1
|
González-Mesa E, González-Cazorla A, González-Cazorla E, Mozas-Moreno J, Gokce Isbir G, Abreu W, Lubián-López D. Contribution of the abbreviated CAVE-st questionnaire in Spanish: the attitudes toward childbirth experiences. J Psychosom Obstet Gynaecol 2024; 45:2380860. [PMID: 39044401 DOI: 10.1080/0167482x.2024.2380860] [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: 11/16/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024] Open
Abstract
There are several factors that influence women's childbirth experience, and personal interactions with health professionals are of particular significance. The main objective of this study was to present the validation of an abbreviated form of an existing questionnaire on attitudes about childbirth in medical and nursing students. We used a sample of 512 perinatal medicine and nursing students who received the original 52-item CAVE-st questionnaire to obtain a shorter version with proper psychometric properties. We used Cronbach's alpha coefficient to evaluate the new version's internal consistency. The Kaiser- Meyer-Olkin test and the Barlett sphericity test were performed to assess the suitability of exploratory factor analysis (EFA). Subsequently, confirmatory factor analysis (CFA) was performed using structural equation models in a second sample of 139 medical students. We obtained a 15-item version with a Cronbach's alpha of 0.82. The EFA revealed a four-dimensional structure, similar to the full 52-item version. In the CFA the adjustment indexes showed good model fitness, RMSEA= 0.046 [CI 0.00-0.07]; CFI = 0.978. We can conclude that the 15-item version is a valid tool for evaluating the attitude of students toward childbirth, pointing out the matters that should be improved in their training to avoid obstetric trauma by the promotion of a positive experience in women during childbirth.
Collapse
Affiliation(s)
- Ernesto González-Mesa
- School of Medicine, Obstetrics and Gynecology Department, University of Malaga, Málaga, Spain
- Grupo de investigación en Medicina Materno-fetal, epigenética, enfermedades de la mujer y salud reproductiva, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, Spain
- UGC Obstetricia y Ginecología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ana González-Cazorla
- School of Medicine, Obstetrics and Gynecology Department, University of Malaga, Málaga, Spain
| | | | - Juan Mozas-Moreno
- School of Medicine, Obstetrics and Gynecology Department, University of Granada, Granada, Spain
| | | | - Wilson Abreu
- Psychology School, Centro de Investigacao en Tecnologias y Servicios de Saude, Porto University, Porto, Portugal
| | - Daniel Lubián-López
- Obstetrics and Gynecology Department, University Hospital of Jerez de la Frontera, Cádiz, Spain
| |
Collapse
|
2
|
Mayra K, Matthews Z, Sandall J, Padmadas SS. "I have to listen to them or they might harm me" and other narratives of why women endure obstetric violence in Bihar, India. Birth 2024. [PMID: 38840384 DOI: 10.1111/birt.12828] [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: 07/18/2023] [Revised: 03/28/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Evidence suggests that obstetric violence has been prevalent globally and is finally getting some attention through research. This human rights violation takes several forms and is best understood through the narratives of embodied experiences of disrespect and abuse from women and other people who give birth, which is of utmost importance to make efforts in implementing respectful maternity care for a positive birthing experience. This study focused on the drivers of obstetric violence during labor and birth in Bihar, India. METHODS Participatory qualitative visual arts-based method of data collection-body mapping-assisted interviews (adapted as birth mapping)-was conducted to understand women's perception of why they are denied respectful maternity care and what makes them vulnerable to obstetric violence during labor and childbirth. This study is embedded in feminist and critical theories that ensure women's narratives are at the center, which was further ensured by the feminist relational discourse analysis. Eight women participated from urban slums and rural villages in Bihar, for 2-4 interactions each, within a week. The data included transcripts, audio files, body maps, birthing stories, and body key, which were analyzed with the help of NVivo 12. FINDINGS Women's narratives suggested drivers that determine how they will be treated during labor and birth, or any form of sexual, reproductive, and maternal healthcare seeking presented through the four themes: (1) "I am admitted under your care, so, I will have to do what you say"-Influence of power on care during childbirth; (2) "I was blindfolded … because there were men"-Influence of gender on care during childbirth; (3) "The more money we give the more convenience we get"-Influence of structure on care during childbirth; and (4) "How could I ask him, how it will come out?"-Influence of culture on care during childbirth. How women will be treated in the society and in the obstetric environment is determined by their identity at the intersections of age, class, caste, marital status, religion, education, and many other sociodemographic factors. The issues related to each of these are intertwined and cross-cutting, which made it difficult to draw clear categorizations because the four themes influenced and overlapped with each other. Son preference, for example, is a gender-based issue that is part of certain cultures in a patriarchal structure as a result of power-based imbalance, which makes the women vulnerable to disrespect and abuse when their baby is assigned female at birth. DISCUSSION Sensitive unique feminist methods are important to explore and understand women's embodied experiences of trauma and are essential to understand their perspectives of what drives obstetric violence during childbirth. Sensitive methods of research are crucial for the health systems to learn from and embed women's wants, to address this structural challenge with urgency, and to ensure a positive experience of care.
Collapse
Affiliation(s)
- Kaveri Mayra
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zoë Matthews
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Kings College London, London, UK
| | - Sabu S Padmadas
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Alspaugh A, Swan LET, Auerbach SL, Bartmess M, Agbemenu K, Ely GE. Mistreatment in health care among women in Appalachia. CULTURE, HEALTH & SEXUALITY 2023; 25:1690-1706. [PMID: 36780368 DOI: 10.1080/13691058.2023.2176547] [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: 08/12/2022] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
Good quality patient care requires health care providers to respect the humanity and autonomy of their patients. However, this is not achieved in all settings. This study used cross-sectional survey data including open-ended text responses to explore negative experiences with health care providers among women in Appalachia. We used the Heath Stigma & Discrimination Framework (HSDF) to identify how stigma is created and perpetuated through interactions with health care providers. Survey data from 628 women collected through purposive sampling identified that two out of three participants had had a bad encounter with a provider that made them not want to return for care. One in six participants had a negative experience specifically while seeking contraception. Using the domains of the HSDF framework, qualitative answers to open-ended questions illuminated how health care providers, influenced by social and cultural norms related to religiosity, patriarchal views, poverty, poor health infrastructure, and the opioid crisis, created and perpetuated stigma through dehumanising treatment, low-quality care, and health care misogyny. Because stigma is a driver of health inequity, these findings highlight the important and sometimes problematic role that health care providers can play when they create a barrier to future care through poor treatment of patients.
Collapse
Affiliation(s)
- Amy Alspaugh
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | | | | | | | - Gretchen E Ely
- College of Social Work, University of Tennessee, Knoxville, TN, USA
| |
Collapse
|
5
|
Sripad P, Peterson S, Idrissou D, Kamanga M, Kezembe A, Ndwiga C, Okondo C, Ranjalahy AN, Stevanovic-Fenn N, Warren CE, Zieman B, Mathur S. Applying a Power and Gender Lens to Understanding Health Care Provider Experience and Behavior: A Multicountry Qualitative Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200420. [PMID: 38035723 PMCID: PMC10698231 DOI: 10.9745/ghsp-d-22-00420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/21/2023] [Indexed: 12/02/2023]
Abstract
A limited but growing body of literature shows that health care providers (HCPs) in reproductive, maternal, and newborn health face challenges that affect how they provide services. Our study investigates provider perspectives and behaviors using 4 interrelated power domains-beliefs and perceptions; practices and participation; access to assets; and structures-to explore how these constructs are differentially experienced based on one's gender, position, and function within the health system. We conducted a framework-based secondary analysis of qualitative in-depth interview data gathered with different cadres of HCPs across Kenya, Malawi, Madagascar, and Togo (n=123). We find across countries that power dynamics manifest in and are affected by all 4 domains, with some variation by HCP cadre and gender. At the service interface, HCPs' power derives from the nature and quality of their relationships with clients and the community. Providers' power within working relationships stems from unequal decision-making autonomy among HCP cadres. Limited and sometimes gendered access to remuneration, development opportunities, material resources, supervision quality, and emotional support affect HCPs' power to care for clients effectively. Power manifests variably among community and facility-based providers because of differences in prevailing hierarchical norms in routine and acute settings, community linkages, and type of collaboration required in their work. Our findings suggest that applying power-and secondarily, gender lenses-can elucidate consistencies in how providers perceive, internalize, and react to a range of relational and environmental stressors. The findings also have implications on how to improve the design of social behavior change interventions aimed at better supporting HCPs.
Collapse
Affiliation(s)
| | | | - Daoudou Idrissou
- Country Liaison Associate, Ouagadougou Partnership Coordination Unit, Lome, Togo
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Batram-Zantvoort S, Wandschneider L, Razum O, Miani C. A critical review: developing a birth integrity framework for epidemiological studies through meta-ethnography. BMC Womens Health 2023; 23:530. [PMID: 37817176 PMCID: PMC10565979 DOI: 10.1186/s12905-023-02670-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: 11/17/2022] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
Over the past decade, there has been growing evidence that women worldwide experience sub-standard care during facility-based childbirth. With this critical review, we synthesize concepts and measurement approaches used to assess maternity care conditions and provision, birth experiences and perceptions in epidemiological, quantitative research studies (e.g., obstetric violence, maternal satisfaction, disrespect or mistreatment during childbirth, person-centered care), aiming to propose an umbrella concept and framework under which the existing and future research strands can be situated. On the 82 studies included, we conduct a meta-ethnography (ME) using reciprocal translation, in-line argumentation, and higher-level synthesis to propose the birth integrity multilevel framework. We perform ME steps for the conceptual level and the measurement level. At the conceptual level, we organize the studies according to the similarity of approaches into clusters and derive key concepts (definitions). Then, we 'translate' the clusters into one another by elaborating each approach's specific angle and pointing out the affinities and differences between the clusters. Finally, we present an in-line argumentation that prepares ground for the synthesis. At the measurement level, we identify themes from items through content analysis, then organize themes into 14 categories and subthemes. Finally, we synthesize our result to the six-field, macro-to-micro level birth integrity framework that helps to analytically distinguish between the interwoven contributing factors that influence the birth situation as such and the integrity of those giving birth. The framework can guide survey development, interviews, or interventional studies.
Collapse
Affiliation(s)
- Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (Ined), Aubervilliers, France
| |
Collapse
|
7
|
González-de la Torre H, González-Artero PN, Muñoz de León-Ortega D, Lancha-de la Cruz MR, Verdú-Soriano J. Cultural Adaptation, Validation and Evaluation of the Psychometric Properties of an Obstetric Violence Scale in the Spanish Context. NURSING REPORTS 2023; 13:1368-1387. [PMID: 37873822 PMCID: PMC10594477 DOI: 10.3390/nursrep13040115] [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: 08/26/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 10/25/2023] Open
Abstract
Obstetric violence refers to dehumanized or derogative treatment of women in their pregnancy, childbirth or postpartum periods and may be manifested in different ways. Currently, there is no tool validated in Spain to measure women's perception of obstetric violence. The objective of this study was to carry out the cultural adaptation and validation of an existing 14-item obstetric violence scale in the Spanish context and to evaluate its psychometric properties. The research was conducted in two phases: first, a methodological study designed to evaluate content validity, through assessments by eight experts (calculating the Aiken V coefficient) and face validity in a sample of 20 women; second, a cross-sectional study to evaluate construct validity (through confirmatory factor analysis and Rasch analysis), divergent validity against a scale of birth satisfaction, known-groups validity and, finally, reliability. In Phase 1, Aiken V values higher than 0.71 were obtained for all items. Phase 2 was conducted on a sample of 256 women and the fit values for the unidimensional model were RMSEA: 0.070 (95% CI: 0.059-0.105) and GFI: 0.982 (95% CI: 0.823-0.990). The Rasch analysis indicated poor performance of item 2, which was removed. The Omega and Cronbach's Alpha coefficients were 0.863 and 0.860, respectively. A final 13-item version of the Obstetric Violence Scale was produced, with a total score ranging from 0 (no obstetric violence perception) to 52 (maximum obstetric violence perception). The Obstetric Violence Scale is a reliable and useful tool to measure women's perception of obstetric violence. This study was not registered.
