theory include that birth needs to be understood through a neuro-biopsychosocial framework. Longitudinal studies with representative and global samples are warranted; and research on prevention, intervention and cost to society is essential. CONCLUSION Implementation of these recommendations could potentially reduce traumatic births and childbirth-related PTSD worldwide and improve outcomes for women and families. Recommendations should ideally be incorporated into a comprehensive, holistic approach to mental health support for all involved in the childbirth process.
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Affiliation(s)
- Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, EC1V 0HB, UK.
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland; Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Susan Garthus-Niegel
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands; CAPHRI, Maastricht University, 6229 ER Maastricht, the Netherlands
| | - Annick Bogaerts
- REALIFE research group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | | | | | - Mirjam Oosterman
- Faculty of Behavioral and Movement Sciences, Department of Clinical Child & Family Studies, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, the Netherlands
| | - Gulcan Tecirli
- Health Technology Assessment Department, Republic of Turkiye Ministry of Health, Bilkent, Çankaya, Ankara, Turkiye
| | - Jonathan D Turner
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Chervenak FA, McLeod-Sordjan R, Pollet SL, De Four Jones M, Gordon MR, Combs A, Bornstein E, Lewis D, Katz A, Warman A, Grünebaum A. Obstetric violence is a misnomer. Am J Obstet Gynecol 2024; 230:S1138-S1145. [PMID: 37806611 DOI: 10.1016/j.ajog.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
The term "obstetric violence" has been used in the legislative language of several countries to protect mothers from abuse during pregnancy. Subsequently, it has been expanded to include a spectrum of obstetric procedures, such as induction of labor, episiotomy, and cesarean delivery, and has surfaced in the peer-reviewed literature. The term "obstetric violence" can be seen as quite strong and emotionally charged, which may lead to misunderstandings or misconceptions. It might be interpreted as implying a deliberate act of violence by healthcare providers when mistreatment can sometimes result from systemic issues, lack of training, or misunderstandings rather than intentional violence. "Obstetric mistreatment" is a more comprehensive term that can encompass a broader range of behaviors and actions. "Violence" generally refers to the intentional use of physical force to cause harm, injury, or damage to another person (eg, physical assault, domestic violence, street fights, or acts of terrorism), whereas "mistreatment" is a more general term and refers to the abuse, harm, or control exerted over another person (such as nonconsensual medical procedures, verbal abuse, disrespect, discrimination and stigmatization, or neglect, to name a few examples). There may be cases where unprofessional personnel may commit mistreatment and violence against pregnant patients, but as obstetrics is dedicated to the health and well-being of pregnant and fetal patients, mistreatment of obstetric patients should never be an intended component of professional obstetric care. It is necessary to move beyond the term "obstetric violence" in discourse and acknowledge and address the structural dimensions of abusive reproductive practices. Similarly, we do not use the term "psychiatric violence" for appropriately used professional procedures in psychiatry, such as electroshock therapy, or use the term "neurosurgical violence" when drilling a burr hole. There is an ongoing need to raise awareness about the potential mistreatment of obstetric patients within the context of abuse against women in general. Using the term "mistreatment in healthcare" instead of the more limited term "obstetric violence" is more appropriate and applies to all specialties when there is unprofessional abuse and mistreatment, such as biased care, neglect, emotional abuse (verbal), or physical abuse, including performing procedures that are unnecessary, unindicated, or without informed patient consent. Healthcare providers must promote unbiased, respectful, and patient-centered professional care; provide an ethical framework for all healthcare personnel; and work toward systemic change to prevent any mistreatment or abuse in our specialty.
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Affiliation(s)
- Frank A Chervenak
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Renee McLeod-Sordjan
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra Northwell School of Nursing and Physician Assistant Studies, Northwell Health, New York, NY
| | - Susan L Pollet
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Monique De Four Jones
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Hospital, Manhasset, NY
| | | | - Adriann Combs
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY
| | - Eran Bornstein
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Dawnette Lewis
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, South Shore University Hospital, Bay Shore, NY
| | - Adi Katz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Ashley Warman
- Division of Medical Ethics, Department of Medicine, Lenox Hill Hospital, New York, NY
| | - Amos Grünebaum
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY.
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Dmowska A, Fielding-Singh P, Halpern J, Prata N. The intersection of traumatic childbirth and obstetric racism: A qualitative study. Birth 2024; 51:209-217. [PMID: 37849421 PMCID: PMC10922554 DOI: 10.1111/birt.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/02/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Traumatic childbirth experiences are common in the United States - affecting a third to a fourth of mothers - with significant negative impacts on maternal health. Yet most research on traumatic childbirth focuses on white mothers' experiences. Drawing on a racially and ethnically diverse sample of mothers who experienced traumatic childbirth, this exploratory qualitative study examined Black, Latina, and Asian mothers' traumatic birth experiences and the role of obstetric racism in shaping these experiences. METHODS In-depth, semi-structured interviews were conducted in 2019-2020 with 30 mothers who identified as women of color (37% Black, 40% Latina, and 23% Asian) who gave birth in the US and self-identified as having experienced a traumatic childbirth. Data were analyzed using qualitative content analysis. RESULTS Mothers reported obstetric racism as core to their traumatic birth experiences. This racism manifested through practitioners' use of gendered and racialized stereotypes, denying and delegitimizing mothers' needs. Mothers shared key consequences of the obstetric racism they experienced, including postpartum anxiety and depression, increased medical mistrust, and decreased desire for future children. CONCLUSIONS Mothers' reports suggest that obstetric racism played a role in their traumatic birth experiences. Particularly, practitioners' deployment of gendered and racialized stereotypes influenced mothers' treatment during birth. These findings point to opportunities to address obstetric racism during childbirth and improve patients' experiences through enhancing their agency and empowerment. The findings, in addition, highlight the need for increased practitioner training in anti-racist practice and cultural humility.
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Affiliation(s)
- Amelia Dmowska
- Medical Student, University of California Berkeley and University of California San Francisco Joint Medical Program
| | | | - Jodi Halpern
- Professor of Bioethics and Medical Humanities, University of California Berkeley and University of California San Francisco Joint Medical Program
| | - Ndola Prata
- Professor of Maternal, Child and Adolescent Health, University of California Berkeley School of Public Health
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Leijerzapf DR, van der Pijl MSG, Hollander MH, Kingma E, de Jonge A, Verhoeven CJM. Experienced disrespect & abuse during childbirth and associated birth characteristics: a cross-sectional survey in the Netherlands. BMC Pregnancy Childbirth 2024; 24:170. [PMID: 38424515 PMCID: PMC10905902 DOI: 10.1186/s12884-024-06360-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Experiencing upsetting disrespect and abuse (D&A) during labour and birth negatively affects women's birth experiences. Knowing in what circumstances of birth women experience upsetting situations of D&A can create general awareness and help healthcare providers judge the need for extra attention in their care to help reduce these experiences. However, little is known about how different birth characteristics relate to the experience of D&A. Previous studies showed differences in birth experiences and experienced D&A between primiparous and multiparous women. This study explores, stratified for parity, (1) how often D&A are experienced in the Netherlands and are considered upsetting, and (2) which birth characteristics are associated with these upsetting experiences of D&A. METHODS For this cross-sectional study, an online questionnaire was set up and disseminated among women over 16 years of age who gave birth in the Netherlands between 2015 and 2020. D&A was divided into seven categories: emotional pressure, unfriendly behaviour/verbal abuse, use of force/physical violence, communication issues, lack of support, lack of consent and discrimination. Stratified for parity, univariable and multivariable logistic regression analyses were performed to examine which birth characteristics were associated with the upsetting experiences of different categories of D&A. RESULTS Of all 11,520 women included in this study, 45.1% of primiparous and 27.0% of multiparous women reported at least one upsetting experience of D&A. Lack of consent was reported most frequently, followed by communication issues. For both primiparous and multiparous women, especially transfer from midwife-led to obstetrician-led care, giving birth in a hospital, assisted vaginal birth, and unplanned cesarean section were important factors that increased the odds of experiencing upsetting situations of D&A. Among primiparous women, the use of medical pain relief was also associated with upsetting experiences of D&A. CONCLUSION A significant number of women experience upsetting disrespectful and abusive care during birth, particularly when medical interventions are needed after the onset of labour, when care is transferred during birth, and when birth takes place in a hospital. This study emphasizes the need for improving quality of verbal and non-verbal communication, support and adequate decision-making and consent procedures, especially before, during, and after the situations of birth that are associated with D&A.
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Affiliation(s)
- Denise R Leijerzapf
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, Netherlands.
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands.
