Operationalizing respectful maternity care at the healthcare provider level: a systematic scoping review

Black Women's Maternal Health: Insights From Community Based Participatory Research in Newark, New Jersey

This study on Black women's maternal health engaged a group of six community members in a community based participatory research project in a state with one of the largest racial disparities in maternal mortality and severe maternal morbidity in the United States. The community members conducted 31 semi-structured interviews with other Black women who had given birth within the past 3 years to examine their experiences throughout the perinatal and post-partum period. Four main themes emerged: (1) challenges related to the structure of healthcare, including insurance gaps, long wait times, lack of co-location of services, and financial challenges for both insured and uninsured people; (2) negative experiences with healthcare providers, including dismissal of concerns, lack of listening, and missed opportunities for relationship building; (3) preference for racial concordance with providers and experiences with discrimination across multiple dimensions; and (4) mental health concerns and lack of social support. CBPR is a research methodology that could be more widely deployed to illuminate the experiences of community members in order to develop solutions to complex problems. The results indicate that Black women's maternal health will benefit from multi-level interventions with changes driven by insights from Black women.

Healthcare providers' perspectives on sustaining respectful maternity care appreciated by mothers in five hospitals of Rwanda

BACKGROUND

Childbirth reserves respect, as emphasized by the World Health Organization in 2018, and the focus towards the need for positive, dignified delivery experiences has become an integral aspect of Respectful Maternity Care (RMC). It is a known fact that RMC is pivotal for favourable birth outcomes and contributes to the satisfaction of maternity care. The absence of RMC negatively affects women's and newborns' rights. The study aimed to explore healthcare providers' perspectives on sustaining RMC actions that mothers previously reported.

METHODOLOGY

This study was conducted in five hospitals in the Eastern province of Rwanda, involving 5 Focus Group Discussions (FGDs) with midwives and nurses. For interviews, we purposively selected 5-unit managers and five physicians. Additionally, 40 midwives and nurses were recruited for the FGDs. The research utilized the Dream phase of Appreciative Inquiry (AI) for interviews and Focus Groups. Data collection aimed to gain insights into Healthcare Providers' perceptions of how RMC is provided and how to establish and sustain RMC in Rwandan health facilities. Nvivo 12 was employed for organizing codes and creating a codebook, and thematic analysis was applied.

RESULTS

Four themes with sub-themes emerged. Namely, 1) Women-centered care, with Compassionate care, Privacy and confidentiality maintenance, Information provision and Liberty in decision making, Effective communication, Family involvement, Cleanliness, and Equality care. 2) Professionalism compliance with Motivated staff, Teamwork, Continuous development, Quality work provision, and Community trust. 3) RMC encounters 4) RMC sustenance.

CONCLUSION AND RECOMMENDATIONS

The continuous pursuit of high RMC standards in Rwanda involves improving childbirth experiences through utilizing existing resources, ongoing improvement, and sustaining achievements. Key recommended actions in this study for sustaining RMC encompass promoting women-centred care, enhancing healthcare provider attitudes, ensuring professionalism, building community trust, maintaining conducive health facility environments, and involving leadership.

A case study analysis of a successful birth center in northern Uganda

BACKGROUND

Mothers and infants continue to die at alarming rates throughout the Global South. Evidence suggests that high-quality midwifery care significantly reduces preventable maternal and neonatal morbidity and mortality. This paper uses a case study approach to describe the social and institutional model at one birth center in Northern Uganda where, in over 20,000 births, there have been no maternal deaths and the neonatal mortality rate is 11/1000-a rate that is lower than many high-resource countries.

METHODS

This case study combined institutional ethnographic and narrative methods to explore key maternal and neonatal outcomes. The sample included birthing people who intended to or had given birth at the center, as well as the midwives, staff, stakeholders, and community health workers affiliated with the center. Data were collected through individual and small group interviews, participant observation, field notes, data and document reviews. Iterative and systematic analytical steps were followed, and all data were organized and managed with Atlas.ti software.