Collapse
Affiliation(s)
- Héctor González-de la Torre
- Department of Nursing, University of Las Palmas de Gran Canaria, Edificio Ciencias de la Salud, C/Blas Cabrera Felipe s/n, CP 35016 Las Palmas de Gran Canaria, Spain
- Research Support Unit of Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, Avda Marítima del Sur s/n, CP 35016 Las Palmas de Gran Canaria, Spain
| | - Paula Nikola González-Artero
- Department of Obstetrics and Gynaecology, Insular Maternal and Child University Hospital Complex of Gran Canaria-Canary Health Service, Avda Marítima del Sur s/n, CP 35016 Las Palmas de Gran Canaria, Spain; (P.N.G.-A.); (D.M.d.L.-O.)
| | - Daniel Muñoz de León-Ortega
- Department of Obstetrics and Gynaecology, Insular Maternal and Child University Hospital Complex of Gran Canaria-Canary Health Service, Avda Marítima del Sur s/n, CP 35016 Las Palmas de Gran Canaria, Spain; (P.N.G.-A.); (D.M.d.L.-O.)
| | - María Reyes Lancha-de la Cruz
- Delivery Room Service, General Hospital of Fuerteventura Virgen de la Peña-Canary Health Service, Carretera del Aeropuerto, Km 1, CP 35600 Puerto del Rosario, Spain;
| | - José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante (UA), CP 03690 Alicante, Spain;
| |
Collapse
|
8
|
Afulani PA, Nakphong MK, Sudhinaraset M. Person-centred sexual and reproductive health: A call for standardized measurement. Health Expect 2023; 26:1384-1390. [PMID: 37232021 PMCID: PMC10349248 DOI: 10.1111/hex.13781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/26/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023] Open
Abstract
Person-centred sexual and reproductive health (PCSRH) care refers to care that is respectful of and responsive to people's preferences, needs, and values, and which empowers them to take charge of their own sexual and reproductive health (SRH). It is an important indicator of SRH rights and quality of care. Despite the recognition of the importance of PCSRH, there is a gap in standardized measurement in some SRH services, as well as a lack of guidance on how similar person-centred care measures could be applied across the SRH continuum. Drawing on validated scales for measuring person-centred family planning, abortion, prenatal and intrapartum care, we propose a set of items that could be validated in future studies to measure PCSRH in a standardized way. A standardized approach to measurement will help highlight gaps across services and facilitate efforts to improve person-centred care across the SRH continuum. PATIENT OR PUBLIC CONTRIBUTION: This viewpoint is based on a review of validated scales that were developed through expert reviews and cognitive interviews with services users and providers across the different SRH services. They provided feedback on the relevance, clarity, and comprehensiveness of the items in each scale.
Collapse
Affiliation(s)
- Patience A. Afulani
- Departments of Epidemiology and Biostatistics and Obstetrics, Gynecology, and Reproductive Sciences, School of MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Michelle K. Nakphong
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public HealthUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - May Sudhinaraset
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public HealthUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| |
Collapse
|
9
|
Bah A, Russo G. Factors that influenced utilization of antenatal and immunization services in two local government areas in The Gambia during COVID-19: An interview-based qualitative study. PLoS One 2023; 18:e0276357. [PMID: 37384645 PMCID: PMC10309596 DOI: 10.1371/journal.pone.0276357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 06/08/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Evidence is being consolidated that shows that the utilization of antenatal and immunization services has declined in low-income countries (LICs) during the COVID-19 pandemic. Very little is known about the effects of the pandemic on antenatal and immunization service utilization in The Gambia. We set out to explore the COVID-19-related factors affecting the utilization of antenatal and immunization services in two Local Government Areas (LGAs) in The Gambia. METHODS A qualitative methodology was used to explore patients' and providers' experiences of antenatal and immunization services during the pandemic in two LGAs in The Gambia. Thirty-one study participants were recruited from four health facilities, applying a theory-driven sampling framework, including health workers as well as female patients. Qualitative evidence was collected through theory-driven semi-structured interviews, and was recorded, translated into English, transcribed, and analysed thematically, applying a social-ecological framework. RESULTS In our interviews, we identified themes at five different levels: individual, interpersonal, community, institutional and policy factors. Individual factors revolved around patients' fear of being infected in the facilities, and of being quarantined, and their anxiety about passing on infections to family members. Interpersonal factors involved the reluctance of partners and family members, as well as perceived negligence and disrespect by health workers. Community factors included misinformation within the community and mistrust of vaccines. Institutional factors included the shortage of health workers, closures of health facilities, and the lack of personal protective equipment (PPEs) and essential medicines. Finally, policy factors revolved around the consequences of COVID-19 prevention measures, particularly the shortage of transport options and mandatory wearing of face masks. CONCLUSIONS Our findings suggest that patients' fears of contagion, perceptions of poor treatment in the health system, and a general anxiety around the imposing of prevention measures, undermined the uptake of services. In future emergencies, the government in The Gambia, and governments in other LICs, will need to consider the unintended consequences of epidemic control measures on the uptake of antenatal and immunization services.
Collapse
Affiliation(s)
- Abdourahman Bah
- The Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Giuliano Russo
- The Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
10
|
Adinew YM, Kelly J, Smith M, Marshall A. Women's perspectives on disrespect and abuse during facility-based childbirth in Ethiopia: a qualitative study. BMC Pregnancy Childbirth 2023; 23:444. [PMID: 37316792 DOI: 10.1186/s12884-023-05762-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Disrespect and abuse violates women's basic human rights and autonomy and can traumatize women who are already in a vulnerable position during childbirth and deter them from utilizing skilled care for future childbirth. This study explored women's perspectives on the acceptability of disrespect and abuse during facility-based childbirth in Ethiopia. METHODS A qualitative descriptive design using five focus group discussions and fifteen in-depth, semi-structured, interviews was conducted with women between October 2019 to January 2020 in north Showa zone of Oromia region, central Ethiopia. Using purposive sampling, women who had given birth at public health facilities of North Showa zone during the twelve months preceding data collection were recruited, regardless of birth outcome. Inductive thematic analysis using Open Code software was used to explore the perspectives of participants. RESULTS While women reject disrespectful and abusive acts during childbirth generally, they may consider some disrespectful acts as acceptable and or necessary under certain circumstances. Four emerging themes were identified. (1) Disrespect and abuse is not acceptable, (2) Disrespectful and abusive actions are acceptable only if intended to save lives, (3) Disrespectful and abusive actions are an accepted part of everyday practice to prevent complications and adverse outcomes, (4) Disrespectful and abusive actions are necessary to discipline disobedient women. CONCLUSION Women's perceptions of disrespectful and abusive acts of care providers is deeply rooted within the context of violence in Ethiopia and the societal hierarchies that have systematically disempowered women. Given the pervasiveness of disrespect and abusive actions during childbirth, policymakers, clinical managers and care providers must take these essential contextual and societal norms into account and devise comprehensive clinical interventions that addresses the root causes.
Collapse
Affiliation(s)
- Yohannes Mehretie Adinew
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia.
- College of Health sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia.
| | - Janet Kelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Morgan Smith
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Amy Marshall
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| |
Collapse
|
11
|
Ottosen M, Eloi H, Lyons M. Engaging patients as teachers in a baccaulaureate nursing reproductive health care course: A qualitative study. NURSE EDUCATION TODAY 2023; 128:105859. [PMID: 37348405 DOI: 10.1016/j.nedt.2023.105859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 05/01/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Teaching nursing students about the principles and practical application of person-centered care is an essential yet challenging component of nursing education. Integrating patients as teachers to share their personal stories of maternity care can elicit positive outcomes toward students achieving course objectives. OBJECTIVES To determine how the educational experience of having patients as teachers in the classroom could influence students' awareness of patients' perceptions of their maternity care, delivering person-centered care and the roles of nursing in their future practice. DESIGN Retrospective qualitative study of student reflections. SETTINGS Reproductive health course within a BSN program. PARTICIPANTS Ninety-nine second semester BSN student reflections. METHODS Two course faculty and a qualitative nurse researcher conducted a thematic content analysis of written student reflections. RESULTS Three primary themes emerged from the students' reflections of hearing patient and family advisors describe their maternity experiences: 1) awareness of the impact of nursing practice on patient and family well-being, 2) awareness of personal biases and emotions about difficulties in maternity care, and 3) appreciation to hear from patients directly as part of didactic coursework. CONCLUSIONS Including patients as teachers is an enhanced method to aid nursing students in understanding the humanistic and impactful roles of nursing in the clinical setting.
Collapse
Affiliation(s)
- Madelene Ottosen
- Department of Graduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Ste. 681, Houston, TX 77030, United States of America.
| | - Hildreth Eloi
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Ste. 787, Houston, TX 77030, United States of America.
| | - Mandi Lyons
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Ste. 764, Houston, TX 77030, United States of America.
| |
Collapse
|
12
|
Downe S, Nowland R, Clegg A, Akooji N, Harris C, Farrier A, Gondo LT, Finlayson K, Thomson G, Kingdon C, Mehrtash H, McCrimmon R, Tunçalp Ö. Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001594. [PMID: 37093790 PMCID: PMC10124898 DOI: 10.1371/journal.pgph.0001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Despite global attention, physical and verbal abuse remains prevalent in maternity and newborn healthcare. We aimed to establish theoretical principles for interventions to reduce such abuse. We undertook a mixed methods systematic review of health and social care literature (MEDLINE, SocINDEX, Global Index Medicus, CINAHL, Cochrane Library, Sept 29th 2020 and March 22nd 2022: no date or language restrictions). Papers that included theory were analysed narratively. Those with suitable outcome measures were meta-analysed. We used convergence results synthesis to integrate findings. In September 2020, 193 papers were retained (17,628 hits). 154 provided theoretical explanations; 38 were controlled studies. The update generated 39 studies (2695 hits), plus five from reference lists (12 controlled studies). A wide range of explicit and implicit theories were proposed. Eleven non-maternity controlled studies could be meta-analysed, but only for physical restraint, showing little intervention effect. Most interventions were multi-component. Synthesis suggests that a combination of systems level and behavioural change models might be effective. The maternity intervention studies could all be mapped to this approach. Two particular adverse contexts emerged; social normalisation of violence across the socio-ecological system, especially for 'othered' groups; and the belief that mistreatment is necessary to minimise clinical harm. The ethos and therefore the expression of mistreatment at each level of the system is moderated by the individuals who enact the system, through what they feel they can control, what is socially normal, and what benefits them in that context. Interventions to reduce verbal and physical abuse in maternity care should be locally tailored, and informed by theories encompassing all socio-ecological levels, and the psychological and emotional responses of individuals working within them. Attention should be paid to social normalisation of violence against 'othered' groups, and to the belief that intrapartum maternal mistreatment can optimise safe outcomes.
Collapse
Affiliation(s)
- Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Rebecca Nowland
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Andrew Clegg
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Naseerah Akooji
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom
| | - Cath Harris
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Alan Farrier
- Healthy and Sustainable Settings Unit, University of Central Lancashire, Preston, United Kingdom
| | | | - Kenny Finlayson
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Carol Kingdon
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rebekah McCrimmon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
13
|
A qualitative analysis of obstetric violence in rural Madagascar. Heliyon 2023; 9:e13905. [PMID: 36895360 PMCID: PMC9988542 DOI: 10.1016/j.heliyon.2023.e13905] [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: 09/28/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
In Madagascar, a country where maternal mortality remains high, the quality of obstetric care as perceived by users has been little explored. In this paper, we examine the perception of the quality of care in rural areas, by identifying women's experiences and expectations for basic and emergency obstetric care and how providers are meeting them. Data were collected in 2020, in three rural regions (Fenerive-Est, Manakara and Miandrivazo). 58 semi-structured interviews were conducted with women who had given birth in basic health centers or at home, and with other key informants including caregivers, birth attendants (known as matrones), grandmothers and community agents. 6 focus groups took place with mothers who had given birth at home and at a basic health centers and 6 observations took place during prenatal consultations. This article highlights the major dysfunctions perceived in the services offered and their influence on healthcare use. The women highlighted a lack of consideration of their expectations in obstetric care, with a defective caregiver/patient relationship, unforeseen costs and inadequate infrastructures incapable of guaranteeing intimacy. The women also complained of a lack of consideration of their fady (cultural prohibitions that can lead to misfortune) that surround pregnancy. These local practices conflict with the medical requirements of priority interventions in maternal care, and the respect of these practices by the women leads to reprimands and humiliation from caregivers. This obstetric violence, which emanates from the structure of society, gender relations and the biomedical practices governing pregnancy and childbirth in health facilities in Madagascar, constitutes an obstacle to the use of obstetric services. We hope that this description of the various dimensions of obstetric violence in Madagascar will make it possible to identify the structural obstacles limiting the capacity to provide quality care and to engender positive improvements in obstetric care in Madagascar.