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
- Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Marit S G van der Pijl
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martine H Hollander
- Amalia Children's Hospital, Department of Obstetrics, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Ank de Jonge
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands
- Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Corine J M Verhoeven
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands
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Rubashkin N, Bingham B, Baji P, Szebik I, Kremmer S, Vedam S. In search of respect and continuity of care: Hungarian women's experiences with midwifery-led, community birth. Birth 2024:10.1111/birt.12818. [PMID: 38409862 PMCID: PMC11345881 DOI: 10.1111/birt.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/20/2023] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION To describe and compare intervention rates and experiences of respectful care when Hungarian women opt to give birth in the community. METHODS We conducted a cross-sectional online survey (N = 1257) in 2014. We calculated descriptive statistics comparing obstetric procedure rates, respectful care indicators, and autonomy (MADM scale) across four models of care (public insurance; chosen doctor or chosen midwife in the public system; private midwife-led community birth). We used an intention-to-treat approach. After adjusting for social and clinical covariates, we used logistic regression to estimate the odds of obstetric procedures and disrespectful care and linear regression to estimate the level of autonomy (MADM scale). FINDINGS In the sample, 99 (7.8%) saw a community midwife for prenatal care. Those who planned community births had the lowest rates of cesarean at 9.1% (public: 30.4%; chosen doctor: 45.2%; chosen midwife 16.5%), induced labor at 7.1% (public: 23.1%; chosen doctor: 26.0%; chosen midwife: 19.4%), and episiotomy at 4.44% (public: 62.3%; chosen doctor: 66.2%; chosen midwife: 44.9%). Community birth clients reported the lowest rates of disrespectful care at 25.5% (public: 64.3%; chosen doctor: 44.3%; chosen midwife: 38.7%) and the highest average MADM score at 31.5 (public: 21.2; chosen doctor: 25.5; chosen midwife: 28.6). In regression analysis, community midwifery clients had significantly reduced odds of cesarean (0.35, 95% CI 0.16-0.79), induced labor (0.27, 95% CI 0.11-0.67), episiotomy (0.04, 95% CI 0.01-0.12), and disrespectful care (0.36, 95% CI 0.21-0.61), while also having significantly higher average MADM scores (5.71, 95% CI 4.08-7.36). CONCLUSIONS Hungarian women who plan to give birth in the community have low obstetric procedure rates and report greater respect, in line with international data on the effects of place of birth and model of care on experiences of perinatal care.
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Affiliation(s)
- Nicholas Rubashkin
- Department of Obstetrics, Gynaecology, & Reproductive Sciences, University of California at San Francisco, San Francisco, California, USA
- Institute for Global Health Sciences, University of California at San Francisco, San Francisco, California, USA
| | - Brianna Bingham
- Institute for Global Health Sciences, University of California at San Francisco, San Francisco, California, USA
| | - Petra Baji
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Imre Szebik
- Institute of Behavioural Sciences, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Sarolta Kremmer
- Program in Midwifery B.SC, Semmelweis University Faculty of Health Sciences, Budapest, Hungary
| | - Saraswathi Vedam
- School of Population & Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Midwifery, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Muriithi FG, Banke-Thomas A, Forbes G, Gakuo RW, Thomas E, Gallos ID, Devall A, Coomarasamy A, Lorencatto F. A systematic review of behaviour change interventions to improve maternal health outcomes in sub-Saharan Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002950. [PMID: 38377077 PMCID: PMC10878526 DOI: 10.1371/journal.pgph.0002950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
The rate of decline in the global burden of avoidable maternal deaths has stagnated and remains an issue of concern in many sub-Saharan Africa countries. As per the most recent evidence, an average maternal mortality ratio (MMR) of 223 deaths per 100,000 live births has been estimated globally, with sub-Saharan Africa's average MMR at 536 per 100,000 live births-more than twice the global average. Despite the high MMR, there is variation in MMR between and within sub-Saharan Africa countries. Differences in the behaviour of those accessing and/or delivering maternal healthcare may explain variations in outcomes and provide a basis for quality improvement in health systems. There is a gap in describing the landscape of interventions aimed at modifying the behaviours of those accessing and delivering maternal healthcare for improving maternal health outcomes in sub-Saharan Africa. Our objective was to extract and synthesise the target behaviours, component behaviour change strategies and outcomes of behaviour change interventions for improving maternal health outcomes in sub-Saharan Africa. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Our protocol was published a priori on PROSPERO (registration number CRD42022315130). We searched ten electronic databases (PsycINFO, Cochrane Database of Systematic Reviews, International Bibliography of Social Sciences, EMBASE, MEDLINE, Scopus, CINAHL PLUS, African Index Medicus, African Journals Online, and Web of Science) and included randomised trials and quasi-experimental studies. We extracted target behaviours and specified the behavioural interventions using the Action, Actor, Context, Time, and Target (AACTT) framework. We categorised the behaviour change strategies using the intervention functions described in the Behaviour Change Wheel (BCW). We reviewed 52 articles (26 randomized trials and 26 quasi-experimental studies). They had a mixed risk of bias. Out of these, 41 studies (78.8%) targeted behaviour change of those accessing maternal healthcare services, while seven studies (13.5%) focused on those delivering maternal healthcare. Four studies (7.7%) targeted mixed stakeholder groups. The studies employed a range of behaviour change strategies, including education 37 (33.3%), persuasion 20 (18%), training 19 (17.1%), enablement 16 (14.4%), environmental restructuring 8 (7.2%), modelling 6 (5.4%) and incentivisation 5 (4.5%). No studies used restriction or coercion strategies. Education was the most common strategy for changing the behaviour of those accessing maternal healthcare, while training was the most common strategy in studies targeting the behaviour of those delivering maternal healthcare. Of the 52 studies, 40 reported effective interventions, 7 were ineffective, and 5 were equivocal. A meta-analysis was not feasible due to methodological and clinical heterogeneity across the studies. In conclusion, there is evidence of effective behaviour change interventions targeted at those accessing and/or delivering maternal healthcare in sub-Saharan Africa. However, more focus should be placed on behaviour change by those delivering maternal healthcare within the health facilities to fast-track the reduction of the huge burden of avoidable maternal deaths in sub-Saharan Africa.
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Affiliation(s)
- Francis G. Muriithi
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Aduragbemi Banke-Thomas
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, Greenwich, London, United Kingdom
| | - Gillian Forbes
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Ruth W. Gakuo
- Department of Nursing, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Lenton, Nottingham, United Kingdom
| | - Eleanor Thomas
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Ioannis D. Gallos
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Adam Devall
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Arri Coomarasamy
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, United Kingdom
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Kasaye H, Scarf V, Sheehy A, Baird K. The mistreatment of women during maternity care and its association with the maternal continuum of care in health facilities. BMC Pregnancy Childbirth 2024; 24:129. [PMID: 38350892 PMCID: PMC10863180 DOI: 10.1186/s12884-024-06310-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Mistreatment of childbearing women continues despite global attention to respectful care. In Ethiopia, although there have been reports of mistreatment of women during maternity care, the influence of this mistreatment on the continuum of maternity care remains unclear. In this paper, we report the prevalence of mistreatment of women from various dimensions, factors related to mistreatment and also its association to the continuum of maternity care in health facilities. METHODS We conducted an institution-based cross-sectional survey among women who gave birth within three months before the data collection period in Western Ethiopia. A total of 760 women participated in a survey conducted face-to-face at five health facilities during child immunization visits. Using a validated survey tool, we assessed mistreatment in four categories and employed a mixed-effects logistic regression model to identify its predictors and its association with the continuum of maternity care, presenting results as adjusted odds ratios (AORs) with their 95% confidence intervals (CIs). RESULTS Over a third of women (37.4%) experienced interpersonal abuse, 29.9% received substandard care, 50.9% had poor interactions with healthcare providers, and 6.2% faced health system constraints. The odds of mistreatment were higher among women from the lowest economic status, gave birth vaginally and those who encountered complications during pregnancy or birth, while having a companion of choice during maternity care was associated to reduced odds of mistreatment by 42% (AOR = 0.58, 95% CI: [0.42-0.81]). Women who experienced physical abuse, verbal abuse, stigma, or discrimination during maternity care had a significantly reduced likelihood of completing the continuum of care, with their odds decreased by half compared to those who did not face such interpersonal abuse (AOR = 0.49, 95% CI: [0.29-0.83]). CONCLUSIONS Mistreatment of women was found to be a pervasive problem that extends beyond labour and birth, it negatively affects upon maternal continuum of care. Addressing this issue requires an effort to prevent mistreatment through attitude and value transformation trainings. Such interventions should align with a system level actions, including enforcing respectful care as a competency, enhancing health centre functionality, improving the referral system, and influencing communities to demand respectful care.
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Affiliation(s)
- Habtamu Kasaye
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Vanessa Scarf
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Annabel Sheehy
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Kathleen Baird
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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75
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Souza JP, Day LT, Rezende-Gomes AC, Zhang J, Mori R, Baguiya A, Jayaratne K, Osoti A, Vogel JP, Campbell O, Mugerwa KY, Lumbiganon P, Tunçalp Ö, Cresswell J, Say L, Moran AC, Oladapo OT. A global analysis of the determinants of maternal health and transitions in maternal mortality. Lancet Glob Health 2024; 12:e306-e316. [PMID: 38070536 DOI: 10.1016/s2214-109x(23)00468-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 01/22/2024]
Abstract
The reduction of maternal mortality and the promotion of maternal health and wellbeing are complex tasks. This Series paper analyses the distal and proximal determinants of maternal health, as well as the exposures, risk factors, and micro-correlates related to maternal mortality. This paper also examines the relationship between these determinants and the gradual shift over time from a pattern of high maternal mortality to a pattern of low maternal mortality (a phenomenon described as the maternal mortality transition). We conducted two systematic reviews of the literature and we analysed publicly available data on indicators related to the Sustainable Development Goals, specifically, estimates prepared by international organisations, including the UN and the World Bank. We considered 23 frameworks depicting maternal health and wellbeing as a multifactorial process, with superdeterminants that broadly affect women's health and wellbeing before, during, and after pregnancy. We explore the role of social determinants of maternal health, individual characteristics, and health-system features in the production of maternal health and wellbeing. This paper argues that the preventable deaths of millions of women each decade are not solely due to biomedical complications of pregnancy, childbirth, and the postnatal period, but are also tangible manifestations of the prevailing determinants of maternal health and persistent inequities in global health and socioeconomic development. This paper underscores the need for broader, multipronged actions to improve maternal health and wellbeing and accelerate sustainable reductions in maternal mortality. For women who have pregnancy, childbirth, or postpartum complications, the health system provides a crucial opportunity to interrupt the chain of events that can potentially end in maternal death. Ultimately, expanding the health sector ecosystem to mitigate maternal health determinants and tailoring the configuration of health systems to counter the detrimental effects of eco-social forces, including though increased access to quality-assured commodities and services, are essential to improve maternal health and wellbeing and reduce maternal mortality.
