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Kasaye H, Scarf V, Sheehy A, Baird K. The mistreatment of women during maternity care and its association with the maternal continuum of care in health facilities. BMC Pregnancy Childbirth 2024; 24:129. [PMID: 38350892 PMCID: PMC10863180 DOI: 10.1186/s12884-024-06310-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Mistreatment of childbearing women continues despite global attention to respectful care. In Ethiopia, although there have been reports of mistreatment of women during maternity care, the influence of this mistreatment on the continuum of maternity care remains unclear. In this paper, we report the prevalence of mistreatment of women from various dimensions, factors related to mistreatment and also its association to the continuum of maternity care in health facilities. METHODS We conducted an institution-based cross-sectional survey among women who gave birth within three months before the data collection period in Western Ethiopia. A total of 760 women participated in a survey conducted face-to-face at five health facilities during child immunization visits. Using a validated survey tool, we assessed mistreatment in four categories and employed a mixed-effects logistic regression model to identify its predictors and its association with the continuum of maternity care, presenting results as adjusted odds ratios (AORs) with their 95% confidence intervals (CIs). RESULTS Over a third of women (37.4%) experienced interpersonal abuse, 29.9% received substandard care, 50.9% had poor interactions with healthcare providers, and 6.2% faced health system constraints. The odds of mistreatment were higher among women from the lowest economic status, gave birth vaginally and those who encountered complications during pregnancy or birth, while having a companion of choice during maternity care was associated to reduced odds of mistreatment by 42% (AOR = 0.58, 95% CI: [0.42-0.81]). Women who experienced physical abuse, verbal abuse, stigma, or discrimination during maternity care had a significantly reduced likelihood of completing the continuum of care, with their odds decreased by half compared to those who did not face such interpersonal abuse (AOR = 0.49, 95% CI: [0.29-0.83]). CONCLUSIONS Mistreatment of women was found to be a pervasive problem that extends beyond labour and birth, it negatively affects upon maternal continuum of care. Addressing this issue requires an effort to prevent mistreatment through attitude and value transformation trainings. Such interventions should align with a system level actions, including enforcing respectful care as a competency, enhancing health centre functionality, improving the referral system, and influencing communities to demand respectful care.
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Affiliation(s)
- Habtamu Kasaye
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Vanessa Scarf
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Annabel Sheehy
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Kathleen Baird
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Ferede WY, Erega BB, Sisay FA, Ayalew AB, Belachew YY, Yimer TS. Consented maternal care and associated factors among mothers who gave birth at public health institutions in South Wollo Zone, Amhara region, Ethiopia 2022. SAGE Open Med 2024; 12:20503121241227083. [PMID: 38347850 PMCID: PMC10860419 DOI: 10.1177/20503121241227083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Informed consent in healthcare services is a legal, ethical, and professional requirement on the part of all treating health providers and providing person-centered care. The methods of requesting consent during childbirth have not been extensively studied. In Ethiopia, there is not at all a single study done. Objective The purpose of this study is to determine associated factors among mothers who gave birth at health institutions in the South Wollo Zone, Amhara region, Ethiopia in 2022. Methods Mothers who gave birth at South Wollo Zone public health institutions, from 01 March to 30 April 2022 participated in a multi-center institutional-based cross-sectional study design. Systematic random sampling was used to select 423 study participants. A validated questionnaire was used for data collection, and the data were collected through face-to-face interviews. Data were entered into Epi-Data version 4.6 and exported to SPSS version 23 for analysis. A multivariable logistic regression analysis was performed to identify factors associated with the outcome variable. The level of significance was determined using an adjusted odds ratio with a 95% confidence interval. Result The study had 416 participants in total, with a response rate of 98.3%. Out of the 416 respondents interviewed, 67.1% of the women received consented care. The age group of 30-34, complications during childbirth, intended pregnancy, merchant, and primary and referral hospital were significantly associated with consented care. Conclusion The level of non-consented care during delivery was high compared with other literature reflecting substantial mistreatment. Therefore, stakeholders should strengthen monitoring and assessment systems to prevent abuse, and further study is required to look for practical ways to make improvements. Key elements of consented care have also been included in Basic and Emergency Obstetric Care training sessions and given to health providers.