Collapse
|
14
|
Alspaugh A, Swan LET, Auerbach SL, Bartmess M, Agbemenu K, Ely GE. Mistreatment in health care among women in Appalachia. CULTURE, HEALTH & SEXUALITY 2023:1-17. [DOI: https:/doi.org/10.1080/13691058.2023.2176547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/31/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Amy Alspaugh
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | - Laura E. T. Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | | | | | | | - Gretchen E. Ely
- College of Social Work, University of Tennessee, Knoxville, TN, USA
| |
Collapse
|
15
|
Schaaf M, Jaffe M, Tunçalp Ö, Freedman L. A critical interpretive synthesis of power and mistreatment of women in maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000616. [PMID: 36962936 PMCID: PMC10021192 DOI: 10.1371/journal.pgph.0000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Labouring women may be subjected to physical and verbal abuse that reflects dynamics of power, described as Mistreatment of Women (MoW). This Critical Interpretive Synthesis on power and MoW consolidates current research and advances theory and practice through inter-disciplinary literature exploration. The review was undertaken in 3 phases. Phase 1 consisted of topic scoping; phase 2 entailed exploration of key power-related drivers emerging from the topic scoping; and phase 3 entailed data synthesis and analysis, with a particular focus on interventions. We identified 63 papers for inclusion in Phase 1. These papers utilized a variety of methods and approaches and represented a wide range of geographic regions. The power-related drivers of mistreatment in these articles span multiple levels of the social ecological model, including intrapersonal (e.g. lack of knowledge about one's rights), interpersonal (e.g. patient-provider hierarchy), community (e.g. widespread discrimination against indigenous women), organizational (e.g. pressure to achieve performance goals), and law/policy (e.g. lack of accountability for rights violations). Most papers addressed more than one level of the social-ecological model, though a significant minority were focused just on interpersonal factors. During Phase 1, we identified priority themes relating to under-explored power-related drivers of MoW for exploration in Phase 2, including lack of conscientization and normalization of MoW; perceptions of fitness for motherhood; geopolitical and ethnopolitical projects related to fertility; and pressure to achieve quantifiable performance goals. We ultimately included 104 papers in Phase 2. The wide-ranging findings from Phase 3 (synthesis and analysis) coalesce in several key meta-themes, each with their own evidence-base for action. Consistent with the notion that research on power can point us to "drivers of the drivers," the paper includes some intervention-relevant insights for further exploration, including as relating to broader social norms, health systems design, and the utility of multi-level strategies.
Collapse
Affiliation(s)
- Marta Schaaf
- Independent Consultant, Brooklyn, New York, United States of America
| | - Maayan Jaffe
- Independent Consultant, Brooklyn, New York, United States of America
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Lynn Freedman
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
| |
Collapse
|
16
|
Jacobs C, Michelo C, Hyder A. Understanding maternal choices and experiences of care by skilled providers: Voices of mothers who delivered at home in selected communities of Lusaka city, Zambia. Front Glob Womens Health 2023; 3:916826. [PMID: 36683603 PMCID: PMC9852978 DOI: 10.3389/fgwh.2022.916826] [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: 04/10/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
Background Significant proportions of women living in urban areas including the capital cities continue to deliver at home. We aimed to understand why mothers in a selected densely populated community of Lusaka city in Zambia deliver from home without assistance from a skilled provider during childbirth. Methods Using a phenomenological case study design, we conducted Focus Group Discussions and In-depth Interviews with mothers who delivered at home without assistance from a skilled provider. The study was conducted between November 2020 and January 2021 among 19 participants. Data were analysed using content analysis. Results Individual-related factors including the belief that childbirth is a natural and easy process that did not require assistance, lack of transport to get to the health facility, influence and preference for care from older women who were perceived to have the experience and better care, failure to afford baby supplies, and waiting for partner to provide the supplies that were required at the health facility influenced mothers' choices to seek care from skilled providers. Health system-related factors included mistreatment and disrespectful care such as verbal and physical abuse by skilled healthcare providers, stigma and discrimination, institutional fines, and guidelines such as need to attend antenatal care with a spouse and need to provide health facility demanded supplies. Conclusion Individual and health system access related factors largely drive the choice to involve skilled providers during childbirth. The socioeconomic position particularly contributes to limited decision-making autonomy of mothers, thus, creating challenges to accessing care in health facilities. The health system-related factors found in this study such as mistreatment and disrespectful care suggests the need for redesigning effective and sustainable urban resource-limited context maternal health strategies that are culturally acceptable, non-discriminatory, and locally responsive and inclusive. Rethinking these strategies this way has the potential to strengthening equitable responsive health systems that could accelerate attainment of sustainable developmental goal (SDG) 3 targets.
Collapse
Affiliation(s)
- Choolwe Jacobs
- School of Public Health, University of Zambia, Lusaka, Zambia,Correspondence: Choolwe Jacobs
| | - Charles Michelo
- Harvest Research Institutes, Harvest University, Lusaka, Zambia
| | - Adnan Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| |
Collapse
|
17
|
Bercu C, Jacobson LE, Gebrehanna E, Ramirez AM, Katz AJ, Filippa S, Baum SE. "I was afraid they will be judging me and even deny me the service": Experiences of denial and dissuasion during abortion care in Ethiopia. Front Glob Womens Health 2022; 3:984386. [PMID: 36386432 PMCID: PMC9663468 DOI: 10.3389/fgwh.2022.984386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/07/2022] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Disrespect and abuse are components of poor quality abortion care. This analysis aimed to understand negative experiences of care from perspectives of abortion clients in public and private facilities in Ethiopia. STUDY DESIGN We conducted 23 in-depth interviews with people who obtained abortion care in Addis Ababa, Ethiopia as well as Aksum and Mekele in Tigray State, Ethiopia. The interviews were coded using a priori and emergent codes and we conducted thematic analysis to understand negative interactions with providers from participant's perspectives. RESULTS Participants experienced denial of abortion services along their pathway to care and attempts by providers to dissuade them prior to providing an abortion. Underlying both the denial and the dissuasion were reports of disrespect and condemnation from providers. Participants described how providers doubted or forced them to justify their reasons for having an abortion, stigmatized them for seeking multiple abortions or later abortions, and ascribed misinformation about abortion safety. Despite reports of denial, dissuasion, and disrespect, abortion clients generally felt that providers had their best interest at heart and were grateful for having access to an abortion. CONCLUSIONS Participants in Ethiopia experienced providers as gatekeepers to legal abortion services, facing disrespect and judgment at facilities where they sought care. Interventions aimed at increasing awareness of abortion laws such that clients understand their rights and values clarification interventions for providers could help reduce barriers to accessing care and improve the quality of abortion services.
Collapse
Affiliation(s)
- Chiara Bercu
- Ibis Reproductive Health, Oakland, CA, United States
| | - Laura E. Jacobson
- School of Public Health, Oregon Health and Science University-Portland State University (OHSU-PSU), Portland, OR, United States
| | - Ewenat Gebrehanna
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Anna J. Katz
- Ibis Reproductive Health, Oakland, CA, United States
| | - Sofía Filippa
- Ibis Reproductive Health, Oakland, CA, United States
| | - Sarah E. Baum
- Ibis Reproductive Health, Oakland, CA, United States
| |
Collapse
|
18
|
Paiz JC, de Jezus Castro SM, Giugliani ERJ, Dos Santos Ahne SM, Aqua CBD, Giugliani C. Association between mistreatment of women during childbirth and symptoms suggestive of postpartum depression. BMC Pregnancy Childbirth 2022; 22:664. [PMID: 36028806 PMCID: PMC9413948 DOI: 10.1186/s12884-022-04978-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Postpartum depression is a common condition in the pregnancy and postpartum cycle. The development of this condition is multifactorial and can be influenced by previous traumas. This study sought to verify whether there is an association between having been exposed to mistreatment during childbirth and presenting symptoms suggestive of postpartum depression. Methods This is a cross-sectional study, with the inclusion of 287 women without complications in childbirth, randomly selected from two maternity hospitals of Porto Alegre, southern Brazil, in 2016. Four weeks after delivery, the postpartum women answered a face-to-face interview about socioeconomic aspects, obstetric history, health history, and childbirth experience (practices and interventions applied) and completed the Edinburgh Postnatal Depression Scale (EPDS). From the perception of women regarding the practices performed in the context of childbirth care, a composite variable was created, using item response theory, to measure the level of mistreatment during childbirth. The items that made up this variable were: absence of a companion during delivery, feeling insecure and not welcome, lack of privacy, lack of skin-to-skin contact after delivery, not having understood the information shared with them, and not having felt comfortable to ask questions and make decisions about their care. To define symptoms suggestive of postpartum depression, reflecting on increased probability of this condition, the EPDS score was set at ≥ 8. Poisson Regression with robust variance estimation was used for modeling. Results Women who experienced mistreatment during childbirth had a higher prevalence of symptoms suggestive of postpartum depression (PR 1.55 95% CI 1.07–2.25), as well as those with a history of mental health problems (PR 1.69 95% CI 1.16–2.47), while higher socioeconomic status (A and B) had an inverse association (PR 0.53 95% CI 0.33–0.83). Conclusions Symptoms suggestive of postpartum depression seem to be more prevalent in women who have suffered mistreatment during childbirth, of low socioeconomic status, and with a history of mental health problems. Thus, qualifying care for women during pregnancy, childbirth and postpartum and reducing social inequalities are challenges to be faced in order to eliminate mistreatment during childbirth and reduce the occurrence of postpartum depression.
Collapse
Affiliation(s)
- Janini Cristina Paiz
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil.
| | - Stela Maris de Jezus Castro
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil.,Department of Statistics, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Elsa Regina Justo Giugliani
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Child and Adolescent Health, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil
| | - Sarah Maria Dos Santos Ahne
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil
| | - Camila Bonalume Dall' Aqua
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil
| | - Camila Giugliani
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil
| |
Collapse
|
19
|
Hughes CS, Kamanga M, Jenny A, Zieman B, Warren C, Walker D, Kazembe A. Perceptions and predictors of respectful maternity care in Malawi: A quantitative cross-sectional analysis. Midwifery 2022; 112:103403. [PMID: 35728299 DOI: 10.1016/j.midw.2022.103403] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Access to high-quality, respectful care is a basic human right. A lack of respectful care during childbirth is associated with poor outcomes and can negatively influence care-seeking and maternal mental health. We aimed to describe how women perceive their experience of maternity care in Malawi. METHODS We implemented a cross-sectional survey of women (n = 660) who delivered in 25 birth facilities in four districts in Malawi in March 2020 using a validated 30-item, 90-point person-centered maternity care (PCMC) scale. We used descriptive statistics to examine women's experience of care and analyzed bivariable and multivariable mixed-effects models to evaluate predictors of PCMC. Statistical models accounted for clustering of women at the facility level and included maternal age, marital status, education, parity, mother or infant complications, timing of antenatal care (ANC), provider cadre and gender, facility type and sector, and district. RESULTS Mean PCMC score was 57.5 (range 21-84), with the lowest score (12.4 of 27 points) in communication and autonomy. Women reported: being prohibited from having a birth companion during labor (49.4%) or delivery (60.3%); providers did not introduce themselves (81.1%); providers did not ask consent before procedures/examinations (42.4%); women felt they could not ask questions (40.9%); and were not involved in care decisions (61.5%). Few women reported being frequently abused physically (2%) or verbally (3.5%); almost all had water/electricity available (>95%). In bivariate analyses, statistically significant positive associations were found between PCMC score and early ANC, male accompaniment to the facility, male provider, and a lack of complications; all associations remained at least potentially statistically significant in multivariable modeling. CONCLUSIONS Physical and verbal abuse and a lack of basic amenities were rare, while a lack of communication with patients and social support were common. Maternal characteristics (like timing of ANC and maternal or newborn complications) were predictors of RMC, while facility/system factors, like facility type and sector, were not. Continued efforts to improve respectful care will require strengthening provider communication skills and encouraging patient and companion involvement in care.