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Affiliation(s)
- João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil; BIREME, Department of Evidence and Intelligence for Action in Health, Pan American Health Organization (PAHO)-World Health Organization Americas Regional Office, São Paulo, Brazil.
| | - Louise Tina Day
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Clara Rezende-Gomes
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rintaro Mori
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Adama Baguiya
- Kaya Health and Demographic Surveillance System (Kaya-HDSS), Research Institute for Health Sciences (IRSS), Ouagadougou, Burkina Faso
| | | | - Alfred Osoti
- Department of Obstetrics, University of Nairobi, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Oona Campbell
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kidza Y Mugerwa
- Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda
| | - Pisake Lumbiganon
- Department of Obstetrics & Gynecology, Khon Kaen University, Khon Kaen, Thailand
| | - Özge Tunçalp
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jenny Cresswell
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lale Say
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Allisyn Carol Moran
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Straneo M, Hanson C, van den Akker T, Afolabi BB, Asefa A, Delamou A, Dennis M, Gadama L, Mahachi N, Mlilo W, Pembe AB, Tsuala Fouogue J, Beňová L. Inequalities in use of hospitals for childbirth among rural women in sub-Saharan Africa: a comparative analysis of 18 countries using Demographic and Health Survey data. BMJ Glob Health 2024; 9:e013029. [PMID: 38262683 PMCID: PMC10806834 DOI: 10.1136/bmjgh-2023-013029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Rising facility births in sub-Saharan Africa (SSA) mask inequalities in higher-level emergency care-typically in hospitals. Limited research has addressed hospital use in women at risk of or with complications, such as high parity, linked to poverty and rurality, for whom hospital care is essential. We aimed to address this gap, by comparatively assessing hospital use in rural SSA by wealth and parity. METHODS Countries in SSA with a Demographic and Health Survey since 2015 were included. We assessed rural hospital childbirth stratifying by wealth (wealthier/poorer) and parity (nulliparity/high parity≥5), and their combination. We computed percentages, 95% CIs and percentage-point differences, by stratifier level. To compare hospital use across countries, we produced a composite index, including six utilisation and equality indicators. RESULTS This cross-sectional study included 18 countries. In all, a minority of rural women used hospitals for childbirth (2%-29%). There were disparities by wealth and parity, and poorer, high-parity women used hospitals least. The poorer/wealthier difference in utilisation among high-parity women ranged between 1.3% (Mali) and 13.2% (Rwanda). We found use and equality of hospitals in rural settings were greater in Malawi and Liberia, followed by Zimbabwe, the Gambia and Rwanda. DISCUSSION Inequalities identified across 18 countries in rural SSA indicate poor, higher-risk women of high parity had lower use of hospitals for childbirth. Specific policy attention is urgently needed for this group where disadvantage accumulates.
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Affiliation(s)
- Manuela Straneo
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, LSHTM, London, UK
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics & Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bosede B Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Alexandre Delamou
- Africa Center for Excellence (CEA-PMCT), Universite Gamal Abdel Nasser de Conakry, Conakry, Guinea
- Maferinyah Training and Research Center, Forécariah, Guinea
| | | | - Luis Gadama
- Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
| | - Nyika Mahachi
- Zimbabwe College of Public Health Physicians, Harare, Zimbabwe
| | - Welcome Mlilo
- Matabeleland North Provincial Medical Directorate, Zimbabwe Ministry of Health and Child Care, Bulawayo, Zimbabwe
| | - Andrea B Pembe
- Department of Obstetric and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jovanny Tsuala Fouogue
- Department of Obstetrics and Gynecology and Maternal Health, Faculty of Medicine and Pharmaceutical Sciences, Université de Dschang, Dschang, Cameroon
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Epidemiology and Population Health, LSHTM, London, UK
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Palgi-Hacker H, Sacks E, Landry M. Respectful maternity care in Israel during the Covid-19 pandemic: a cross-sectional study of associations between childbirth care practices and women's perceptions of care. BMC Pregnancy Childbirth 2024; 24:50. [PMID: 38200458 PMCID: PMC10777588 DOI: 10.1186/s12884-023-06030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/26/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Respectful maternity care is a crucial part of quality care and is associated with better health outcomes. Early in the Covid-19 pandemic, reports from across the world indicated that infection containment measures were often implemented in ways that resulted in disrespectful care of women during facility-based childbirths in violation of evidence-based practices. This study aimed to explore the associations between childbirth care practices and perceptions of care as satisfactory and respectful among women who delivered in Israeli hospitals during the first six months of the Covid-19 pandemic. METHODS A cross-sectional self-administered online survey was conducted to explore women's perceptions of maternity care using an adapted version of the WHO Community Survey Tool for measuring how women are treated during facility-based childbirth. Multivariate logistic regression models evaluated the associations between sociodemographic characteristics, obstetric information, and measurements of childbirth experiences and women's perceptions of receiving respectful and satisfactory care. RESULTS The responses of 981 women were included in the analysis. While the majority of women perceived the care they received as both respectful (86.54%) and satisfactory (80.22%), almost 3 in 4 women (72.68%) reported experiencing at least one type of disrespectful care. Positive communication with the medical staff and respect for autonomy were associated with a more positive birth experience for women. Women were more likely to perceive their care as respectful if they did not feel ignored (AOR = 40.11;22.87-70.34). Perception of satisfactory care was more likely among women who had the opportunity to discuss preferences with the medical staff (AOR = 10.15; 6.93-14.86). Having Covid-19 procedures explained increased the likelihood of reporting respectful and satisfactory care (AOR = 2.89;1.91-4.36; AOR = 2.83;2.01-4). CONCLUSION Understanding which care practices are associated with women's perceptions of care at facility-based births is critical to ensuring quality care. The findings of this study can inform future work and research aimed at enhancing respectful maternity care during times of crisis and beyond.
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Affiliation(s)
- Hagar Palgi-Hacker
- Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C, 20052, USA.
| | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St, E8011, Baltimore, MD, 21205, USA
| | - Megan Landry
- Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C, 20052, USA
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Manalai P, Ansari N, Tappis H, Kim YM, Stekelenburg J, van Roosmalen J, Currie S. Women's experience of childbirth care in health facilities: a qualitative assessment of respectful maternity care in Afghanistan. BMC Pregnancy Childbirth 2024; 24:48. [PMID: 38200450 PMCID: PMC10777596 DOI: 10.1186/s12884-023-06234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Respectful maternity care (RMC) remains a key challenge in Afghanistan, despite progress on improving maternal and newborn health during 2001-2021. A qualitative study was conducted in 2018 to provide evidence on the situation of RMC in health facilities in Afghanistan. The results are useful to inform strategies to provide RMC in Afghanistan in spite of the humanitarian crisis due to Taliban's takeover in 2021. METHODS Focus group discussions were conducted with women (4 groups, 43 women) who had used health facilities for giving birth and with providers (4 groups, 21 providers) who worked in these health facilities. Twenty key informant interviews were conducted with health managers and health policy makers. Motivators for, deterrents from using, awareness about and experiences of maternity care in health facilities were explored. RESULTS Women gave birth in facilities for availability of maternity care and skilled providers, while various verbal and physical forms of mistreatment were identified as deterrents from facility use by women, providers and key informants. Low awareness, lack of resources and excessive workload were identified among the reasons for violation of RMC. CONCLUSION Violation of RMC is unacceptable. Awareness of women and providers about the rights of women to respectful maternity care, training of providers on the subject, monitoring of care to prevent mistreatment, and conditioning any future technical and financial assistance to commitments to RMC is recommended.
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Affiliation(s)
| | | | - Hannah Tappis
- Jhpiego - Johns Hopkins University Affiliate, Baltimore, USA
| | - Young Mi Kim
- Jhpiego - Johns Hopkins University Affiliate, Baltimore, USA
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen, Groningen, Netherlands
| | | | - Sheena Currie
- Jhpiego - Johns Hopkins University Affiliate, Baltimore, USA
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Rezaei G, SadeghzadehMaharluie M, Ebrahimi M, Ebrahimi M. Assessing midwifery services in Iran via the balanced scorecard framework. Health Policy Plan 2024; 39:32-43. [PMID: 37952095 PMCID: PMC10775216 DOI: 10.1093/heapol/czad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
This study investigates the impact of intra-organizational information, midwife job satisfaction and performance assessment on the quality of midwife services. The questions are empirically tested with survey data obtained from 276 midwives, specialist doctors and nurses, and mothers who recently gave birth in a cross-section of Iranian public healthcare organizations. The results from a structural equation model suggest that an improved performance assessment system leads to higher quality midwife services. In addition, the results indicate that midwife job satisfaction and intra-organizational information increases the quality of midwife services, both directly and indirectly, through the mediating effect of a performance assessment system. Our study contributes to the growing research exploring the interface between accounting and health issues by recognizing the importance of a performance assessment system of midwifery services via the balanced scorecard framework for understanding the quality of midwife services.