RESULTS

Findings describe the setting, an overview of the birth center's history, how it is situated within the community, its staffing, administration, clinical outcomes, and model of care. A synthesis of contextual variables and key outcomes as they relate to the components of the evidence-informed Quality Maternal and Newborn Care (QMNC) framework are presented. Three overarching themes were identified: (a) community knowledge and understanding, (b) community integrated care, and (c) quality care that is respectful, accessible, and available.

CONCLUSIONS

This birth center is an example of care that embodies the findings and anticipated outcomes described in the QMNC framework. Replication of this model in other childbearing settings may help alleviate unnecessary perinatal morbidity and mortality.

Women's experiences of disrespect and abuse in Swiss facilities during the COVID-19 pandemic: a qualitative analysis of an open-ended question in the IMAgiNE EURO study

BACKGROUND

The COVID-19 pandemic has challenged the provision of maternal care. The IMAgiNE EURO study investigates the Quality of Maternal and Newborn Care during the pandemic in over 20 countries, including Switzerland.

AIM

This study aims to understand women's experiences of disrespect and abuse in Swiss health facilities during the COVID-19 pandemic.

METHODS

Data were collected via an anonymous online survey on REDCap®. Women who gave birth between March 2020 and March 2022 and answered an open-ended question in the IMAgiNE EURO questionnaire were included in the study. A qualitative thematic analysis of the women's comments was conducted using the International Confederation of Midwives' RESPECT toolkit as a framework for analysis.

FINDINGS

The data source for this study consisted of 199 comments provided by women in response to the open-ended question in the IMAgiNE EURO questionnaire. Analysis of these comments revealed clear patterns of disrespect and abuse in health facilities during the COVID-19 pandemic. These patterns include non-consensual care, with disregard for women's choices and birth preferences; undignified care, characterised by disrespectful attitudes and a lack of empathy from healthcare professionals; and feelings of abandonment and neglect, including denial of companionship during childbirth and separation from newborns. Insufficient organisational and human resources in health facilities were identified as contributing factors to disrespectful care. Empathic relationships with healthcare professionals were reported to be the cornerstone of positive experiences.

DISCUSSION

Swiss healthcare facilities showed shortcomings related to disrespect and abuse in maternal care. The pandemic context may have brought new challenges that compromised certain aspects of respectful care. The COVID-19 crisis also acted as a magnifying glass, potentially revealing and exacerbating pre-existing gaps and structural weaknesses within the healthcare system, including understaffing.

CONCLUSIONS

These findings should guide advocacy efforts, urging policy makers and health facilities to allocate adequate resources to ensure respectful and high-quality maternal care during pandemics and beyond.

A qualitative descriptive training needs analysis of midwives perceived continuous professional development in providing intranatal respectful maternal care

BACKGROUND

The Vietnam midwifery report acknowledges that while health services are available in Vietnam, there is growing need to increase levels of respectful maternal care provided to women in labour.

OBJECTIVE

In conjunction with newborns Vietnam charity, our objective was to assess the perceived continuous professional development needs of midwives working in Vietnam to inform development of an intranatal respectful maternal care education resource.

METHOD

A qualitative exploratory descriptive method was used to conduct a training needs analysis, which identified perceived education requirements of midwives in Vietnam in relation to providing respectful maternal care.

PARTICIPANTS

A convenience sample of midwives (n = 49) participated in the study.

DATA-COLLECTION

Eight on-line focus groups were carried out in four hospitals (maternity units) across Vietnam using WebEx, with the interview schedule informed by the World Health Organization guide for delivering intrapartum care for a positive birth experience.

DATA-ANALYSIS

Data were transcribed into English and analysed using the 6-steps of thematic analysis outlined by Braun and Clark.

FINDINGS

Three themes and 9 sub-themes were developed from the data. The first theme addressed aspects that contribute towards creating a positive birth experience; the second theme observed barriers to changing practice; and the third theme noted that there are a variety of preferred teaching methods.