Collapse
Affiliation(s)
- Carolyn Smith Hughes
- University of California San Francisco, 550 16th St, 3rd Floor, San Francisco, CA 94158, USA.
| | - Martha Kamanga
- University of Malawi Kamuzu College of Nursing, P/Bag 1, Lilongwe, Malawi
| | - Alisa Jenny
- University of California San Francisco, 550 16th St, 3rd Floor, San Francisco, CA 94158, USA
| | - Brady Zieman
- Population Council, One Dag Hammarskjold Plaza, 3rd Floor, New York, NY 10017, USA
| | - Charlotte Warren
- Population Council, One Dag Hammarskjold Plaza, 3rd Floor, New York, NY 10017, USA
| | - Dilys Walker
- University of California San Francisco, 550 16th St, 3rd Floor, San Francisco, CA 94158, USA
| | - Abigail Kazembe
- University of Malawi Kamuzu College of Nursing, P/Bag 1, Lilongwe, Malawi
| |
Collapse
|
20
|
Obstetric gaslighting and the denial of mothers' realities. Soc Sci Med 2022; 301:114938. [PMID: 35395611 PMCID: PMC9167791 DOI: 10.1016/j.socscimed.2022.114938] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/10/2022] [Accepted: 03/19/2022] [Indexed: 11/23/2022]
Abstract
Gaslighting is a type of abuse aimed at making victims question their sanity as well as the veracity and legitimacy of their own perspectives and feelings. In this article, we show how gaslighting can operate as a key, yet underexamined strategy of obstetric violence, or the institutional and interpersonal violation of women's rights during pregnancy, childbirth, and postpartum. We draw on forty-six in-depth, semi-structured interviews with mothers who experienced a traumatic childbirth to examine how obstetric providers gaslight mothers before, during and after childbirth when they deny - and thereby destabilize - mothers' realities. We identify and examine four core types of denials: denials of 1) mothers' humanity, 2) mothers' knowledge as valid, 3) mothers' judgements as rational and 4) mothers' feelings as legitimate. All four denials work to render mothers noncredible and their claims illegible within clinical encounters. In explicitly naming, theorizing, and examining obstetric gaslighting, our aims are threefold: 1) to uncover and theorize an underexamined mechanism of obstetric violence through a sociological lens, 2) to offer a typology of obstetric gaslighting's manifestations to aid scholars and practitioners in recognizing when obstetric gaslighting is occurring and 3) to advance a growing research program on gaslighting in medicine.
Collapse
|
21
|
Sripad P, Merritt MW, Kerrigan D, Abuya T, Ndwiga C, Warren CE. Determining a Trusting Environment for Maternity Care: A Framework Based on Perspectives of Women, Communities, Service Providers, and Managers in Peri-Urban Kenya. Front Glob Womens Health 2022; 3:818062. [PMID: 35528311 PMCID: PMC9069110 DOI: 10.3389/fgwh.2022.818062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/17/2022] [Indexed: 11/18/2022] Open
Abstract
Trust in health service providers and facilities is integral to health systems accountability. Understanding determinants of trust, a relational construct, in maternity settings necessitates exploring hierarchical perspectives of users, providers, and influencers in the care environment. We used a theoretically driven qualitative approach to explore trust determinants in a maternity setting across patient-provider, inter-provider, and community-policymaker interactions and relationships in peri-urban Kenya. Focus groups (n = 8, N = 70) with women who recently gave birth (WRB), pregnant women, and male partners, and in-depth-interviews (n = 33) with WRB, health care providers and managers, and community health workers (CHWs) were conducted in 2013, soon after the national government's March 2013 introduction of a policy mandate for "Free Maternity Care." We used thematic coding, memo writing, and cross-perspective triangulation to develop a multi-faceted trust determinants framework. We found that determinants of trust in a maternity setting can be broadly classified into six types of factors, where each type of factor represents a cluster of determinants that may each positively or negatively influence trust: patient, provider, health facility, community, accountability, and structural. Patient factors are prior experiences, perceived risks and harms, childbirth outcomes, and maternal health literacy. Provider factors are empathy and respect, responsiveness, and perceived capability of providers. Health facility factors are "good services" as perceived by patients, physical environment, process navigability, provider collaboration and oversight, discrimination, and corruption. Community factors are facility reputation and history, information channels, and maternal health literacy. Accountability factors are alignment of actions with expectations, adaptations to policy changes, and voice and feedback. Structural factors are institutional hierarchies and policies in the form of professional codes. Trust determinants are complex, nuanced and reflect power dynamics across relationships. Findings offer insight into socio-political maternity norms and demand a more equitable care interface between users and providers.
Collapse
Affiliation(s)
- Pooja Sripad
- Population Council, Washington, DC, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Maria W. Merritt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, United States
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | | | | | | |
Collapse
|
22
|
|
23
|
Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2022; 51:e3-e54. [PMID: 35101344 DOI: 10.1016/j.jogn.2022.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
|
24
|
Dong K, Jameel B, Gagliardi AR. How is patient-centred care conceptualized in obstetrical health? comparison of themes from concept analyses in obstetrical health- and patient-centred care. Health Expect 2022; 25:823-839. [PMID: 35026046 PMCID: PMC9122412 DOI: 10.1111/hex.13434] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/24/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022] Open
Abstract
Background Due to gender inequities that exist for women of childbearing age, there exists a need to deliver care tailored to their needs and preferences. Patient‐centred care (PCC) can be used to meet these needs. This review aims to compare patient care delivery between PCC and obstetrical care. This can help us address how PCC should be delivered to women before, during and after pregnancy versus how it is delivered to patients regardless of sex. Methods A review of literature was conducted on MEDLINE, EMBASE, CINAHL and SCOPUS for English PCC and high‐quality perinatal reviews published between 2010 and 2021. The data were analysed using a modified Walker and Avant framework. Results A total of 2138 unique studies were identified, with 11 PCC and 9 high‐quality obstetrical care studies included. Common defining features between PCC and obstetrical care include respect and dignity, informed decision‐making, therapeutic alliance, effective communication, social relationships and autonomy. PCC‐specific features were holistic care, empowerment, individualized care, coordinated care and empathy. Unique high‐quality obstetrical care themes included continuity of care, privacy and confidentiality, provider education and status, physical environment and equitable maternal care. Conclusions There are shared defining attributes between PCC and obstetrical care, including respect and dignity, informed decision‐making, the therapeutic alliance, effective communication, social relationships and autonomy. However, there remain unique defining attributes for high‐quality obstetrical care and PCC. This highlights the need for a unique approach to obstetrical care. More research on care for different physiological conditions in women is needed to address patient care that addresses different parts of the lifespan and develop frameworks that can influence health policy, patient care and health system evaluation. Patient or Public Contribution This study was one part of a larger, multicomponent study of how to implement PCC for women across the lifespan. While we did not specifically consult or involve women in this dual concept analysis, our larger study (content analysis of clinical guidelines and government policies, qualitative interviews with women and clinicians, Delphi study to prioritize consensus recommendations for achieving PCC for women) was guided by the experiences and input of a 50+ women advisory panel.
Collapse
Affiliation(s)
- Kelly Dong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bismah Jameel
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Okedo-Alex IN, Akamike IC, Eze II, Onwasigwe CN. Does disrespect and abuse during childbirth differ between public and private hospitals in Southeast Nigeria. BMC Pregnancy Childbirth 2021; 21:852. [PMID: 34972518 PMCID: PMC8719415 DOI: 10.1186/s12884-021-04298-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disrespect and Abuse (D&A) during childbirth represents an important barrier to skilled birth utilization, indicating a problem with quality of care and a violation of women's human rights. This study compared prevalence of D&A during childbirth in a public and a private hospital in Southeast Nigeria. METHODS This study was a cross-sectional study among women who gave birth in two specialized health facilities: a public teaching and a private-for-profit faith-based hospital in Southeast Nigeria. In each facility, systematic random sampling was used to select 310 mothers who had given birth in the facility and were between 0-14 weeks after birth. Study participants were recruited through the immunization clinics. Semi-structured, interviewer-administered questionnaires using the Bowser and Hills classification of D&A during childbirth were used for data collection. Data were analyzed using SPSS version 20 at 95% significance level. RESULTS Mean age of the participants in the public hospital was 30.41 ± 4.4 and 29.31 ± 4.4 in the private hospital. Over three-fifths (191; 61.6%) in the public and 156 women (50.3%) in the private hospital had experienced at least one form of D&A during childbirth [cOR1.58; 95% CI 1.15, 2.18]. Abandonment and neglect [Public153 (49.4%) vs. Private: 91 (29.4%); cOR2.35; 95% CI. 1.69, 3.26] and non-consented care [Public 45 (14.5%) vs. Private 67(21.6%): cOR0.62; 95% CI. 0.41, 0.93] were the major types of D&A during childbirth. Denial of companionship was the most reported subtype of D&A during childbirth in both facilities [Public 135 (43.5%) vs. Private66 (21.3%); cOR2.85; 95% CI. 2.00, 4.06]. Rural residents were less likely to report at least one form of D&A during childbirth (aOR 0.53; CI 0.35-0.79). CONCLUSION Although prevalence was high in both facilities, overall prevalence of D&A during childbirth and most subtypes were higher in the public health facility. There is a need to identify contextual factors enabling D&A during childbirth in public and private health care settings.
Collapse
Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria. .,African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.
| | - Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
| | - Irene Ifeyinwa Eze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
| | - Chika Nwamma Onwasigwe
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
| |
Collapse
|
26
|
Saygın Avşar T, Jackson L, McLeod H. Potential for health economics to influence policies on tobacco use during pregnancy in low-income and middle-income countries: a qualitative case study. BMJ Open 2021; 11:e045624. [PMID: 34880008 PMCID: PMC8655542 DOI: 10.1136/bmjopen-2020-045624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Tobacco control during pregnancy is a policy priority in high-income countries (HICs) because of the significant health and inequality consequences. However, little evidence exists on interventions to reduce tobacco use in low-income and middle-income countries (LMICs), especially for pregnant women. This study aimed to assess how health economics evidence, which is mainly produced in HICs, could be adopted for tobacco cessation policies for pregnant women in LMICs. METHODS A qualitative case study was conducted in an international public health organisation. The organisation was chosen due to its capacity to influence health policies around the world. Tobacco control experts working in the organisation were identified through purposeful sampling and snowballing. Semistructured interviews were conducted with 18 informants with relevant experience of countries from all of the regions covered by the organisation. Data were analysed using the framework method. RESULTS In practice, tobacco cessation during pregnancy was not viewed as a priority in LMICs despite international recognition of the issue. In LMICs, factors including the recorded country-specific prevalence of tobacco use during pregnancy, availability of healthcare resources and the characteristics of potential interventions all affected the use of health economics evidence for policy making. CONCLUSION The scale of tobacco use among pregnant women might be greater than reported in LMICs. Health economics evidence produced in HICs has the potential to inform health policies in LMICs around tobacco cessation interventions if the country-specific circumstances are addressed. Economic evaluations of cessation interventions integrated into antenatal care with a household perspective would be especially relevant in LMICs.