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Affiliation(s)
- GholamReza Rezaei
- Department of Accounting, Faculty of Management and Economics, University of Sistan and Baluchestan, Zahedan, Sistan and Baluchestan Province 98167-45845, Iran
| | - Mohammad SadeghzadehMaharluie
- Department of Accounting, Faculty of Economics, Management and Social Sciences, Shiraz University, Shiraz, Fars 71946-84334, Iran
| | - Maedeh Ebrahimi
- Department of MBA, Apadana Institute of Higher Education, Shiraz, Fars 71946-44635, Iran
| | - Marziyeh Ebrahimi
- Bachelor Student of Midwifery, Islamic Azad University, Arsanjan Branch, Arsanjan, Fars 71946-44635, Iran
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de Oliveira Paes LB, Fabbro MRC, de Oliveira Toso BRG, de Castro Bussadori JC, Ruiz MT, Salim NR, Wernet M, Silveira AO, de Abreu D Agostini FCP. Factors intervening in the childbirth experience: a mixed-methods study. BMC Pregnancy Childbirth 2024; 24:14. [PMID: 38166863 PMCID: PMC10759435 DOI: 10.1186/s12884-023-06175-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To analyze the childbirth experience focusing on the intervening factors and on the delivery method. METHOD A sequential and explanatory mixed-methods study guided by the World Health Organization document for positive childbirth experiences. The participants were puerperal women in a maternity teaching hospital from inland São Paulo (Brazil). The first quantitative stage involved descriptive analysis with Poisson regression of 265 answers to the "Termômetro da Iniciativa Hospital Amigo da Mulher e da Criança" ("Women- and Baby-Friendly Hospital Initiative Thermometer") questionnaire. The second stage, qualitative, thematically analyzed the interviews conducted with 44 puerperal women who took part in the first stage. Data integration was by connection. THE RESULTS AND DISCUSSION The analysis by connection showed that among the factors that restricted the positive experience, C-section was predominant (61.9%), understood as an option due to fear of pain, the treatment modality and previous traumas. Restrictions referring to the presence of a companion (99.6%), not having privacy (83%), disrespectful situations (69.5%), too many touches (56.9%) and the absence of skin-to-skin contact (55%), among others, potentiated fear, loneliness, concern, shame, the perception of disrespect and insecurity with the assistance provided. The promoting factors were as follows: choosing the companion (95.4%) for collaborating in the safety perception, not having infections (83.9%), having continuous team monitoring (82.2%) and pain relief methods (78.9%), which were valued by the women. CONCLUSION The intervening factors that promoted positive experiences were related to clinical and protocol-related issues and to service availability. The restrictive factors were associated with excess interventions, deprivation of rights and of choice, absence of privacy and restriction referring to the presence of a companion. Women with a normal postpartum period felt more insecure and disrespected when compared to those subjected to C-sections, whose choices were considered, although they had lower prevalence of skin-to-skin contact. There is an urgent need to apprehend women's experiences and turn them into actions that guarantee their lives in a safe and respectful way.
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Affiliation(s)
| | | | | | | | | | - Natália Rejane Salim
- Federal University of Sao Carlos, São Carlos, SP, 13565-905, Rod. Washington Luís, s/n, Brazil
| | - Monika Wernet
- Federal University of Sao Carlos, São Carlos, SP, 13565-905, Rod. Washington Luís, s/n, Brazil
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Sheikh J, Allotey J, Kew T, Khalil H, Galadanci H, Hofmeyr GJ, Abalos E, Vogel JP, Lavin T, Souza JP, Kaur I, Ram U, Betran AP, Bohren MA, Oladapo OT, Thangaratinam S. Vulnerabilities and reparative strategies during pregnancy, childbirth, and the postpartum period: moving from rhetoric to action. EClinicalMedicine 2024; 67:102264. [PMID: 38314056 PMCID: PMC10837549 DOI: 10.1016/j.eclinm.2023.102264] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 02/06/2024] Open
Abstract
Maternal outcomes throughout pregnancy, childbirth, and the postnatal period are influenced by interlinked and interdependent vulnerabilities. A comprehensive understanding of how various threats and barriers affect maternal and perinatal health is critical to plan, evaluate and improve maternal health programmes. This paper builds on the introductory paper of the Series on the determinants of maternal health by assessing vulnerabilities during pregnancy, childbirth, and the postnatal period. We synthesise and present the concept of vulnerability in pregnancy and childbirth, and map vulnerability attributes and their dynamic influence on maternal outcomes in early and late pregnancy and during childbirth and the postnatal period, with a particular focus on low-income and middle-income countries (LMICs). We summarise existing literature and present the evidence on the effects of various reparative strategies to improve pregnancy and childbirth outcomes. Lastly, we discuss the implications of the identified vulnerability attributes and reparative strategies for the efforts of policymakers, healthcare professionals, and researchers working towards improving outcomes for women and birthing people in LMICs.
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Affiliation(s)
- Jameela Sheikh
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John Allotey
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Tania Kew
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Halimah Khalil
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
- University of the Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- BIREME, Evidence and Intelligence for Action in Health Department, Pan America Health Organization/World Health Organization, São Paulo, Brazil
| | - Inderjeet Kaur
- Fernandez Hospital Educational & Research Foundation, Hyderabad, India
| | - Uma Ram
- Seethapathy Clinic & Hospital, Chennai, India
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
- Birmingham Women’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
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82
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Bohren MA, Iyer A, Barros AJ, Williams CR, Hazfiarini A, Arroyave L, Filippi V, Chamberlain C, Kabakian-Khasholian T, Mayra K, Gill R, Vogel JP, Chou D, George AS, Oladapo OT. Towards a better tomorrow: addressing intersectional gender power relations to eradicate inequities in maternal health. EClinicalMedicine 2024; 67:102180. [PMID: 38314054 PMCID: PMC10837533 DOI: 10.1016/j.eclinm.2023.102180] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 02/06/2024] Open
Abstract
An equity lens to maternal health has typically focused on assessing the differences in coverage and use of healthcare services and critical interventions. While this approach is important, we argue that healthcare experiences, dignity, rights, justice, and well-being are fundamental components of high quality and person-centred maternal healthcare that must also be considered. Looking at differences across one dimension alone does not reflect how fundamental drivers of maternal health inequities-including racism, ethnic or caste-based discrimination, and gendered power relations-operate. In this paper, we describe how using an intersectionality approach to maternal health can illuminate how power and privilege (and conversely oppression and exclusion) intersect and drive inequities. We present an intersectionality-informed analysis on antenatal care quality to illustrate the advantages of this approach, and what is lost in its absence. We reviewed and mapped equity-informed interventions in maternal health to existing literature to identify opportunities for improvement and areas for innovation. The gaps and opportunities identified were then synthesised to propose recommendations on how to apply an intersectionality lens to maternal health research, programmes, and policies.
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Affiliation(s)
- Meghan A. Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Aditi Iyer
- Ramalingaswami Centre on Equity & Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Aluisio J.D. Barros
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Caitlin R. Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS-Argentina), Buenos Aires, Argentina
| | - Alya Hazfiarini
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Luisa Arroyave
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Veronique Filippi
- London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Kaveri Mayra
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Roopan Gill
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada
- Vitala Global Foundation, Vancouver, British Columbia, Canada
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Doris Chou
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Asha S. George
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Western Cape, South Africa
- South African Medical Research Council, South Africa
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Cantor AG, Jungbauer RM, Skelly AC, Hart EL, Jorda K, Davis-O'Reilly C, Caughey AB, Tilden EL. Respectful Maternity Care : A Systematic Review. Ann Intern Med 2024; 177:50-64. [PMID: 38163377 DOI: 10.7326/m23-2676] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Severe maternal morbidity and mortality are worse in the United States than in all similar countries, with the greatest effect on Black women. Emerging research suggests that disrespectful care during childbirth contributes to this problem. PURPOSE To conduct a systematic review on definitions and valid measurements of respectful maternity care (RMC), its effectiveness for improving maternal and infant health outcomes for those who are pregnant and postpartum, and strategies for implementation. DATA SOURCES Systematic searches of Ovid Medline, CINAHL, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, and SocINDEX for English-language studies (inception to July 2023). STUDY SELECTION Randomized controlled trials and nonrandomized studies of interventions of RMC versus usual care for effectiveness studies; additional qualitative and noncomparative validation studies for definitions and measurement studies. DATA EXTRACTION Dual data abstraction and quality assessment using established methods, with resolution of disagreements through consensus. DATA SYNTHESIS Thirty-seven studies were included across all questions, of which 1 provided insufficient evidence on the effectiveness of RMC to improve maternal outcomes and none studied RMC to improve infant outcomes. To define RMC, authors identified 12 RMC frameworks, from which 2 main concepts were identified: disrespect and abuse and rights-based frameworks. Disrespect and abuse components focused on recognizing birth mistreatment; rights-based frameworks incorporated aspects of reproductive justice, human rights, and antiracism. Five overlapping framework themes include freedom from abuse, consent, privacy, dignity, communication, safety, and justice. Twelve tools to measure RMC were validated in 24 studies on content validity, construct validity, and internal consistency, but lack of a gold standard limited evaluation of criterion validity. Three tools specific for RMC had at least 1 study demonstrating consistency internally and with an intended construct relevant to U.S. settings, but no single tool stands out as the best measure of RMC. LIMITATIONS No studies evaluated other health outcomes or RMC implementation strategies. The lack of definition and gold standard limit evaluation of RMC tools. CONCLUSION Frameworks for RMC are well described but vary in their definitions. Tools to measure RMC demonstrate consistency but lack a gold standard, requiring further evaluation before implementation in U.S. settings. Evidence is lacking on the effectiveness of implementing RMC to improve any maternal or infant health outcome. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality. (PROSPERO: CRD42023394769).