CONCLUSIONS

In response to the training needs analysis, a respectful maternal care education resource has been designed to transform selected areas of intranatal care in Vietnam. Integrating the respectful maternal care educational resource into midwives' continuous professional development in Vietnam is intended to increase women's rights to have safe childbirth, which accommodates choice and control, and promotes a positive birth experience.

RECOMMENDATIONS FOR PRACTICE

Post-completion and evaluation, we hope that the intranatal respectful maternal care educational resource will be rolled out to all practising midwives in Vietnam.

Respectful maternity care interventions to address women mistreatment in childbirth: What has been done?

INTRODUCTION

Over the last decade, there has been an increasing number of studies regarding experiences of mistreatment, disrespect and abuse (D&A) during facility-based childbirth. These negative experiences during labour have been proven to create a barrier for seeking both facility-based childbirth and postnatal health care, as well as increasing severe postpartum depression among the women who experienced them. This constitutes a serious violation of human rights. However, few studies have carried out specifically designed interventions to reduce these practices. The aim of this scoping review is to synthetise available evidence on this subject, and to identify initiatives that have succeeded in reducing the mistreatment, D&A that women suffer during childbirth in health facilities.

METHODS

A PubMed search of the published literature was conducted, and all original studies evaluating the efficacy of any type of intervention specifically designed to reduce these negative experiences and promote RMC were selected.

RESULTS

Ten articles were included in this review. Eight studies were conducted in Africa, one in Mexico, and the other in the U.S. Five carried out a before-and-after study, three used mixed-methods, one was a comparative study between birth centres, and another was a quasi-experimental study. The most common feature was the inclusion of some sort of RMC training for providers at the intervention centre, which led to the conclusion that this training resulted in an improvement in the care received by the women in childbirth. Other strategies explored by a small number of articles were open maternity days, clinical checklists, wall posters and constant user feedback.

DISCUSSION

These results indicate that there are promising interventions to reduce D&A and promote RMC for women during childbirth in health facilities. RMC training for providers stands as the most proven strategy, and the results suggest that it improves the experiences of care received by women in labour.

CONCLUSION

The specific types of training and the different initiatives that complement them should be evaluated through further scientific research, and health institutions should implement RMC interventions that apply these strategies to ensure human rights-based maternity care for women giving birth in health facilities around the world.

Translation and validation of Vietnamese version of the Birth Satisfaction Scale-Revised (BSS-R)

BACKGROUND

The 10-item Birth Satisfaction Scale-Revised (BSS-R) is a quick and easy survey instrument recommended by the International Consortium for Health Outcome Measures as the tool of choice for measuring women's birth satisfaction.

AIM

To translate and validate a Vietnamese-language version of the BSS-R.

METHOD

A quantitative cross-sectional method was used to gather data post translation and back-translation of a Vietnamese version of the BSS-R (VN-BSS-R). Data collected were psychometrically evaluated using key indices of validity and reliability.

PARTICIPANTS

Vietnamese women who were within one month postpartum of birth (N = 383) took part in the study.

RESULTS

Findings illustrate that a two-factor model offered excellent psychometric properties. With the two-factor VN-BSS-R, five items loaded onto a subscale 'Positive birth experiences' and the other five onto a second subscale 'Negative birth experiences'. This two-factor model offered a fit to data (root mean square error of approximation [RMSEA] = 0.07, 90% confidence interval [CI] [0.05, 0.09], root square mean residual [RMSE] = 0.04 and comparative fit index [CFI] = 0.97). Mean scores for the exploratory factor analysis [EFA]-derived 'positive' and 'negative' sub-scales were 17.12 (SD 2.34) and 8.40 (SD 4.18) respectively.

CONCLUSION

The translated and validated VN-BSS-R is a psychometrically robust tool for measuring birth satisfaction in Vietnamese postpartum women.The VN-BSS-R is available for use to measure experiences and perceptions of intrapartum care received by Vietnamese women.