Collapse
Affiliation(s)
- Tuba Saygın Avşar
- National Institute for Health Research Applied Research Collaboration (NIHR ARC) North Thames, Department of Applied Health Research, University College London, London, UK
| | - Louise Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Hugh McLeod
- Population Health Sciences, Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| |
Collapse
|
27
|
Miani C, Batram-Zantvoort S, Wandschneider L, Spallek J, Razum O. Potential of Standard Perinatal Data for Measuring Violation of Birth Integrity. Front Glob Womens Health 2021; 1:581244. [PMID: 34816160 PMCID: PMC8594012 DOI: 10.3389/fgwh.2020.581244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/10/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Measuring the phenomenon of violation of birth integrity (vBI) (e.g., obstetric violence) relies in part on the availability and content of maternity care providers' data. The population coverage and linkage possibilities that these data provide make for a yet untapped potential. Although vBI is a complex phenomenon best measured with dedicated instruments, we argue that maternity care providers' data could contribute to enhance our knowledge of the manifestations and frequency of vBI, and allow for analyses across different sub-groups of the population. Looking into the German standardized perinatal data, we investigate which variables are relevant to vBI-related research, and how complete their reporting is. Methods: First, we analyse state-of-the-art frameworks and recommendations, and, for each vBI-related domain, we search for and list corresponding variables in the perinatal data which could contribute to a better understanding of vBI issues. Second, we use an example and analyse the content of perinatal data obtained between 2013 and 2016 in the context of the BaBi birth cohort study set in Bielefeld, Germany. We use descriptive statistics to assess the completeness of the data. Results: The vBI-related variables can be classified in three main categories: discrimination based on specific patient socio-demographic attributes (e.g., height and weight to calculate BMI before pregnancy, foreign origin), indication for medical interventions (i.e., medicalization-related variables: indication for cesarean sections and induction), and supportive care, in particular the mobilization dimension (e.g., continuous fetal heartbeat monitoring). The data analyses included 876 births, of which 601 were vaginal birth. We found poor reporting on demographic variables in terms of completeness. Medicalization and mobilization variables are better documented, although limited in scope. Conclusions: Putting more emphasis on the completeness of standardized data could increase their potential for vBI-related research. Perinatal data alone are insufficient to assess vBI, but a broader, theory-informed discussion of indicators to be included in standardized datasets would contribute to capturing the different aspects of integrity violation in a more systematic way and expand the evidence-base on different types of vBI.
Collapse
Affiliation(s)
- Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
28
|
Ramsey K. Systems on the Edge: Developing Organizational Theory for the Persistence of Mistreatment in Childbirth. Health Policy Plan 2021; 37:400-415. [PMID: 34755181 DOI: 10.1093/heapol/czab135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/05/2021] [Accepted: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Mistreatment in childbirth is institutionalized in many healthcare settings globally, causing widespread harm. Rising concern has elicited research on its prevalence and characteristics, with limited attention to developing explanatory theory. Mistreatment, a complex systemic and behavioral phenomenon, requires social science theory to explain its persistence despite official norms that promote respectful care. Diane Vaughan's normalization of organizational deviance theory from organizational sociology, emerged from studies of how things go wrong in organizations. Its multi-level framework provided an opportunity for analogical cross-case comparison to elaborate theory on mistreatment as normalized organizational deviance. To elaborate the theory, the Tanzanian public health system in the period of 2010-2015 was selected as a case. A broad Scopus search identified 4,068 articles published on the health system and maternal health in Tanzania of which 122 were selected. Data was extracted using a framework based on the theory and reviews of mistreatment in healthcare. Relationships and patterns emerged through comparative analysis across concepts and system levels and then were compared with Vaughan's theory and additional organizational theories. Analysis revealed that normalized scarcity at the macro-level combined with production pressures for biomedical care and imbalanced power-dependence altered values, structures, and processes in the health system. Meso-level actors struggled to achieve production goals with limited autonomy and resources, resulting in workarounds and informal rationing. Biomedical care was prioritized, and emotion work was rationed in provider interactions with women, which many women experienced as disrespect. Analogical comparison with another case of organizational deviance based on literature enabled a novel approach to elaborate theory. The emergent theory sheds light on opportunities to transform systems and routinize respectful care. Theory application in additional settings and exploration of other social theories is needed for further understanding of this complex problem.
Collapse
Affiliation(s)
- Kate Ramsey
- Columbia University Mailman School of Public Health, Department of Population and Family Health, 60 Haven Avenue, New York, NY 10032, USA
| |
Collapse
|
29
|
Onchonga D, Keraka M, MoghaddamHosseini V, Várnagy Á. Does institutional maternity services contribute to the fear of childbirth? A focus group interview study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 30:100669. [PMID: 34583286 DOI: 10.1016/j.srhc.2021.100669] [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: 08/03/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The quality of institutional maternity services offered significantly determine the health outcomes of pregnant women and their infants. OBJECTIVES The study aimed at understanding perceptions and experiences of new mothers diagnosed with the fear of childbirth in Kenya; regarding the institutional maternity services offered and if they contribute to the fear of childbirth (FOC). METHODS This was a qualitative descriptive study. A total of 29 women who had given birth recently in a maternity institution, and had been screened with the fear of childbirth at 32 weeks' gestation period participated in focus group interviews. The Framework for Assessing the Quality of Care of institutional maternity services (FAQC) developed by the University of Southampton was adopted in this study. Thematic analyses were used. RESULTS It was reported that institutional maternity services contributed directly and indirectly to FOC. The direct contribution included the performance of unintended caesarian sections, severe and prolonged labour pains and negative attitude of healthcare providers. The indirect contribution was in form of challenges in the provision of care and the experience of care in the maternity institutions. In the provision of care; human and physical resources, inadequate referral systems, and inadequate management of emergencies were reported. In the experience of care; lack of cognition, respect, dignity, equity and inadequacies in emotional support were reported. CONCLUSION The study identified systemic challenges related to both the provision and the experience of care. Therefore, there is need to astutely analyze all critical steps identified in the FAQC, as this will greatly improve the uptake of institutional maternity services.
Collapse
Affiliation(s)
- David Onchonga
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Hungary; School of Public Health, Kenyatta University, Kenya.
| | | | - Vahideh MoghaddamHosseini
- Department of Midwifery, Faculty of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Ákos Várnagy
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Hungary
| |
Collapse
|
30
|
Taghizadeh Z, Ebadi A, Jaafarpour M. Childbirth violence-based negative health consequences: a qualitative study in Iranian women. BMC Pregnancy Childbirth 2021; 21:572. [PMID: 34412598 PMCID: PMC8377955 DOI: 10.1186/s12884-021-03986-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Violation of mothers' rights during childbirth is a global problem that often silently torments women in many parts of the world. The aim of this study was to explore negative health consequences due to childbirth violence based on mothers' perceptions and experiences. METHODS To achieve rich data, an exploratory qualitative study was carried out in 2019 on 26 women with childbirth violence experience who had given birth in hospitals of Ilam, Iran. Data were collected using semi‑structure in‑depth interviews (IDIs) and a purposive sampling. Participants were asked about their experiences and perceptions of negative health consequences due to childbirth violence. Data were analyzed by conventional content analysis based on Graneheim and Lundman approach. MAXQDA (v.18) software was used for better data management. RESULTS Final codes were classified into 9 sub-categories and 3 main categories including maternal and newborn injuries, weakening of family ties, sense of distrust and hatred. These findings emerged the theme: negative health consequences. CONCLUSIONS This study broke the silence of abused mothers during childbirth and expressed the perspective of mothers who suffered childbirth violence as a routine phenomenon in maternal care, and a serious threat to the health of mothers, newborns and families. Findings of this study can be a warning for maternity health system, monitoring and support structures as well as health policy-makers to seriously plan to prevent and eliminate this problem.
Collapse
Affiliation(s)
- Ziba Taghizadeh
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Molouk Jaafarpour
- Department of Reproductive Health, Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
31
|
Mengistu B, Alemu H, Kassa M, Zelalem M, Abate M, Bitewulign B, Mathewos K, Njoku K, Prose NS, Magge H. An innovative intervention to improve respectful maternity care in three Districts in Ethiopia. BMC Pregnancy Childbirth 2021; 21:541. [PMID: 34362332 PMCID: PMC8343890 DOI: 10.1186/s12884-021-03934-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from attending skilled birth. In Ethiopia, mistreatment occurs in up to 49.4% of mothers giving birth in health facilities. This study describes the development, implementation and results of interventions to improve respectful maternity care. As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed respectful maternity care training module with three core components: testimonial videos developed from key themes identified by staff as experiences of mothers, skills-building sessions on communication and onsite coaching. Respectful maternity care training was conducted in February 2017 in three districts within three regions. METHODS Facility level solutions applied to enhance the experience of care were documented. Safe Childbirth Checklist data measuring privacy and birth companion offered during labor and childbirth were collected over 27 months from 17 health centers and three hospitals. Interrupted time series and regression analysis were conducted to assess significance of improvement using secondary routinely collected programmatic data. RESULTS Significant improvement in the percentage of births with two elements of respectful maternal care-privacy and birth companionship offered- was noted in one district (with short and long-term regression coefficient of 18 and 27% respectively), while in the other two districts, results were mixed. The short-term regression coefficient in one of the districts was 26% which was not sustained in the long-term while in the other district the long-term coefficient was 77%. Testimonial videos helped providers to see their care from their clients' perspectives, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions. This includes organizing tour to the birthing ward and allowing cultural celebrations. CONCLUSION This study demonstrated effective way of improving respectful maternity care. Use of a multipronged approach, where the respectful maternity care intervention was embedded in quality improvement approach helped in enhancing respectful maternity care in a comprehensive manner.
Collapse
Affiliation(s)
- Birkety Mengistu
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia.
| | - Haregeweyni Alemu
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia
| | - Munir Kassa
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Mehiret Abate
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia
| | - Befikadu Bitewulign
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia
| | | | - Kendra Njoku
- Institute for Healthcare Improvement, Abuja, Nigeria
| | | | - Hema Magge
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
32
|
Lydon MM, Maruf F, Tappis H. Facility-level determinants of quality routine intrapartum care in Afghanistan. BMC Pregnancy Childbirth 2021; 21:438. [PMID: 34162347 PMCID: PMC8223289 DOI: 10.1186/s12884-021-03916-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there have been notable improvements in availability and utilization of maternal health care in Afghanistan over the last few decades, risk of maternal mortality remains very high. Previous studies have highlighted gaps in quality of emergency obstetric and newborn care practices, however, little is known about the quality of routine intrapartum care at health facilities in Afghanistan. METHODS We analyzed a subset of data from the 2016 Afghanistan Maternal and Newborn Health Quality of Care Assessment that comprised of observations of labor, delivery and immediate post-partum care, as well as health facility assessments and provider interviews across all accessible public health facilities with an average of five or more births per day in the preceding year (N = 77). Using the Quality of the Process of Intrapartum and Immediate Postpartum Care index, we calculated a quality of care score for each observation. We conducted descriptive and bivariate analyses and built a multivariate linear regression model to identify facility-level factors associated with quality of care scores. RESULTS Across 665 childbirth observations, low quality of care was observed such that no health facility type received an average quality score over 56%. The multivariate regression model indicated that availability of routine labor and delivery supplies, training in respectful maternity care, perceived gender equality for training opportunities, recent supervision, and observation during supervision have positive, statistically significant associations with quality of care. CONCLUSIONS Quality of routine intrapartum care at health facilities in Afghanistan is concerningly low. Our analysis suggests that multi-faceted interventions are needed to address direct and indirect contributors to quality of care including clinical care practices, attention to client experiences during labor and childbirth, and attention to staff welfare and opportunities, including gender equality within the health workforce.