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Affiliation(s)
- Amy G Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology; Department of Family Medicine; and Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.G.C.)
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., E.L.H., C.D.)
| | - Andrea C Skelly
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, and Aggregate Analytics, Fircrest, Washington (A.C.S.)
| | - Erica L Hart
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., E.L.H., C.D.)
| | - Katherine Jorda
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (K.J., A.B.C.)
| | - Cynthia Davis-O'Reilly
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., E.L.H., C.D.)
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (K.J., A.B.C.)
| | - Ellen L Tilden
- Department of Obstetrics and Gynecology and School of Nursing, Oregon Health & Science University, Portland, Oregon (E.L.T.)
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84
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Tumwine G, Östergren PO, Gummesson C, Agardh A. Assessing the effectiveness of a sexual and reproductive health and rights training programme in changing healthcare practitioners' attitudes and practices in low-income countries. Glob Health Action 2023; 16:2230814. [PMID: 37459238 PMCID: PMC10353321 DOI: 10.1080/16549716.2023.2230814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/25/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION In low-income countries the utilisation of sexual and reproductive health and rights (SRHR) services is influenced by healthcare practitioners' knowledge, attitudes and practices. Despite awareness of the potential problems due to ingrained biases and prejudices, few approaches have been effective in changing practitioners' knowledge, attitudes and practices concerning SRHR in low-income countries. OBJECTIVES 1) To assess whether participating in an SRHR international training programme (ITP) changed healthcare practitioners' SRHR knowledge, SRHR attitudes and SRHR practices and 2) examine associations between trainees' characteristics, their SRHR work environment and transfer of training. METHODS A pre- and post-intervention study, involving 107 trainees from ten low-income countries, was conducted between 2017 and 2018. Paired samples t-test and independent samples t-test were used to assess differences between trainees' pre- and post-training scores in self-rated SRHR knowledge, attitudes, knowledge seeking behaviour and practices. Linear regression models were used to examine association between trainees' baseline characteristics and post-training attitudes and practices. RESULTS Trainees' self-rated scores for SRHR knowledge, attitudes and practices showed statistically significant improvement. Baseline high SRHR knowledge was positively associated with improvements in attitudes but not practices. High increases in scores on knowledge seeking behaviour were associated with higher practice scores. No statistically significant associations were found between scores that measured changes in SRHR knowledge, attitudes and practices. CONCLUSION The findings indicate that the ITP was effective in improving trainees' self-rated scores for SRHR knowledge, attitudes and behaviours (practices). The strongest association was found between improvement in SRHR knowledge seeking behaviour and the improvement in SRHR practices. This suggests that behaviour intention may have a central role in promoting fair open-minded SRHR practices among healthcare practitioners in low-income countries.
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Affiliation(s)
- Gilbert Tumwine
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden
- Obstetrics and Gynecology Department, St. Francis Hospital Nsambya, Kampala, Uganda
| | - Per-Olof Östergren
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden
| | | | - Anette Agardh
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden
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Ray S, Mudokwenyu-Rawdon C, Bonduelle M, Iliff G, Maposhere C, Mataure P, Jacobs C, Van Schalkwyk SC. Hearing the voices of midwives through reflective writing journals: Qualitative research on an educational intervention for Respectful Maternity Care in Zimbabwe. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002008. [PMID: 38134000 PMCID: PMC10745140 DOI: 10.1371/journal.pgph.0002008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 11/19/2023] [Indexed: 12/24/2023]
Abstract
Women attending public and private sector health facilities in Africa have reported abuse and neglect during childbirth, which carries a risk of poor health outcomes. We explored from the midwives' perspective the influence of an educational intervention in changing the attitudes, behaviour and practices of a group of midwives in Zimbabwe, using transformative learning theory as the conceptual framework. The twelve-week educational intervention motivating for Respectful Maternity Care consisted of a two-day workshop and five follow-up sessions every two weeks. Thematic analysis was conducted on eighteen reflective journals written by the midwives with member-checking during follow-up discussions and a further one-day participative workshop a year later. The midwives reported being more women-centred, with involvement of birth companions and use of different labour positions, stronger professional pride and agency, collaborative decision-making and less hierarchical relationships which persisted over the year. Their journal narratives included examples of treating birthing women with more compassion. Some categories aligned with the phases of transformative learning theory (self-examination of prior experience, building of competence and self-confidence into new roles and relationships). Others related to improving communications and effective teamwork, providing role-models of good behaviour, use of scientific knowledge to inform practice and demonstrating competence in management of complex cases. This study shows that innovative educational initiatives have the potential to change the way midwives work together, even in challenging physical environments, leading to a shared vision for the quality of service they want to provide, to improve health outcomes and to develop life-long learning skills.
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Affiliation(s)
- Sunanda Ray
- Department of Community Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Myriam Bonduelle
- Swansea Bay University Health Board, Swansea, Wales, United Kingdom
| | - Ginny Iliff
- Private obstetric practice, Harare, Zimbabwe
| | | | - Priscilla Mataure
- Department of Family and Health Sciences, Women’s University in Africa, Harare, Zimbabwe
| | - Cecilia Jacobs
- Faculty of Medicine and Health Sciences, Centre for Health Professions Education, Stellenbosch University, Stellenbosch, South Africa
| | - Susan C. Van Schalkwyk
- Faculty of Medicine and Health Sciences, Centre for Health Professions Education, Stellenbosch University, Stellenbosch, South Africa
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Avan BI, Hameed W, Khan B, Asim M, Saleem S, Siddiqi S. Understanding the Mechanisms of Change in the Supportive and Respectful Maternity Care Intervention in Sindh, Pakistan: Provider Perspectives. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300216. [PMID: 38050091 PMCID: PMC10749650 DOI: 10.9745/ghsp-d-23-00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/24/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION We conducted this qualitative investigation to explore the mechanisms of change in providing respectful care resulting from the supportive and respectful maternity care intervention (S-RMC) in Sindh, Pakistan. METHODS We applied the principles of realist evaluation methodology with a descriptive explanatory research design. We conducted in-depth interviews with 36 maternity care providers at secondary-level public health facilities where S-RMC was implemented for 6 months. The S-RMC broad components included capacity-building of maternity teams and systemic changes for improvements in governance and accountability within public health facilities. Data were analyzed using a deductive content analysis approach. RESULTS We identified mechanisms of change, categorized by the S-RMC components: (1) S-RMC training: insight into women's feelings and rights, realization of the value that nonclinical staff can play, understanding of team coordination, orientation in psychosocial components of maternity care; (2) assessment of women's psychosocial vulnerabilities: identification of women's differential needs beyond routine care to provide woman-centered care; (3) psychosocial support: effective engagement with women and within maternity teams and the customization of woman- and companion-focused care; (4) care coordination: improved coordination among clinical and nonclinical staff to provide personalized care and psychosocial support and proper handover to ensure continuity of care; (5) assessment of quality of care: identification of service gaps from women's feedback; and (6) performance review and accountability: monthly performance review meetings to establish team member communication, systematic awareness of the maternity team's performance and challenges, and implementation of collective corrective actions. CONCLUSION Our findings pointed to S-RMC working along multiple pathways-and concertedly with various health system components-to enable positive processes and behavioral change in maternity teams.
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Affiliation(s)
- Bilal Iqbal Avan
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Pakistan
| | - Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Corsi Decenti E, Salvatore MA, Mandolini D, Sampaolo L, D'Aloja P, Donati S. Perinatal care in SARS-CoV-2 infected women: the lesson learnt from a national prospective cohort study during the pandemic in Italy. BMC Public Health 2023; 23:2562. [PMID: 38129838 PMCID: PMC10740257 DOI: 10.1186/s12889-023-17390-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Despite the growing importance given to ensuring high-quality childbirth, perinatal good practices have been rapidly disrupted by SARS-CoV-2 pandemic. This study aimed at describing the childbirth care provided to infected women during two years of COVID-19 emergency in Italy. METHODS A prospective cohort study enrolling all women who gave birth with a confirmed SARS-CoV-2 infection within 7 days from hospital admission in the 218 maternity units active in Italy during the periods February 25, 2020-June 30, 2021, and January 1-May 31, 2022. Perinatal care was assessed by evaluating the prevalence of the following indicators during the pandemic: presence of a labour companion; skin-to-skin; no mother-child separation at birth; rooming-in; breastfeeding. Logistic regression models including women' socio-demographic, obstetric and medical characteristics, were used to assess the association between the adherence to perinatal practices and different pandemic phases. RESULTS During the study period, 5,360 SARS-CoV-2 positive women were enrolled. Overall, among those who had a vaginal delivery (n = 3,574; 66.8%), 37.5% had a labour companion, 70.5% of newborns were not separated from their mothers at birth, 88.1% were roomed-in, and 88.0% breastfed. These four indicators showed similar variations in the study period with a negative peak between September 2020 and January 2021 and a gradual increase during the Alpha and Omicron waves. Skin-to-skin (mean value 66.2%) had its lowest level at the beginning of the pandemic and gradually increased throughout the study period. Among women who had a caesarean section (n = 1,777; 33.2%), all the indicators showed notably worse outcomes with similar variations in the study period. Multiple logistic regression analyses confirm the observed variations during the pandemic and show a lower adherence to good practices in southern regions and in maternity units with a higher annual number of births. CONCLUSIONS Despite the rising trend in the studied indicators, we observed concerning substandard childbirth care during the SARS-CoV-2 pandemic. Continued efforts are necessary to underscore the significance of the experience of care as a vital component in enhancing the quality of family-centred care policies.