Surgical informed consent practices and influencing factors in sub-Saharan Africa: a scoping review of the literature

INTRODUCTION

Current international standards in consent to surgery practices are usually derived from health systems in Western countries, while little attention has been given to other contexts such as sub-Saharan Africa (SSA), despite this region facing the highest burdens of disease amenable to surgery globally. The aim of this study was to examine how the concept of informed consent for surgery is interpreted and applied in the context of SSA, and factors affecting current practices.

METHODS

A systematic search of Medline, Embase and African Journal OnLine databases as well as grey sources was executed in May 2023 to retrieve relevant literature published since 2010 in English language against a set of given criteria. The socioecological framework for health was used for organising and summarising the identified evidence.

RESULTS

A total of 27 papers were included in the review. Findings revealed that consent to surgery practices is generally substandard across SSA and the process is not adequate. Patients' understanding of informed consent is limited, likewise awareness of their rights to decision-making. A range of factors at the individual, interpersonal, institutional and system/societal levels affect the informed consent process.

CONCLUSION

There is a need to find more culturally acceptable and ethical ways to include the participation of patients in the decision-making process for surgical treatment in the SSA and define standards more closely aligned with the local context.

Implementing a Respectful Maternity Care Guideline During Childbirth Experiences

OBJECTIVE

To measure the impact of an evidence-based guideline on respectful maternity care on nurses' attitudes and beliefs about childbirth practices.

DESIGN

A quality improvement pilot project with a pretest/posttest design examining the attitudes and beliefs of intrapartum nurses about childbirth practices of respectful care.

SETTING

High-risk intrapartum unit at a tertiary care center in the southeastern United States.

PARTICIPANTS

A convenience sample of 130 registered nurses were invited to participate, and nine completed the pre- and posttests.

INTERVENTION/MEASUREMENTS

The intervention included a recorded webinar, access to printed and electronic copies of the guideline, discussions in daily huddles, and a virtual journal club. Data were collected using the 42-item Nurse Attitudes and Beliefs Questionnaire-Revised. Lower scores are reflective of attitudes and beliefs that support a medical model of care, whereas higher scores are reflective of a physiologic model of care. Descriptive statistics and the Wilcoxon signed rank test were used to analyze changes in attitudes and beliefs based on the aggregate scores of the nurse participants.

RESULTS

Although there was no change in nurse attitude and beliefs about childbirth practices after 3 months (p = .058), the aggregate scores on a scale of 42 to 168 increased by 5.6 points. Two subscales of the Nurse Attitudes and Beliefs Questionnaire-Revised-Medical Model of Conflict and Women's Autonomy-had the greatest increase in aggregate scores.

CONCLUSION

Understanding nurses' attitudes and beliefs can assist in identifying barriers to the provision of respectful care, particularly during labor and birth, when patients are most vulnerable. Measurement of nurse attitudes and beliefs regarding respectful maternity care may require a longer immersion in a respectful maternity care program to allow for changes over time.

Development and psychometric properties of the Respectful Maternity Care Scale (RMCS)

AIMS/BACKGROUND

The Respectful Maternity Care Scale (RMCS) was developed specifically to assess the health care that women receive during pregnancy, labour and the postnatal period. The aim of this study was to investigate the validity and reliability of the RMCS.

DESIGN/METHODS

This study used a methodological design. The RMCS, a self-report instrument, was developed in consultation with professionals and women who had given birth, based on the literature. It was tested for content and construct validity. Reliability was assessed using Cronbach's alpha, test-retest method, and adjusted item-total correlation. The study sample consisted of 405 women between 6 weeks and 12 months postpartum who were admitted to a family health centre in Istanbul between April and June 2023.

RESULTS

The scale's content validity index is 0.92. The scale consists of 29 items and 3 sub-dimensions, which explain 61% of the total variance. χ2/df was less than 5 and RMSEA was less than 0.08, which confirms the validity of this model. The corrected item-total correlations were acceptable, and the Cronbach's alpha coefficient was 0.96.

CONCLUSION

The RMCS has been shown to be valid and reliable and can be used to assess respectful maternity care among Turkish women.