Collapse
Affiliation(s)
| | - Farzana Maruf
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Global Financing Facility, World Bank Group, Kabul, Afghanistan
| | | |
Collapse
|
33
|
Collins CC, Rice H, Bai R, Brown PL, Bronson C, Farmer C. "I felt like it would've been perfect, if they hadn't been rushing": Black women's childbirth experiences with medical providers when accompanied by perinatal support professionals. J Adv Nurs 2021; 77:4131-4141. [PMID: 34137066 DOI: 10.1111/jan.14941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/01/2022]
Abstract
AIMS This study examined the nature and characteristics of Black women's interactions with medical providers during childbirth when accompanied by a perinatal support professional (PSP; similar to a doula). DESIGN The design was qualitative, and a phenomenological approach was employed to examine the meaning of women's experiences. METHODS We conducted in-depth interviews with 25 Black women enrolled in a perinatal support program in Cleveland, Ohio, in late 2017 and early 2018, exploring their interactions with medical providers, the meaning of their experiences, and the roles their PSPs played. RESULTS Clients broadly categorized experiences as positive or negative. When medical providers respected them, their birth plans and/or collaborated with PSPs, women reported more positive experiences. They associated negative experiences with providers having their own timelines and agendas, and women perceiving their needs were unheard and/or disrespected. CONCLUSION The findings emphasize the need for medical providers to be patient-centred, set aside assumptions, treat their patients as experts, value women's knowledge and voice, and treat patients and their supports as part of the team. IMPACT Findings support the importance of having a knowledgeable but non-medical support person present during birth. We discuss implications for how empowerment may be a tool to achieving better birth outcomes.
Collapse
Affiliation(s)
- Cyleste C Collins
- School of Social Work, Cleveland State University, Cleveland, OH, USA
| | - Heather Rice
- School of Nursing, Cleveland State University, Cleveland, OH, USA
| | - Rong Bai
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | | | | |
Collapse
|
34
|
Currie S, Natiq L, Anwari Z, Tappis H. Assessing respectful maternity care in a fragile, conflict-affected context: Observations from a 2016 national assessment in Afghanistan. Health Care Women Int 2021; 45:169-189. [PMID: 34126037 DOI: 10.1080/07399332.2021.1932890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 05/17/2021] [Indexed: 12/17/2022]
Abstract
Evidence on experiences and perceptions of care in pregnancy and childbirth in conflict-affected settings is limited. We interviewed 561 maternity care providers and observed 413 antenatal care consultations, 671 births, and 393 postnatal care consultations at public health facilities across Afghanistan. We found that healthcare providers work under stressed conditions with insufficient support, and most women receive mixed quality care. Understanding socio-cultural and contextual factors underpinning acceptance of mistreatment in childbirth, related to conflict, insecurity, gender and power dynamics, is critical for improving the quality of maternity care in Afghanistan and similar fragile and conflict affected settings.
Collapse
Affiliation(s)
- Sheena Currie
- Jhpiego, Technical Leadership Office, Baltimore, Maryland, USA
| | - Laila Natiq
- Jhpiego, Technical Leadership Office, Baltimore, Maryland, USA
- Independent Researcher, Alexandria, Virginia, USA
| | | | - Hannah Tappis
- Jhpiego, Technical Leadership Office, Baltimore, Maryland, USA
| |
Collapse
|
35
|
Mayra K, Matthews Z, Padmadas SS. Why do some health care providers disrespect and abuse women during childbirth in India? Women Birth 2021; 35:e49-e59. [PMID: 33678563 DOI: 10.1016/j.wombi.2021.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Disrespect and abuse during childbirth can result in fear of childbirth. Consequently, women may be discouraged to seek care, increasing the likelihood for women to choose elective cesarean section in order to avoid humiliation, postnatal depression and even maternal mortality. This study investigates the causes underlying mistreatment of women during childbirth by health care providers in India, where evidence of disrespect and abuse has been reported. METHODS Qualitative research was undertaken involving 34 in-depth interviews with midwifery and nursing leaders from India who represent administration, advocacy, education, regulation, research and service provision at state and national levels. Data are analysed thematically with NVivo12. The analysis added value by bringing an international perspective from interviews with midwifery leaders from Switzerland and the United Kingdom. FINDINGS The factors leading to disrespect and abuse of women relate to characteristics of both women and their midwives. Relevant woman-related attributes include her age, gender, physical appearance and education, extending to the social environment including her social status, family support, culture of abuse, myths around childbirth and sex-based discrimination. Midwife-related factors include gender, workload, medical hierarchy, bullying and powerlessness. DISCUSSION The intersectionality of factors associated with mistreatment during childbirth operate at individual, infrastructural, social and policy levels for both the women and nurse-midwives, and these factors could exacerbate existing gender-based inequalities. Maternal health policies should address the complex interplay of these factors to ensure a positive birthing experience for women in India. CONCLUSION Maternal health interventions could improve by integrating women-centred protocols and monitoring measures to ensure respectful and dignified care during childbirth.
Collapse
Affiliation(s)
- Kaveri Mayra
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, United Kingdom. https://www.twitter.com/myheroistrane
| | - Zoë Matthews
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, United Kingdom.
| | - Sabu S Padmadas
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, United Kingdom.
| |
Collapse
|
36
|
Oduenyi C, Banerjee J, Adetiloye O, Rawlins B, Okoli U, Orji B, Ugwa E, Ishola G, Betron M. Gender discrimination as a barrier to high-quality maternal and newborn health care in Nigeria: findings from a cross-sectional quality of care assessment. BMC Health Serv Res 2021; 21:198. [PMID: 33663499 PMCID: PMC7934485 DOI: 10.1186/s12913-021-06204-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor reproductive, maternal, newborn, child, and adolescent health outcomes in Nigeria can be attributed to several factors, not limited to low health service coverage, a lack of quality care, and gender inequity. Providers' gender-discriminatory attitudes, and men's limited positive involvement correlate with poor utilization and quality of services. We conducted a study at the beginning of a large family planning (FP) and maternal, newborn, child, and adolescent health program in Kogi and Ebonyi States of Nigeria to assess whether or not gender plays a role in access to, use of, and delivery of health services. METHODS We conducted a cross-sectional, observational, baseline quality of care assessment from April-July 2016 to inform a maternal and newborn health project in health facilities in Ebonyi and Kogi States. We observed 435 antenatal care consultations and 47 births, and interviewed 138 providers about their knowledge, training, experiences, working conditions, gender-sensitive and respectful care, and workplace gender dynamics. The United States Agency for International Development's Gender Analysis Framework was used to analyze findings. RESULTS Sixty percent of providers disagreed that a woman could choose a family planning method without a male partner's involvement, and 23.2% of providers disagreed that unmarried clients should use family planning. Ninety-eight percent believed men should participate in health services, yet only 10% encouraged women to bring their partners. Harmful practices were observed in 59.6% of deliveries and disrespectful or abusive practices were observed in 34.0%. No providers offered clients information, services, or referrals for gender-based violence. Sixty-seven percent reported observing or hearing of an incident of violence against clients, and 7.9% of providers experienced violence in the workplace themselves. Over 78% of providers received no training on gender, gender-based violence, or human rights in the past 3 years. CONCLUSION Addressing gender inequalities that limit women's access, choice, agency, and autonomy in health services as a quality of care issue is critical to reducing poor health outcomes in Nigeria. Inherent gender discrimination in health service delivery reinforces the critical need for gender analysis, gender responsive approaches, values clarification, and capacity building for service providers.
Collapse
Affiliation(s)
- Chioma Oduenyi
- Maternal and Child Survival Program and Jhpiego, Abuja, Plot 971 Reuben Okoya Crescent, Wuye District, P.O. Box 14832, Abuja, FCT, Nigeria.
| | - Joya Banerjee
- Maternal and Child Survival Program and Jhpiego, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Oniyire Adetiloye
- Maternal and Child Survival Program and Jhpiego, Abuja, Plot 971 Reuben Okoya Crescent, Wuye District, P.O. Box 14832, Abuja, FCT, Nigeria
| | - Barbara Rawlins
- Maternal and Child Survival Program and Jhpiego, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Ugo Okoli
- Maternal and Child Survival Program and Jhpiego, Abuja, Plot 971 Reuben Okoya Crescent, Wuye District, P.O. Box 14832, Abuja, FCT, Nigeria
| | - Bright Orji
- Maternal and Child Survival Program and Jhpiego, Abuja, Plot 971 Reuben Okoya Crescent, Wuye District, P.O. Box 14832, Abuja, FCT, Nigeria
| | - Emmanuel Ugwa
- Maternal and Child Survival Program and Jhpiego, Abuja, Plot 971 Reuben Okoya Crescent, Wuye District, P.O. Box 14832, Abuja, FCT, Nigeria
| | - Gbenga Ishola
- Maternal and Child Survival Program and Jhpiego, Abuja, Plot 971 Reuben Okoya Crescent, Wuye District, P.O. Box 14832, Abuja, FCT, Nigeria
| | - Myra Betron
- Maternal and Child Survival Program and Jhpiego, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| |
Collapse
|
37
|
Doyle K, Kazimbaya S, Levtov R, Banerjee J, Betron M, Sethi R, Kayirangwa MR, Vlahovicova K, Sayinzoga F, Morgan R. The relationship between inequitable gender norms and provider attitudes and quality of care in maternal health services in Rwanda: a mixed methods study. BMC Pregnancy Childbirth 2021; 21:156. [PMID: 33622278 PMCID: PMC7903699 DOI: 10.1186/s12884-021-03592-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/27/2021] [Indexed: 01/18/2023] Open
Abstract
Background Rwanda has made great progress in improving reproductive, maternal, and newborn health (RMNH) care; however, barriers to ensuring timely and full RMNH service utilization persist, including women’s limited decision-making power and poor-quality care. This study sought to better understand whether and how gender and power dynamics between providers and clients affect their perceptions and experiences of quality care during antenatal care, labor and childbirth. Methods This mixed methods study included a self-administered survey with 151 RMNH providers with questions on attitudes about gender roles, RMNH care, provider-client relations, labor and childbirth, which took place between January to February 2018. Two separate factor analyses were conducted on provider responses to create a Gender Attitudes Scale and an RMNH Quality of Care Scale. Three focus group discussions (FGDs) conducted in February 2019 with RMNH providers, female and male clients, explored attitudes about gender norms, provision and quality of RMNH care, provider-client interactions and power dynamics, and men’s involvement. Data were analyzed thematically. Results Inequitable gender norms and attitudes – among both RMNH care providers and clients – impact the quality of RMNH care. The qualitative results illustrate how gender norms and attitudes influence the provision of care and provider-client interactions, in addition to the impact of men’s involvement on the quality of care. Complementing this finding, the survey found a relationship between health providers’ gender attitudes and their attitudes towards quality RMNH care: gender equitable attitudes were associated with greater support for respectful, quality RMNH care. Conclusions Our findings suggest that gender attitudes and power dynamics between providers and their clients, and between female clients and their partners, can negatively impact the utilization and provision of quality RMNH care. There is a need for capacity building efforts to challenge health providers’ inequitable gender attitudes and practices and equip them to be aware of gender and power dynamics between themselves and their clients. These efforts can be made alongside community interventions to transform harmful gender norms, including those that increase women’s agency and autonomy over their bodies and their health care, promote uptake of health services, and improve couple power dynamics. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03592-0.
Collapse
Affiliation(s)
- Kate Doyle
- Promundo-US, 1367 Connecticut Avenue, NW, Suite 310, Washington, DC, 20036, USA.
| | - Shamsi Kazimbaya
- Promundo-US, 1367 Connecticut Avenue, NW, Suite 310, Washington, DC, 20036, USA
| | - Ruti Levtov
- Promundo-US, 1367 Connecticut Avenue, NW, Suite 310, Washington, DC, 20036, USA.,Present Address: The Prevention Collaborative, Washington, DC, USA
| | - Joya Banerjee
- Present Address: The Prevention Collaborative, Washington, DC, USA.,Present Address: CARE, 1899 L St NW #500, Washington, DC, 20036, USA
| | - Myra Betron
- Maternal and Child Survival Program/Jhpiego, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Reena Sethi
- Maternal and Child Survival Program/Jhpiego, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Marie Rose Kayirangwa
- Maternal and Child Survival Program/Jhpiego, 8 Avenue, Rwanda National Police (RNP Road), Kigali, Rwanda
| | | | - Felix Sayinzoga
- Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| |
Collapse
|
38
|
Oliveira CDF, Ribeiro AÂV, Luquine Jr. CD, de Bortoli MC, Toma TS, Chapman EMG, Barreto JOM. Barriers to implementing guideline recommendations to improve childbirth care: a rapid review of evidence. Rev Panam Salud Publica 2021; 45:e7. [PMID: 33643394 PMCID: PMC7898361 DOI: 10.26633/rpsp.2021.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/18/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To identify potential barriers to the implementation of the National Childbirth Guidelines in Brazil based on the best available global evidence. METHOD A rapid review of evidence was performed in six databases in March/April 2019. Secondary studies published in English, Spanish, or Portuguese with a focus on barriers of any nature relating to the implementation of the Guidelines were retrieved. RESULTS Twenty-three documents (21 reviews and two practice guides) were included in the review. The barriers identified were grouped into 52 meaning categories and then reorganized into nine thematic clusters: delivery and childbirth care model, human resource management, knowledge and beliefs, gender relations, health care service management, attitudes and behaviors, communication, socioeconomic conditions, and political interests. CONCLUSIONS The results show that combined approaches may be required to address different barriers to the implementation of the Guidelines. For successful implementation, it is essential to engage health care leaders, professionals, and users in the effort to change the delivery and childbirth care model. Also necessary is the development of intersectoral initiatives to improve the socioeconomic conditions of women and families and to curtail gender inequalities.