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Affiliation(s)
- Edoardo Corsi Decenti
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Michele Antonio Salvatore
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Donatella Mandolini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Letizia Sampaolo
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Paola D'Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
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Uwamahoro V, Semasaka JPS, Ndagijimana A, Humuza J. Perceptions and attitudes of midwives on respectful maternity care during childbirth: a qualitative study in three district hospitals of Kigali City of Rwanda. Pan Afr Med J 2023; 46:110. [PMID: 38435405 PMCID: PMC10908299 DOI: 10.11604/pamj.2023.46.110.40764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/15/2023] [Indexed: 03/05/2024] Open
Abstract
Introduction Respectful Maternity Care (RMC) is "a universal human right for every childbearing woman". In Rwanda, few studies conducted on RMC assessed how women perceive care provided during childbirth, yet little is known about providers' perspectives. We investigated the perceptions and attitudes of midwives towards the provision of RMC to complement women's viewpoints. Methods this qualitative study used individual in-depth interviews in Kinyarwanda language. A purposive sampling method was used to reach out to twenty-eight midwives from three district hospitals in Kigali City. Transcribed interviews were translated into English and thematic content analysis was performed using Atlas Ti, version 7. The University of Rwanda College of Medicine and Health Sciences Institutional Review Board (Ref: 363/CHMS/IRB/2019) ethically approved this study before data collection. Results the majority of participants revealed that they have knowledge on RMC and perceive that they provide maternal health care based on women´s rights. Positive attitudes towards providing RMC were reported by midwives, however, a considerable number of participants reported the existence of abusive practices. The majority of midwives reported facing many challenges affecting their ability to provide respectful maternal care. Conclusion midwives understand the seven rights of women and have a positive attitude towards providing RMC. However, abusive practices still exist while providing RMC with considerable challenges, including overload and lack of labour monitoring materials. The adjustment of the ratio of midwives to clients and the availability of essential materials in labour monitoring is recommended to improve the quality of healthcare received by women during childbirth.
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Affiliation(s)
- Valentine Uwamahoro
- University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
| | - Jean Paul Sengoma Semasaka
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Faculty of Medicine, Umeå, Sweden
| | - Albert Ndagijimana
- University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
| | - James Humuza
- University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
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Kajjoune I, de Brouwere V, Manoussi A, Elomrani S, Assarag B. L'expérience de l'accouchement en milieu surveillé dans la province d'Essaouira au Maroc: Quelle réalité? Sex Reprod Health Matters 2023; 31:2272712. [PMID: 38088854 PMCID: PMC11078118 DOI: 10.1080/26410397.2023.2272712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
RésuméUne expérience positive de l'accouchement (EPA) est fondamentale pour des soins maternels de qualité. Toutefois, de nombreuses femmes subissent des comportements non respectueux lors de ce moment crucial. Au Maroc, peu d'études ont mesuré cette expérience, et les éléments l'influençant demeurent insuffisamment documentés. Nous avons conduit une recherche mixte dans la province d'Essaouira entre avril et décembre 2021. Notre enquête, basée sur un questionnaire, a sollicité l'avis de 240 femmes issues de huit centres de santé choisis au hasard. Par ailleurs, des entretiens semi-directifs ont été conduits avec 20 femmes, 47 professionnels de santé et quatre responsables administratifs. Les données quantitatives ont été soumises à des analyses descriptives, bi- et multivariées, tandis que les entretiens ont été analysés selon une approche de contenu thématique. Les données révèlent que 59.2% des participantes ont eu une expérience défavorable lors de leur dernier accouchement. Parmi elles, la majorité a déploré des soins non consentis (86.7%), un manque de respect de leur intimité (45.4%) et des abus verbaux (25%). L'EPA était principalement associée à la qualité de l'environnement de l'accouchement, au soutien pour l'allaitement, à la propreté des installations, au type d'établissement (privé) et à l'absence de complications médicales pendant le travail. Les entretiens ont révélé que le manque de motivation des professionnels de santé, l'absence de formation continue appropriée et des lacunes organisationnelles et managériales ont affecté l'EPA. Notre étude souligne le besoin crucial de formation continue axée sur le respect des patients, l'éthique et la déontologie, et met en lumière l'importance d'une politique motivante pour les professionnels de santé, notamment dans le secteur public.
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Affiliation(s)
- Imane Kajjoune
- Lauréate, École Nationale de Santé Publique, Rabat, Maroc. Correspondence:
- Chef du Service du réseau des Etablissements de Santé à la Délégation Provinciale de Rhamna, Ministère de la Santé et de la Protection Sociale, Rabat, Morocco
| | - Vincent de Brouwere
- Professeur émérite, Institute of Tropical Medicine, Antwerp, Belgium
- Professeur associé, École Internationale de Santé Publique, Université Mohamed VI des Sciences de la Santé, Casablanca, Maroc
- Visitng Professor, School of Tropical Medicine & Global Health, University of Nagasaki, Nagasaki, Japon
| | - Abdelmounaim Manoussi
- Doctorant, Université Cadi Ayyad, Faculté des sciences Semlalia, Département de biologie, Marrakech, Maroc
| | - Sanae Elomrani
- Doctorante, École Nationale de Santé Publique, Rabat, Maroc
| | - Bouchra Assarag
- Chercheure en DSSR, Directrice Adjoint chargée des études, École Nationale de Santé Publique, Rabat, Maroc
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van der Waal R, van Nistelrooij I, Leget C. The Undercommons of Childbirth and Their Abolitionist Ethic of Care. A Study into Obstetric Violence Among Mothers, Midwives (in Training), and Doulas. Violence Against Women 2023:10778012231205591. [PMID: 38055959 DOI: 10.1177/10778012231205591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Engaging in dialogue with critical mothers, midwives, midwives in training, and doulas in the Netherlands, this study furthers the theoretical understanding of both obstetric violence and the activist resistance against it. Obstetric violence is understood as part of a process of relational separation, leaving the pregnant person isolated. The activist resistance against it is consequently theorized as the abolitionist building of an alternative "otherworld" of radical relational care. The themes established are: (1) "institutionalized separation" with the subtheme's "expropriation," "carcerality," and "obstetric violence;" and (2) "undercommoning childbirth" with subthemes "fugitive planning," "anarchic relationality," and "obstetric abolition."
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Affiliation(s)
| | | | - Carlo Leget
- University for Humanistic Studies, Utrecht, The Netherlands
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Mrayan L, Abuidhail J, Abujilban S, Al-Modallal H. Exploring Jordanian mothers' experiences of childbirth. Midwifery 2023; 127:103859. [PMID: 37931459 DOI: 10.1016/j.midw.2023.103859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/19/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
AIM To explore the experiences of Jordanian mothers who gave birth in three public hospitals. DESIGN A descriptive qualitative research design was used. METHODS Purposive sampling was used to choose the study participants. Semi-structured one-to-one in-depth interviews were conducted with twenty postpartum mothers who had recently given birth at three public hospitals and agreed to participate in the study. Thematic content analysis (TCA) was used to analyze the data and to identify the main themes. FINDINGS Three major themes were generated from the data collected: (1) Mothers' experiences of dehumanization and lack of dignity during childbirth; (2) Mothers' experiences of lack of privacy during childbirth; (3) Childbirth practices. CONCLUSION AND IMPLICATIONS This study explored the childbirth experiences of Jordanian mothers. This study found that the childbirth experience of mothers under study was not satisfactory. Many outdated childbirth practices are still widely used by healthcare providers. The results of this study should be an alarm to review on the quality of the maternal care services in Jordan hospitals.