Impacts of disrespectful care and abusive care practices in maternity units and potential interventions to improve the quality of care in low- and middle-income countries: A narrative review

This review article explored the impacts of disrespectful care and abusive care practices and the potential interventions to eliminate those practices. Respectful maternity care is a fundamental right for all women. It ensures that women are able to exercise their rights in maternity care. However, research studies have shown the recent prevalence of poor-quality care for women in maternity units in low- and middle-income countries. The literature on this topic was searched on PubMed, Medline, Google Scholar, Cochrane, Science Direct/ Elsevier, and SCOPUS. A total of 24 qualitative and quantitative research articles were included. Thematic analysis was conducted by using the six steps. Impacts are coded on topics including psychological impacts due to disrespectful and abusive care practices, impact on the care process, normalization of the absence of care, suppression of knowledge regarding the labor process, and poor obstetric outcomes. Interventions are coded on topics including programs for health professionals to improve care, education and empowerment programs targeting the women and community, enacting policies and guidelines regarding disrespectful and abusive care practices and improving the facilities in the healthcare system. The majority of the evidenced-based interventions were multi-component and tailored to the needs of a particular setting. More research evidence is needed to inform the healthcare authorities and policymakers to transform these potential interventions into practice. Future research should clearly document the effectiveness of various combinations of interventions, feasibility, cost-effectiveness, and outcomes.

Predictors of childbirth experience: Prospective observational study in eastern Spain

BACKGROUND

In recent years, birth experience has been highlighted by national and international organisations as a relevant value in measuring maternal health care quality. According to a standardised tool, we aimed to assess which clinical indicators had the most significant influence on the birth experience.

METHODS

This prospective observational study was carried out in fourteen hospitals in eastern Spain. 749 women consented to the collection of birth variables at discharge, and subsequently, at 1-4 months, data were collected on the birth experience as measured by the Spanish version of the Childbirth Experience Questionnaire. Next, a linear regression analysis was performed to determine which clinical birth indicators greatly influence the birth experience measure.

RESULT

The study sample (n = 749) was predominantly Spanish and primipara, with 19.5% vaginal births. The predictors that emerged in the linear regression model were to have a birth companion (B = 0.250, p = 0.028), drink fluids during labour (B = 0.249, p < 0.001), have early skin-to-skin contact (B = 0.213, p < 0.001) and being transferred to a specialised room for the second stage of labour (B = 0.098, p = 0.016). The episiotomy (B = -0.100, p < 0.015) and having an operative birth (B = -0.128, p < 0.008) showed a negative influence.

CONCLUSION

Our study supports that intrapartum interventions recommended according to clinical practice guidelines positively influence the mother's birth experience. Episiotomy and operative birth should not be used routinely as they negatively influence the birth experience.

Comparing the Effectiveness of a Web-Based Application With a Digital Live Seminar to Improve Safe Communication for Pregnant Women: 3-Group Partially Randomized Controlled Trial

BACKGROUND

Medical internet interventions such as asynchronous apps and synchronous digital live seminars can be effective behavior change interventions. The research question of this study was whether digital interventions based on the Health Action Process Approach can improve pregnant women's safe communication and patient safety in obstetric care.

OBJECTIVE

This study aims to compare a digital live seminar with a web-based application intervention and a passive control group and to identify which social cognitive variables determine safe communication behavior and patient safety.

METHODS

In total, 657 pregnant women were recruited, and hereof, 367 expectant mothers from 2 German university hospitals participated in the pre-post study (live seminar: n=142; web-based app: n=81; passive control group: n=144). All interventions targeted intention, planning, self-efficacy, and communication of personal preferences. The 2.5-hour midwife-assisted live seminar included exercises on empathy and clear communication. The fully automated web-based application consisted of 9 consecutive training lessons with the same content as that of the live seminar.