Collapse
Affiliation(s)
- Cintia de Freitas Oliveira
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Aline Ângela Victoria Ribeiro
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Cézar D. Luquine Jr.
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Maritsa Carla de Bortoli
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Tereza Setsuko Toma
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | | | - Jorge Otávio Maia Barreto
- Fundação Oswaldo Cruz (Fiocruz)Brasília (DF)BrazilFundação Oswaldo Cruz (Fiocruz), Brasília (DF), Brazil.
| |
Collapse
|
39
|
Provision of respectful maternal care by midwives during childbirth in health facilities in Lagos State, Nigeria: A qualitative exploratory inquiry. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
40
|
Oliveira CDF, Ribeiro AÂV, Luquine Jr. CD, de Bortoli MC, Toma TS, Chapman EMG, Barreto EJOM. [Barriers to implementing guideline recommendations to improve childbirth care: rapid review of evidenceObstáculos a la aplicación de las recomendaciones para la atención del parto normal: revisión rápida de evidencia]. Rev Panam Salud Publica 2020; 44:e132. [PMID: 33337446 PMCID: PMC7737641 DOI: 10.26633/rpsp.2020.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/18/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To identify potential barriers to the implementation of the National Childbirth Guidelines in Brazil based on the best available global evidence. METHOD A rapid review of evidence was performed in six databases in March/April 2019. Secondary studies published in English, Spanish, or Portuguese with a focus on barriers of any nature relating to the implementation of the Guidelines were retrieved. RESULTS Twenty-three documents (21 reviews and two practice guides) were included in the review. The barriers identified were grouped into 52 meaning categories and then reorganized into nine thematic clusters: delivery and childbirth care model, human resource management, knowledge and beliefs, gender relations, health care service management, attitudes and behaviors, communication, socioeconomic conditions, and political interests. CONCLUSIONS The results show that combined approaches may be required to address different barriers to the implementation of the Guidelines. For successful implementation, it is essential to engage health care leaders, professionals, and users in the effort to change the delivery and childbirth care model. Also necessary is the development of intersectoral initiatives to improve the socioeconomic conditions of women and families and to curtail gender inequalities.
Collapse
Affiliation(s)
- Cintia de Freitas Oliveira
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Aline Ângela Victoria Ribeiro
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Cézar D. Luquine Jr.
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Maritsa Carla de Bortoli
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Tereza Setsuko Toma
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | | | | |
Collapse
|
41
|
Ravindran TKS, Govender V. Sexual and reproductive health services in universal health coverage: a review of recent evidence from low- and middle-income countries. Sex Reprod Health Matters 2020; 28:1779632. [PMID: 32530387 PMCID: PMC7887992 DOI: 10.1080/26410397.2020.1779632] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
If universal health coverage (UHC) cannot be achieved without the sexual and reproductive health (SRH) needs of the population being met, what then is the current situation vis-à-vis universal coverage of SRH services, and the extent to which SRH services have been prioritised in national UHC plans and processes? This was the central question that guided this critical review of more than 200 publications between 2010 and 2019. The findings are the following. The Essential Package of Healthcare Services (EPHS) across many countries excludes several critical SRH services (e.g. safe abortion services, reproductive cancers) that are already poorly available. Inadequate international and domestic public funding of SRH services contributes to a sustained burden of out-of-pocket expenditure (OOPE) and inequities in access to SRH services. Policy and legal barriers, restrictive gender norms and gender-based inequalities challenge the delivery and access to quality SRH services. The evidence is mixed as to whether an expanded role and scope of the private sector improves availability and access to services of underserved populations. As momentum gathers towards SRH and UHC, the following actions are necessary and urgent. Advocacy for greater priority for SRH in government EPHS and health budgets aligned with SRH and UHC goals is needed. Implementation of stable and sustained financing mechanisms that would reduce the proportion of SRH-financing from OOPE is a priority. Evidence, moving from descriptive towards explanatory studies which provide insights into the "hows" and "whys" of processes and pathways are essential for guiding policy and programme actions.
Collapse
Affiliation(s)
- T. K. Sundari Ravindran
- Principal Visiting Fellow, United Nations University, International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Veloshnee Govender
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
42
|
Butler MM, Fullerton J, Aman C. Competencies for respectful maternity care: Identifying those most important to midwives worldwide. Birth 2020; 47:346-356. [PMID: 32052494 DOI: 10.1111/birt.12481] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/01/2020] [Accepted: 01/01/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND A respectful, person-centered philosophy of maternity care has been emerging over several decades. Research conducted on behalf of the International Confederation of Midwives (ICM) to identify essential competencies for midwifery practice also identified the knowledge, skills, and professional behaviors that should be hallmarks of respectful maternity care practices among the global community of midwives. METHODS A three-round, online, modified Delphi survey was conducted between April 2016 and October 2016. A total of 895 individuals from 90 of the then-current 105 ICM member countries participated, with good representation across English, French, and Spanish speakers, high-income, medium-income, and low-income countries, and educators and clinicians. RESULTS A total of 115 respectful maternity care (RMC)-related items were endorsed by participants in Round 1 or 2. These items received average scores of between 90.24% and 99.10%, well above the 85% threshold required to be identified as within the scope of global midwifery practice. These items were compared with the 12 domains of RMC identified by Shakibazadeh and colleagues that defined respectful care during childbirth in health facilities globally, and with similar RMC frameworks, and were found to be highly congruent, thus demonstrating the high value of RMC within the core of midwifery practice. DISCUSSION ICM survey items were endorsed across all 12 RMC domains proposed by Shakibazadeh et al, and the findings affirmed that across ICM countries and regions, the philosophy of RMC was integrally related to the knowledge, skills, and professional behaviors that emerged as essential for basic midwifery practice.
Collapse
Affiliation(s)
- Michelle M Butler
- Faculty of Science and Health, Dublin City University, Dublin 9, Ireland
| | - Judith Fullerton
- University of California San Diego School of Medicine, San Diego, CA, USA
| | - Cheryl Aman
- University of British Columbia Division of Midwifery, Vancouver, BC, Canada
| |
Collapse
|
43
|
Hulsbergen M, van der Kwaak A. The influence of quality and respectful care on the uptake of skilled birth attendance in Tanzania. BMC Pregnancy Childbirth 2020; 20:681. [PMID: 33176709 PMCID: PMC7656707 DOI: 10.1186/s12884-020-03278-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND An increase in the uptake of skilled birth attendance is expected to reduce maternal mortality in low- and middle-income countries. In Tanzania, the proportion of deliveries assisted by a skilled birth attendant is only 64% and the maternal mortality ratio is still 398/100.000 live births. This article explores different aspects of quality of care and respectful care in relation to maternal healthcare. It then examines the influence of these aspects of care on the uptake of skilled birth attendance in Tanzania in order to offer recommendations on how to increase the skilled birth attendance rate. METHODS This narrative review employed the "person-centered care framework for reproductive health equity" as outlined by Sudhinaraset (2017). Academic databases, search engines and websites were consulted, and snowball sampling was used. Full-text English articles from the last 10 years were included. RESULTS Uptake of skilled birth attendance was influenced by different aspects of technical quality of maternal care as well as person-centred care, and these factors were interrelated. For example, disrespectful care was linked to factors which made the working circumstances of healthcare providers more difficult such as resource shortages, low levels of integrated care, inadequate referral systems, and bad management. These issues disproportionately affected rural facilities. However, disrespectful care could sometimes be attributed to personal attitudes and discrimination on the part of healthcare providers. Dissatisfied patients responded with either quiet acceptance of the circumstances, by delivering at home with a traditional birth attendant, or bypassing to other facilities. Best practices to increase respectful care show that multi-component interventions are needed on birth preparedness, attitude and infrastructure improvement, and birth companionship, with strong management and accountability at all levels. CONCLUSIONS To further increase the uptake of skilled birth attendance, respectful care needs to be addressed within strategic plans. Multi-component interventions are required, with multi-stakeholder involvement. Participation of traditional birth attendants in counselling and referral can be considered. Future advances in information and communication technology might support improved quality of care.
Collapse
Affiliation(s)
- Myrrith Hulsbergen
- Royal Tropical Institute (KIT), Amsterdam, the Netherlands.
- Women's Healthcare Center (WHC), Amsterdam, the Netherlands.
| | - Anke van der Kwaak
- Royal Tropical Institute (KIT), Amsterdam, the Netherlands
- Vrije Universiteit (VU), Amsterdam, the Netherlands
| |
Collapse
|
44
|
Tato Nyirenda H, Nyirenda T, Choka N, Agina P, Kuria S, Chengo R, B C Nyirenda H, Mubita B. Abuse and disrespectful care on women during access to antenatal care services and its implications in Ndola and Kitwe health facilities. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 26:100554. [PMID: 33032165 DOI: 10.1016/j.srhc.2020.100554] [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: 02/13/2020] [Revised: 08/06/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Antenatal care utilization is fundamental in preventing adverse pregnancy and birth outcomes. This paper assessed abuse and disrespectful care on women during access to antenatal care services and its implications in Ndola and Kitwe districts of Zambia. METHODS The assessment used a cross-sectional study design with a sample size of 505 women of child bearing age (15-49). Eighteen (18) high volume health facilities were identified as benchmarks for catchment areas (study sites) and using cluster sampling, households within catchment areas of health facilities were sampled. Chi-square and poison regression analysis was performed to ascertain associations between abuse and disrespect and antenatal care utilization. RESULTS One third (33%) of the participants attended less than half of the recommended antenatal visits. Results reveal a statistical significant association between; physical abuse (p value = 0.039); not being allowed to assume position of choice during examination (p value = 0.021); not having privacy during examination (p value = 0.006) and antenatal care service utilization. The difference in the logs of expected count on the number of antenatal care visits is expected to be; 0.066 (CI: -0.115,-0.018) unit lower for women who experienced lack of privacy during examinations; 0.067 (CI: -0.131,-0.004) unit lower for women who were discriminated based on specific attributes and 0.067 (CI: -0.120,-0.014) unit lower for women who were left unattended. CONCLUSION Abuse and disrespect during antenatal care service impedes demand for health care and service utilization thereby barricading the element of the package of services aimed at improving maternal and newborn health.