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Affiliation(s)
- L Mrayan
- Department of Maternal, Child and Family Health Nursing, School of Nursing, The Hashemite University, Zarqa 13115, Jordan.
| | - J Abuidhail
- Department of Maternal, Child and Family Health Nursing, School of Nursing, The Hashemite University, Zarqa 13115, Jordan
| | - S Abujilban
- Department of Maternal, Child and Family Health Nursing, School of Nursing, The Hashemite University, Zarqa 13115, Jordan
| | - H Al-Modallal
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Rubashkin N. Epistemic Silences and Experiential Knowledge in Decisions After a First Cesarean: The case of a vaginal birth after cesarean calculator. Med Anthropol Q 2023; 37:341-353. [PMID: 37459454 PMCID: PMC10993819 DOI: 10.1111/maq.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 05/01/2023] [Indexed: 12/02/2023]
Abstract
Evidence-based obstetrics can employ statistical models to justify greater use of cesareans, sometimes excluding experiential elements from informed decision making. Over the past decade, prenatal providers adopted a vaginal birth after cesarean (VBAC) calculator designed to support patients in making informed decisions about their births by estimating their probability for a VBAC. Among other factors, the calculator used race and ethnicity to make its estimate, assigning lower probabilities for a successful VBAC to Black and Hispanic patients. I analyze how a diverse group of women and their providers engaged with the VBAC calculator. Some providers used low calculator scores to remove a shared decision-making model by prescriptively counseling Black and Hispanic women who desired a VBAC into undergoing repeat cesareans. Consequently, women racialized by the calculator as Black or Hispanic used experiential knowledge to challenge the calculator's assessment of their supposed lesser ability to give birth vaginally.
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Affiliation(s)
- Nicholas Rubashkin
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California at San Francisco, San Francisco, United States
- Institute for Global Health Sciences, University of California at San Francisco, San Francisco, United States
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93
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Garcia LM. Obstetric violence in the United States and other high-income countries: an integrative review. Sex Reprod Health Matters 2023; 31:2322194. [PMID: 38590127 PMCID: PMC11005882 DOI: 10.1080/26410397.2024.2322194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Obstetric violence has been documented throughout the world, yet this human rights issue has mostly been investigated in middle- and low-income countries where the intensity and brutality of abuse and mistreatment is more easily recognised as problematic. This integrative review aimed to analyse sources about obstetric violence in high-income countries with the objective of identifying gaps in the research, challenges to the study of obstetric violence, and solutions to framing research that meets those challenges. A systematic search was conducted using the PubMed and CINAHL databases from February to June 2022. Empirical and non-empirical sources, published in English, with no date restrictions, were retrieved. Citation searching was also done. Forty-six sources were included. Identified gaps in the research were: (a) scarce attention to obstetric violence in most high-income countries; (b) most US sources are non-scientific and from outside the healthcare disciplines; (c) inconsistencies in terminology; (d) most studies were conducted with samples of women who had given birth, with scant research about healthcare providers and obstetric violence, and (e) the association between obstetric violence and traumatic birth was under-recognised. Identified challenges to the study of obstetric violence were: (1) factors that enable and perpetuate obstetric violence are multilevel and nonlinear; (2) the phenomenon is contextually complex; and (3) blind spots from routinised harmful practices and normalised mistreatment can prevent healthcare providers and birthing people from recognising obstetric violence. A systems approach and complexity theory are guiding frameworks recommended as solutions to the challenges of studying and correcting obstetric violence.
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Rost M, Stuerner Z, Niles P, Arnold L. Between "a lot of room for it" and "it doesn't exist"-Advancing and limiting factors of autonomy in birth as perceived by perinatal care practitioners: An interview study in Switzerland. Birth 2023; 50:1068-1080. [PMID: 37593797 DOI: 10.1111/birt.12757] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Numerous studies show that negative birth experiences are often related to birthing people's loss of autonomy. We argue that a fetal-focused decision-making framework and a maternal-fetal conflict lens are often applied, creating a false dichotomy between autonomy and fetal beneficence. Given the high prevalence of autonomy-depriving decision-making, it is important to understand how autonomy can be enhanced. METHODS We interviewed 15 Swiss perinatal care practitioners (eight midwives, five physicians, and two doulas) and employed reflexive thematic analysis. We offer a reflection on underlying assumptions and researcher positionality. RESULTS We generated two descriptive themes: advancing and limiting factors of autonomy. Numerous subthemes, grouped at the levels of companion, birthing person, practitioners, birthing person-practitioner relationship, and structural determinants are also defined. The most salient advancing factors were practitioners' approaches to decision-making, antenatal contacts, and structural determinants. The most salient limiting factors were various barriers within birthing people (e.g., expertise, decisional capacity, and awareness of own rights), practitioners' attitudes and behavior, and structural determinants. DISCUSSION The actualization of autonomy is multifactorially determined and must be understood against the background of power structures both underlying and inherent to decision-making in birth. Practitioners attributed a significant proportion of limited autonomy to birthing people themselves. This reinforces a "mother-blame" narrative that absolves obstetrics of primary responsibility. Practitioners' recognition of their contributions to upholding limits on autonomy should be leveraged to implement training towards rights-based practice standards. Most importantly, autonomy can only fully materialize if the underlying sociocultural, political, and medical contexts undergo a fundamental change.
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Affiliation(s)
- Michael Rost
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Zelda Stuerner
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Paulomi Niles
- Rory Meyers College of Nursing, New York University, New York, USA
| | - Louisa Arnold
- Institute of Psychology, Friedrich-Schiller University Jena, Jena, Germany
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Burnett-Zieman B, Warren CE, Chiundira F, Mandala E, Kachale F, Mchoma CH, Mboma A, Kamanga M, Kazembe A. Modeling Pathways to Describe How Maternal Health Care Providers' Mental Health Influences the Provision of Respectful Maternity Care in Malawi. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300008. [PMID: 38035724 PMCID: PMC10698235 DOI: 10.9745/ghsp-d-23-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/17/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Maternal health (MH) providers may experience traumatic events, such as maternal or fetal death, that can contribute to stress and burnout. Past trauma, poor working relationships, and under-resourced environments not only affect providers' own emotional well-being but also reduce their ability to provide respectful maternity care (RMC). METHODS Data were collected in mid-2021 as a cross-sectional survey with 302 MH providers working in 25 maternities in 3 districts in Malawi to measure burnout, depression, and post-traumatic stress disorder (PTSD). We present a pathway model describing how these factors interact and influence RMC. We used the provider-reported person-centered maternity care scale to measure RMC; the Maslach Burnout Inventory, which examines emotional exhaustion, depersonalization, and professional accomplishment; and standard validated screening tools to measure the prevalence of depression and PTSD. RESULTS Although levels of burnout varied, 30% of MH providers reported high levels of exhaustion, feelings of cynicism manifesting as depersonalization toward their clients (17%), and low levels of professional accomplishment (42%). Moderate to severe depression (9%) and suicidal ideation within the past 2 weeks (10%) were also recorded. Many (70%) reported experiencing an event that could trigger PTSD, and 12% reported at least 4 of 5 symptoms in the PTSD scale. Path analysis suggests that depression and emotional exhaustion negatively influence RMC, and depersonalization is mediated through depression. PTSD has no direct effect on RMC, but increased PTSD scores were associated with increased burnout and depression scores. Positive relationships with facility managers were significantly associated with increased RMC and decreased emotional exhaustion and depersonalization. CONCLUSION Burnout will continue to be a challenge among MH providers. However, pragmatic approaches for improving teamwork, psychosocial, and managerial support for MH providers working in challenging environments may help mitigate burnout, improve MH provider well-being, and, in turn, RMC for women seeking MH services.
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Affiliation(s)
| | | | | | - Edina Mandala
- Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Fannie Kachale
- Reproductive Health Directorate, Ministry of Health, Lilongwe, Malawi
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Kalamar A, Oyedokun-Adebagbo F, Reichenbach L. Advancing Our Understanding of Provider Behavior Change for Improved Health Outcomes. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300314. [PMID: 38035717 PMCID: PMC10698230 DOI: 10.9745/ghsp-d-23-00314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/01/2023] [Indexed: 12/02/2023]
Abstract
The articles in this supplement highlight the need for strengthening the measure of provider behavior change and provide new evidence and tools for advancing our understanding of provider behavior and effective ways to ensure delivery of high-quality care that supports both clients and providers.
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97
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Usso AA, Adem HA, Alemu A, Mohammed A. Disrespect and abuse during childbirth in East Hararghe Zone public health facilities, eastern Ethiopia: a cross-sectional study. Front Glob Womens Health 2023; 4:1237098. [PMID: 38099270 PMCID: PMC10720435 DOI: 10.3389/fgwh.2023.1237098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/31/2023] [Indexed: 12/17/2023] Open
Abstract
Background Compassionate and respectful maternity care during childbirth has been identified as a potential strategy to prevent and reduce maternal mortality and morbidity. Despite its importance, there is a paucity of information on the level of disrespect and abuse meted out to mothers in eastern Ethiopia. This study assesses the level of disrespect and abuse suffered by women during childbirth, and the associated factors, in public health facilities in the rural East Hararghe Zone in eastern Ethiopia. Methods A cross-sectional study was conducted among 530 women who gave birth in 20 public health facilities in the East Hararghe Zone during the period between 1 April and 30 April 2020. Data were collected using a validated questionnaire. Bivariable and multivariable binary logistic regression analyses were employed to identify the factors associated with disrespect and abuse during childbirth. Adjusted odds ratio (AOR) (95% CI) was used to report this association, and statistical significance was set at P < 0.05. Results Overall, 77% (95% CI: 73%-81%) of women reported at least one type of disrespect and abuse during childbirth in the East Hararghe Zone public health facilities. In this study, factors such as households having an average monthly income of below 57.22 USD (AOR = 2.29, 95% CI: 1.41-3.71), mothers residing at more than 30 min away from a nearby health facility (AOR = 2.10, 95% CI: 1.30-3.39), those not receiving antenatal care (AOR = 4.29, 95% CI: 2.17-8.52), and those giving birth during nighttime (AOR = 2.16, 95% CI: 1.37-3.41) were associated with at least one type of disrespect and abuse during childbirth. Conclusion More than three in every four women who gave birth in the East Hararghe Zone public health facilities were disrespected and abused during childbirth. Encouraging all pregnant women to pay attention to antenatal care visits and improving the quality of healthcare service during nighttime in all health facilities will be essential for preventing and reducing disrespect and abuse and its negative consequences.