RESULTS

Controlled for sociodemographic characteristics, repeated measures analyses of covariance revealed that pregnant women significantly improved their self-reported communication behavior in all groups. The improvement was more pronounced after the digital live seminar than after the web-based application (P<.001; ηp2=0.043). Perceived patient safety improved more for pregnant women participating in the live seminar than for those participating in the web-based application group (P=.03 ηp2=0.015). A regression analysis revealed that social cognitive variables predicted safe communication behavior.

CONCLUSIONS

Overall, the web-based application intervention appeared to be less effective than the digital live training in terms of communication behavior. Application interventions addressing communication behaviors might require more face-to-face elements. Improving intention, coping planning, and coping self-efficacy appeared to be key drivers in developing safe communication behavior in pregnant women. Future research should include social learning aspects and focus on the practical application of medical internet interventions when aiming to improve pregnant women's communication and patient safety in obstetrics.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735.

Maternal health policy environment and the relationship with service utilization in low- and middle-income countries

Background

The extent to which a favorable policy environment influences health care utilization and outcomes for pregnant and postpartum women is largely unknown. In this study, we aimed to describe the maternal health policy environment and examines its relationship with maternal health service utilization in low- and middle-income countries (LMICs).

Methods

We used data from World Health Organization's 2018-2019 sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) policy survey linked with key contextual variables from global databases, as well as UNICEF data on antenatal care (ANC), institutional delivery, and postnatal care (PNC) utilization in 113 LIMCs. We grouped maternal health policy indicators into four categories - national supportive structures and standards, service access, clinical guidelines, and reporting and review systems. For each category and overall, we calculated summative scores accounting for available policy indicators in each country. We explored variations of policy indicators by World Bank income group using χ² tests and fitted logistic regression models for ≥85% coverage for each of four or more antenatal care visits (ANC4+), institutional delivery, PNC for the mothers, and for all ANC4+, institutional delivery, and PNC for mothers, adjusting for policy scores and contextual variables.

Results

The average scores for the four policy categories were as follows: 3 for national supportive structures and standards (score range = 0-4), 5.5 for service access (score range = 0-7), 6. for clinical guidelines (score range = 0-10), and 5.7 for reporting and review systems (score range = 0-7), for an average total policy score of 21.1 (score range = 0-28) across LMICs. After adjusting for country context variables, for each unit increase in the maternal health policy score, the odds of ANC4+>85% increased by 37% (95% confidence interval (CI) = 1.13-1.64) and the odds of all ANC4+, institutional deliveries and PNC>85% by 31% (95% CI = 1.07-1.60).

Conclusions

Despite the availability of supportive structures and free maternity service access policies, there is a dire need for stronger policy support for clinical guidelines and practice regulations, as well as national reporting and review systems for maternal health. A more favorable policy environment for maternal health can improve adoption of evidence-based interventions and increase utilization of maternal health services in LMICs.

The Parturient Women's Privacy Preservation in the Delivery Rooms: A Qualitative Study

Introduction: Parturient women's privacy preservation and respectful maternity care (RMC) in delivery room is an important principle in the high quality of midwifery care to achieve maternal satisfaction and positive childbirth experience. Hence, it is essential to make natural vaginal delivery (NVD) a positive experience and increase the mothers' satisfaction. This study aimed to investigate the privacy preservation of parturient women's in the delivery room. Methods: Using conventional content analysis, this qualitative study was conducted from June 2018 to December 2020 at two hospitals and three health centers in Shahroud, Iran. Purposeful sampling was employed and it was continued till data saturation through in-depth interviews with 37 participants. Results: The results of interviews with 21 women with NVD experience and 16 maternity health service providers resulted in the extraction of four themes including physical, spiritual-mental, informational, and social privacy. Conclusion: Various mechanisms were found to promote the privacy and satisfaction of parturient women in the delivery room. They included the necessity continuous education, monitoring about mother's privacy preservation and intervention to improve effective communication skills among staff in delivery rooms.