Collapse
Affiliation(s)
- Herbert Tato Nyirenda
- Copperbelt University, School of Medicine, Department of Clinical Sciences, Public Health Unit, P.O Box 71191, Ndola, Zambia.
| | - Tambulani Nyirenda
- The University of Zambia, School of Humanities and Social Sciences, Department of Political and Administrative Studies, P.O Box 32379, Lusaka, Zambia
| | - Nancy Choka
- The University of Zambia, School of Humanities and Social Sciences, Department of Population Studies, P.O Box 32379, Lusaka, Zambia
| | - Paul Agina
- Amref Health Africa- Kenya. Wilson Airport, PO Box 18617, 00500 Nairobi, Kenya
| | - Shiphrah Kuria
- Amref Health Africa- Kenya. Wilson Airport, PO Box 18617, 00500 Nairobi, Kenya.
| | - Rehema Chengo
- Amref Health Africa- Kenya. Wilson Airport, PO Box 18617, 00500 Nairobi, Kenya.
| | - Herbert B C Nyirenda
- The University of Zambia, School of Education, Department of Adult Education and Extension Studies, P.O Box 80406, Kabwe, Zambia
| | - Brenda Mubita
- Amref Health Africa-Zambia. Copperbelt Provincial Health Office Ndola, Zambia
| |
Collapse
|
45
|
Siyoum M, Astatkie A, Tenaw Z, Abeje A, Melese T. Respectful family planning service provision in Sidama zone, Southern Ethiopia. PLoS One 2020; 15:e0238653. [PMID: 32886923 PMCID: PMC7473780 DOI: 10.1371/journal.pone.0238653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/20/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Disrespect and abusive care is a violation of women's basic human rights and it is serious global problem that needs urgent intervention. Poor quality client-provider interaction is commonly reported from family planning programmes. In Ethiopia, disrespect and abusive care is very common (21-78%) across health facilities. OBJECTIVE To assess the status of respectful family planning service (client-provider interaction) in Sidama zone, south Ethiopia. METHODOLOGY Health facility-based cross-sectional study was conducted from June to August 2018. Data were collected from 920 family planning clients recruited from 40 randomly selected health facilities. The Mother on Respect index (MORi) questionnaire was used to collect the data through client exit interview. Partial proportional odds ordinal regression was employed to identify determinants of respectful family planning service. RESULT Among family planning clients, the level of respectful family planning service was found to be zero (0%) in the very low respect category, 75(18.5%) in the low respect category, 382(41.52%) in moderate respect category and 463(50.33%) in high respect category. Being a short acting method client (AOR = 0.30, 95%CI [0.12, 0.72]), being an uneducated client (AOR = 0.39, 95%CI [0.25, 0.61]) or a client with elementary education (AOR = 0.41, 95%CI [0.23, 0.73]), client's poverty (AOR = 0.75, 95%CI [0.56, 0.99]), and long waiting time (AOR = 0.46, 95%CI [0.30, 0.69])significantly reduced the odds of moderate and high respect compared to low respect. Conversely, preference of male service providers, service providers' work satisfaction and health workers' prior training on respectful care significantly increased the odds of moderate and high respect. CONCLUSION Considering the current strategy of zero tolerance for disrespect and abuse in Ethiopia, the level of respectful care in this study is sub-optimal. Short term training for service providers on respectful care seems valuable to enhance the level of respectful care for family planning clients irrespective of their socioeconomic background.
Collapse
Affiliation(s)
- Melese Siyoum
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- * E-mail:
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Zelalem Tenaw
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Abebaw Abeje
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Teshome Melese
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| |
Collapse
|
46
|
Mattison CA, Lavis JN, Wilson MG, Hutton EK, Dion ML. A critical interpretive synthesis of the roles of midwives in health systems. Health Res Policy Syst 2020; 18:77. [PMID: 32641053 PMCID: PMC7346500 DOI: 10.1186/s12961-020-00590-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Midwives' roles in sexual and reproductive health and rights continues to evolve. Understanding the profession's role and how midwives can be integrated into health systems is essential in creating evidence-informed policies. Our objective was to develop a theoretical framework of how political system factors and health systems arrangements influence the roles of midwives within the health system. METHODS A critical interpretive synthesis was used to develop the theoretical framework. A range of electronic bibliographic databases (CINAHL, EMBASE, Global Health database, HealthSTAR, Health Systems Evidence, MEDLINE and Web of Science) was searched through to 14 May 2020 as were policy and health systems-related and midwifery organisation websites. A coding structure was created to guide the data extraction. RESULTS A total of 4533 unique documents were retrieved through electronic searches, of which 4132 were excluded using explicit criteria, leaving 401 potentially relevant records, in addition to the 29 records that were purposively sampled through grey literature. A total of 100 documents were included in the critical interpretive synthesis. The resulting theoretical framework identified the range of political and health system components that can work together to facilitate the integration of midwifery into health systems or act as barriers that restrict the roles of the profession. CONCLUSIONS Any changes to the roles of midwives in health systems need to take into account the political system where decisions about their integration will be made as well as the nature of the health system in which they are being integrated. The theoretical framework, which can be thought of as a heuristic, identifies the core contextual factors that governments can use to best leverage their position when working to improve sexual and reproductive health and rights.
Collapse
Affiliation(s)
- Cristina A Mattison
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada.
| | - John N Lavis
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada
| | - Michelle L Dion
- Department of Political Science, McMaster University, 1280 Main St. West, KTH-533, Hamilton, ON, L8S 4M4, Canada
| |
Collapse
|
47
|
Hawke M. Subversive acts and everyday midwifery: Feminism in content and context. Women Birth 2020; 34:e92-e96. [PMID: 32593541 DOI: 10.1016/j.wombi.2020.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Midwives are often at the forefront of political campaigns for women's empowerment, overtly advocating for women's rights and reproductive justice. However, midwives can also be found engaging in inadvertent activism on a daily basis within routine care. When casting a feminist lens over both the content and context of midwifery practice in Australia, subversive acts and opportunities for feminist reform can be found. AIM To interrogate the significance of feminism in midwifery practice, identifying feminist successes and further opportunities for implementation including: analysis of the Midwifery Standards for Practice; the primary tenets of woman-centred care; the content versus context of midwifery in Australia; and feminist opportunities for enhanced practice. This paper will discuss the importance of feminism in midwifery practice and its significance in informing optimal midwifery care. DISCUSSION Incorporating women's voice and respecting women's bodies and agency in the delivery of care is a fundamental component of midwifery practice. However, while the content of midwifery practice is innately feminist in its emphasis on woman-centred care, it will be argued that the context of birthing in Australia is not. The resultant effect is the emergence of victim blaming in maternity care and the construction of an archetypal 'good birthing woman'. IMPLICATIONS AND RECOMMENDATIONS Moving away from the myth of the 'good birthing woman' and the act of victim blaming, midwifery could instead direct its focus towards challenging the rigid systems and structures within which midwives implement care. By further embracing feminist principles midwives will ensure a truly woman-centred future.
Collapse
|
48
|
Malet S, Choux C, Akrich M, Simon E, Sagot P. [Mistreatment during childbirth: A prospective multicentric survey among women in maternities in Burgundy]. ACTA ACUST UNITED AC 2020; 48:790-799. [PMID: 32376481 DOI: 10.1016/j.gofs.2020.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The purpose of this study was to estimate the prevalence of mistreatment during childbirth (MDCB), to assess the subjective experience of women and to identify the factors associated with MDCB. METHODS This prospective multicentered study included every single public maternity of the Burgundy Perinatal Network from the 15th of February to the 15th of March 2019. An anonymous questionnaire was distributed on postpartum's second day. It encompassed the following categories of MDCB: verbal, physical abuse, information, consent, failure to meet professional standards of care (PSC), poor rapport between women and providers (PRBWP), and discrimination, as well as the subjective experience, physical and psychological. RESULTS Out of 1793 eligible women, 1149 answered (64.1%). Women reported a positive experience of childbirth, physical (89.8%) and psychological (93.4%). On the other hand, 506 women (44%) reported MDCB. The incidence of verbal (2.3%) or physical (0.4%) abuse or discrimination (3.5%) was marginal. MDCB reported was mainly a lack of research and/or respect of consent (21.5%), lack of satisfying information for at least one procedure (14.4%), declaration of lack of respect of PSC (24.2%), PRBWP (11.1%). When the subjective experience of childbirth was negative on the physical aspect, one MDCB was declared in 80% of cases (P<0.01). CONCLUSIONS This study highlights the importance of involving women in care's decisions. We should systematize the information and seeking of consent in a dynamic way and promote free choice for women.
Collapse
Affiliation(s)
- S Malet
- Service de gynécologie-obstétrique, CHU de Dijon Bourgogne, 14, rue Gaffarel, 21000 Dijon, France
| | - C Choux
- Service de gynécologie-obstétrique, CHU de Dijon Bourgogne, 14, rue Gaffarel, 21000 Dijon, France.
| | - M Akrich
- Collectif interassociatif autour de la naissance - CIANE, 40, rue Chanzy, 75011 Paris, France
| | - E Simon
- Service de gynécologie-obstétrique, CHU de Dijon Bourgogne, 14, rue Gaffarel, 21000 Dijon, France
| | - P Sagot
- Service de gynécologie-obstétrique, CHU de Dijon Bourgogne, 14, rue Gaffarel, 21000 Dijon, France
| |
Collapse
|
49
|
Silveira MF, Mesenburg MA, Bertoldi AD, De Mola CL, Bassani DG, Domingues MR, Stein A, Coll CVN. The association between disrespect and abuse of women during childbirth and postpartum depression: Findings from the 2015 Pelotas birth cohort study. J Affect Disord 2019; 256:441-447. [PMID: 31252237 PMCID: PMC6880287 DOI: 10.1016/j.jad.2019.06.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/23/2019] [Accepted: 06/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study examined the association between disrespect and abuse of women during facility-based childbirth and postpartum depression (PD) occurrence. METHODS We used data from the 2015 Pelotas (Brazil) Birth Cohort, a population-based cohort of all live births in the city. We assessed 3065 mothers at pregnancy and 3-months after birth. Self-reported disrespect and abuse experiences included physical abuse, verbal abuse, denial of care, and undesired procedures. We estimate the occurrence of each disrespect and abuse type, one or more types and disrespect and abuse score. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PD. EPDS scores ≥13 and ≥15 indicated at least moderate PD and marked/severe. Odds ratios (OR) were calculated by logistic regression. RESULTS The prevalence of at least moderate PD and marked/severe PD was 9.4% and 5.7%, respectively. 18% of the women experienced at least one type of disrespect and abuse. Verbal abuse increased the odds of having at least moderate PD (OR = 1.58; 95%CI 1.06-2.33) and marked/severe PD (OR = 1.69; 95%CI 1.06-2.70) and the effect among women who did not experience antenatal depressive symptoms was greater in comparison to those who did (OR = 2.51; 95%CI 1.26-5.04 and OR = 4.27; 95%CI 1.80-10.12). Physical abuse increased the odds of having marked/severe PD (OR = 2.28; 95%CI 1.26-4.12). Having experienced three or more mistreatment types increased the odds of at least moderate PD (OR = 2.90; 95%CI 1.30 - 35.74) and marked/severe PD (OR=3.86; 95%CI 1.58-9.42). LIMITATIONS Disrespect and abuse experiences during childbirth were self-reported. CONCLUSIONS Disrespect and abuse during childbirth increased the odds of PD three months after birth. Strategies to promote high quality and respectful maternal health care are needed to prevent mother-child adverse outcomes.
Collapse
Affiliation(s)
- Mariangela Freitas Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160, 3° andar, Pelotas CEP 96020-220, Brazil
| | - Marilia Arndt Mesenburg
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160, 3° andar, Pelotas CEP 96020-220, Brazil.
| | - Andrea Damaso Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160, 3° andar, Pelotas CEP 96020-220, Brazil
| | - Christian Loret De Mola
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160, 3° andar, Pelotas CEP 96020-220, Brazil; Postgraduate Program in Public Health, Federal University of Rio Grande, Brazil
| | - Diego Garcia Bassani
- Centre for Global Child Health, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto ON M5G 1×8, Canada
| | - Marlos Rodrigues Domingues
- Postgraduate Program in Physical Education, Federal University of Pelotas, Rua Luiz de Camões, n° 625, Pelotas CEP 96055-630, Brazil
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Oxford OX3 7JX, UK
| | - Carolina V N Coll
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160, 3° andar, Pelotas CEP 96020-220, Brazil; International Center for Equity in Health, Federal University of Pelotas, Brazil
| |
Collapse
|
50
|
Morton CH, Simkin P. Can respectful maternity care save and improve lives? Birth 2019; 46:391-395. [PMID: 31273848 DOI: 10.1111/birt.12444] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 06/09/2019] [Indexed: 01/17/2023]
|