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Affiliation(s)
- Ahmedin Aliyi Usso
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hassen Abdi Adem
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Aminu Mohammed
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
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Vallely LH, Shalit A, Nguyen R, Althabe F, Pingray V, Bonet M, Armari E, Bohren M, Homer C, Vogel JP. Intrapartum care measures and indicators for monitoring the implementation of WHO recommendations for a positive childbirth experience: a scoping review. BMJ Open 2023; 13:e069081. [PMID: 37993161 PMCID: PMC10668293 DOI: 10.1136/bmjopen-2022-069081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/29/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE We aimed to identify all available studies describing measures or indicators used to monitor 41 intrapartum care practices described in the 2018 WHO intrapartum care recommendations, with a view to informing development of standardised measurement of implementing these recommendations. DESIGN Systematic scoping review. METHODS We conducted a scoping review to identify studies reporting measures of intrapartum care published between 1 January 2000 and 28 June 2021. Primary and secondary outcome measures included study characteristics (publication year, journal, country and World Bank classification) and intrapartum care measure characteristics (definition, numerator, denominator, measurement level and measurement approach). We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, the Maternity and Infant Care Database, Global Index Medicus and grey literature using structured search terms related to included recommendations, focusing on respectful and supportive care, and clinical practices performed throughout labour and birth. The measures identified were classified by the WHO recommendation and their characteristics reported. RESULTS We identified 150 studies which described 1331 intrapartum care measures. These measures corresponded to 35 of the 41 included WHO recommendations, and represented all domains of the WHO recommendations (care throughout labour and birth, first stage of labour, second stage of labour, third stage of labour). A total of 40.1% (534 of 1331 measures) of measures were related to respectful maternity care. Most studies used a questionnaire or survey measurement approach (522 of 1331 measures, 39.2%). CONCLUSION This scoping review presents a database of existing intrapartum care measures used to monitor the quality of intrapartum care globally. There is no clear consensus on a core set of measures for evaluating the practice of the WHO's intrapartum care recommendations. This review provides a foundation to support the development of a core set of internationally standardised intrapartum care measures for the WHO intrapartum care recommendations, highlighting key areas requiring consensus and validation, and measure development.
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Affiliation(s)
- Lauren Hannah Vallely
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anna Shalit
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renae Nguyen
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Fernando Althabe
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Verónica Pingray
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Elizabeth Armari
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Meghan Bohren
- Centre for Health Equity, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Caroline Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Joshua Peter Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ndwiga C, Abuya T, Okondo C, Akinyi S, Wickramanayake A, Warren CE. Effect of mentorship and a mHealth application in updating provider skills and knowledge in maternal and newborn care in two informal settlements of Nairobi. BMC Womens Health 2023; 23:580. [PMID: 37940919 PMCID: PMC10633915 DOI: 10.1186/s12905-023-02740-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Children and women in urban informal settlements have fewer choices to access quality maternal and newborn health care. Many facilities serving these communities are under-resourced and staffed by fewer providers with limited access to skills updates. We sought to increase provider capacity by equipping them with skills to provide general and emergency obstetric and newborn care in 24 facilities serving two informal settlements in Nairobi. We present evidence of the combined effect of mentorship using facility-based mentors who demonstrate skills, support skills drills training, and provide practical feedback to mentees and a self-guided online learning platform with easily accessible EmONC information on providers' smart phones. METHODS We used mixed methods research with before and after cross-sectional provider surveys conducted at baseline and end line. During end line, 18 in-depth interviews were conducted with mentors and mentees who were exposed, and providers not exposed to the intervention to explore effectiveness and experience of the intervention on quality maternal health services. RESULTS Results illustrated marked improvement from ability to identify antepartum hemorrhage (APH), postpartum hemorrhage (PPH), manage retained placenta, ability to identify and manage obstructed labour, Pre-Eclampsia and Eclampsia (PE/E), puerperal sepsis, and actions taken to manage conditions when they present. Overall, out of 95 elements examined there were statistically significant improvements of both individual scores and overall scores from 29/95 at baseline (30.5%) to 44.3/95 (46.6%) during end line representing a 16- percentage point increase (p > 0.001). These improvements were evident in public health facilities representing a 17.3% point increase (from 30.9% at baseline to 48.2% at end line, p > 0.001). Similarly, providers working in private facilities exhibited a 15.8% point increase in knowledge from 29.7% at baseline to 45.5% at end line (p = 0.0001). CONCLUSION This study adds to the literature on building capacity of providers delivering Maternal and Newborn Health (MNH) services to women in informal settlements. The complex challenges of delivering MNH services in informal urban settings where communities have limited access require a comprehensive approach including ensuring access to supplies and basic equipment. Nevertheless, the combined effects of the self-guided online platform and mentorship reinforces EmONC knowledge and skills. This combined approach is more likely to improve provider competency, and skills as well as improving maternal and newborn health outcomes.
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Affiliation(s)
- Charity Ndwiga
- Population Council, Nairobi Kenya. Avenue 5, 3rd Floor, Rose Avenue, PO Box 17643-00500, Nairobi, Kenya
| | - Timothy Abuya
- Population Council, Nairobi Kenya. Avenue 5, 3rd Floor, Rose Avenue, PO Box 17643-00500, Nairobi, Kenya.
| | - Chantalle Okondo
- Population Council, Nairobi Kenya. Avenue 5, 3rd Floor, Rose Avenue, PO Box 17643-00500, Nairobi, Kenya
| | | | | | - Charlotte E Warren
- Population Council, Suite 280, 4301 Connecticut Ave NW, Washington, DC, USA
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100
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Limmer CM, Stoll K, Vedam S, Leinweber J, Gross MM. Measuring disrespect and abuse during childbirth in a high-resource country: Development and validation of a German self-report tool. Midwifery 2023; 126:103809. [PMID: 37689053 DOI: 10.1016/j.midw.2023.103809] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 06/27/2023] [Accepted: 08/29/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Increasing evidence on disrespect and abuse during childbirth has led to growing concern about the quality of care childbearing women are experiencing. To provide quantitative evidence of disrespect and abuse during childbirth services in Germany a validated measurement tool is needed. RESEARCH AIM The aim of this research project was the development and psychometric validation of a survey tool in the German language that measures disrespect and abuse of women during childbirth. METHODS A survey tool was created including the following measures: German adaptations of the short and long form of the "Mothers on Respect" (MOR) index (MOR-7 and MOR-G); the "Mothers' Autonomy in Decision Making" (MADM) scale; a mistreatment-index (MIST-I) comprising indicators of mistreatment during childbirth; and a set of items that measure experiences of discrimination during maternity care. Internal consistency reliability and construct validity of the scales were assessed using Cronbach's alpha, unweighted least squares factor analysis and non-parametric correlation analysis with a scale that measures a related construct, the Posttraumatic Symptom Scale - Self Report (PSS-SR) scale. We distributed the survey online, recruiting through snowball sampling via social media. A selection bias towards women who had experienced disrespect and abuse during their birth was intended and expedient for tool validation. The final sample of participants (n = 2045) had given birth in Germany between 2009 and 2018. FINDINGS More than 77% of the study participants reported at least one form of mistreatment with non-consented care being the most commonly reported type of mistreatment, followed by physical violence, violation of physical privacy, verbal abuse and neglect. All included scales showed good psychometric properties with high Cronbach's alphas (0.95 for both MOR versions and 0.96 for MADM). Factor analysis generated one factor scales with high factor loadings (0.75 to 0.92 for MOR-7; 0.37 to 0.90 for MOR-G and 0.83 to 0.92 for MADM). MOR-7, MOR-G, MADM and MIST-I scores were significantly (p<0.001) correlated with PSS-SR scores (Spearman's rho -0.70, -0.61 and 0.68 for MOR-G, MADM and the MIST-I, respectively). CONCLUSIONS This study presents a valid and reliable instrument for the quantitative assessment of disrespect and abuse during childbirth in Germany. Childbearing women's experiences of disrespect and abuse are a relevant phenomenon in German hospital based maternity care. Disrespect and abuse during childbirth appear to contribute to post-traumatic symptoms and may be associated with severe mental health problems postpartum.
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Affiliation(s)
- Claudia M Limmer
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover D-30625, Germany; Department Nursing and Management, Faculty of Business and Social Sciences, Hamburg University of Applied Science, Alexanderstr. 1, Hamburg D-20099, Germany
| | - Kathrin Stoll
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover D-30625, Germany; UBC Midwifery, Faculty of Medicine, University of British Columbia, 304-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Saraswathi Vedam
- UBC Midwifery, Faculty of Medicine, University of British Columbia, 304-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Julia Leinweber
- Institute of Midwifery, University Medicine Berlin, Charite, Oudenarder Strasse 16, Berlin 13347, Germany
| | - Mechthild M Gross
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover D-30625, Germany.
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