The prevalence of respectful maternity care during childbirth and its determinants in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Respectful maternity care is the provision of woman-centered health care during childbirth that is friendly, abuse-free, timely, and discrimination-free. Although several epidemiological studies on the magnitude and determinants of Respectful maternity care in Ethiopia have been conducted, the results have been inconsistent and varied. This makes drawing equivocal conclusions and evidence at the national level harder. Hence, this systematic review and meta-analysis aimed at estimating the pooled prevalence of respectful maternity care and its determinants in Ethiopia.

METHODS

Studies conducted from 2013 to June 30, 2022, were searched by using PubMed, Google Scholar, Science Direct, Scopus, ProQuest, Web of Science, Cochrane Library, and Direct of Open Access Journals. Searching was carried out from May 15- June 30, 2022. In total, sixteen studies were considered in the final analysis. The data were extracted using Microsoft Excel and analyzed using STATA 16 software. The methodological quality of included studies was assessed by using Joanna Briggs Institute's critical appraisal checklist for prevalence studies. To estimate the pooled national prevalence of respectful maternity care, a random effect model with a DerSimonian Laird method was used. To assess the heterogeneity of the included studies, the Cochrane Q test statistics and I2 tests were used. To detect the presence of publication bias, a funnel plot and Begg's and Egger's tests were used.

RESULTS

Sixteen studies were eligible for this systematic review and meta-analysis with a total of 6354 study participants. The overall pooled prevalence of respectful maternity care in Ethiopia was 48.44% (95% CI: 39.02-57.87). Receiving service by CRC-trained health care providers [AOR: 4.09, 95% CI: 1.73, 6.44], having ANC visits [AOR: 2.34, 95% CI: 1.62, 3.06], planning status of the pregnancy [AOR = 4.43, 95% CI: 2.74, 6.12], giving birth during the daytime [AOR: 2.61, 95% CI: 1.92, 3.31], and experiencing an obstetric complication[AOR: 0.46, 95% CI: 0.30, 0.61] were identified as determinants of RMC.

CONCLUSION

As per this meta-analysis, the prevalence of respectful maternity care in Ethiopia was low. Managers in the health sector should give due emphasis to the provision of Compassionate, Respectful, and Care(CRC) training for healthcare providers, who work at maternity service delivery points. Stakeholders need to work to increase the uptake of prenatal care to improve client-provider relationships across a continuum of care. Human resource managers should assign an adequate number of health care providers to the night-shift duties to reduce the workload on obstetric providers.

Exposing Obstetric Violence in the Eastern Mediterranean Region: A Review of Women's Narratives of Disrespect and Abuse in Childbirth

Background

Obstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve rights-based and respectful health practice and policy. While efforts to improve the quality of maternal health have long-existed, women's experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the said region.

Aim

This study centered on the experiences of women's mistreatment in childbirth to provide an overview of OV and offer recommendations to improve RMC.

Methods

A scoping review was conducted, and a total of 38 articles met the inclusion criteria and were analyzed using Bowser and Hill's framework of the seven typologies of Disrespect and Abuse (D&A) in childbirth. D&A in childbirth (or violations to RMC) is a manifestation of OV and served as a proxy to analyze its prevalence in the EMR.

Findings and Discussion

This study indicated that across the EMR, women experienced every type of D&A in childbirth. This happens regardless of health systems' strength or country's income, with 6 out of 7 types of D&A found in almost two-thirds of included countries. In the EMR, the most common types of D&A in childbirth are physical abuse (especially overused routine interventions) and non-dignified care (embedded in patriarchal socio-cultural norms). The intersections of these abuses enable the objectification of women's bodies and overuse of unconsented routine interventions in a hierarchical and patriarchal system that regards the power and autonomy of doctors above birthing women. If unchecked, the implications include acceptance, continuation, and underreporting of D&A in childbirth, as well as passivity toward human-rights violations, which all further cause the continuing the cycle of OV.

Conclusion

In order to eliminate OV, a paradigm shift is required involving infrastructure changes, education, empowerment, advocacy, a women-centered and gender-sensitive approach to health system strengthening, and policy development. Recommendations are given at individual, community, health systems, and policy levels to ensure that every woman achieves her right to health and birth in a dignified, respectful, and empowered manner.