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Affiliation(s)
- Wassie Yazie Ferede
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Besfat Berihun Erega
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fillorenes Ayalew Sisay
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abeba Belay Ayalew
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yismaw Yimam Belachew
- School of Medicine, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigist Seid Yimer
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Usso AA, Adem HA, Alemu A, Mohammed A. Disrespect and abuse during childbirth in East Hararghe Zone public health facilities, eastern Ethiopia: a cross-sectional study. Front Glob Womens Health 2023; 4:1237098. [PMID: 38099270 PMCID: PMC10720435 DOI: 10.3389/fgwh.2023.1237098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/31/2023] [Indexed: 12/17/2023] Open
Abstract
Background Compassionate and respectful maternity care during childbirth has been identified as a potential strategy to prevent and reduce maternal mortality and morbidity. Despite its importance, there is a paucity of information on the level of disrespect and abuse meted out to mothers in eastern Ethiopia. This study assesses the level of disrespect and abuse suffered by women during childbirth, and the associated factors, in public health facilities in the rural East Hararghe Zone in eastern Ethiopia. Methods A cross-sectional study was conducted among 530 women who gave birth in 20 public health facilities in the East Hararghe Zone during the period between 1 April and 30 April 2020. Data were collected using a validated questionnaire. Bivariable and multivariable binary logistic regression analyses were employed to identify the factors associated with disrespect and abuse during childbirth. Adjusted odds ratio (AOR) (95% CI) was used to report this association, and statistical significance was set at P < 0.05. Results Overall, 77% (95% CI: 73%-81%) of women reported at least one type of disrespect and abuse during childbirth in the East Hararghe Zone public health facilities. In this study, factors such as households having an average monthly income of below 57.22 USD (AOR = 2.29, 95% CI: 1.41-3.71), mothers residing at more than 30 min away from a nearby health facility (AOR = 2.10, 95% CI: 1.30-3.39), those not receiving antenatal care (AOR = 4.29, 95% CI: 2.17-8.52), and those giving birth during nighttime (AOR = 2.16, 95% CI: 1.37-3.41) were associated with at least one type of disrespect and abuse during childbirth. Conclusion More than three in every four women who gave birth in the East Hararghe Zone public health facilities were disrespected and abused during childbirth. Encouraging all pregnant women to pay attention to antenatal care visits and improving the quality of healthcare service during nighttime in all health facilities will be essential for preventing and reducing disrespect and abuse and its negative consequences.
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Affiliation(s)
- Ahmedin Aliyi Usso
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hassen Abdi Adem
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Aminu Mohammed
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
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Bobo FT, Asante A, Woldie M, Dawson A, Hayen A. Evaluating equity across the continuum of care for maternal health services: analysis of national health surveys from 25 sub-Saharan African countries. Int J Equity Health 2023; 22:239. [PMID: 37978385 PMCID: PMC10656898 DOI: 10.1186/s12939-023-02047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Ensuring access to the continuum of care for maternal, neonatal, and child health is an effective strategy for reducing maternal and child mortality. We investigated the extent of dropout, wealth-related inequalities, and drivers of inequality in the continuum of care for maternal health services in sub-Saharan Africa. METHODS We analysed Demographic and Health Surveys (DHS) conducted between 2013 and 2019 across 25 sub-Saharan African countries. We defined the continuum of care for maternal health services as women who had received at least four ANC contacts (ANC 4 + contacts), skilled care at birth, and immediate postnatal care (PNC). We used concentration index to estimate wealth-related inequalities across the continuum of care. Multilevel logistic regression models were used to identify predictors of inequality in completing the continuum of care. RESULTS We included data on 196,717 women with the most recent live birth. About 87% of women reported having at least one ANC contact, but only 30% of women received the recommended care package that includes ANC 4 + contacts, skilled care at birth, and PNC. The proportion of women who had completed the continuum of care ranged from 6.5% in Chad to 69.5% in Sierra Leone. Nearly 9% of women reported not having contact with the health system during pregnancy or childbirth; this ranged from 0.1% in Burundi to 34% in Chad. Disadvantaged women were more likely to have no contact with health systems and less likely to have the recommended care package than women from wealthier households. Women with higher education levels, higher exposure to mass media (radio and TV), and higher household wealth status had higher odds of completing the continuum of care. CONCLUSIONS Persistent and increasing inequalities were observed along the continuum of care from pregnancy to the postnatal period, with socioeconomically disadvantaged women more likely to drop out of care. Improving access to and integration of services is required to improve maternal health. Initiatives and efforts to improve maternal health should prioritise and address the needs of communities and groups with low coverage of maternal health services.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia.
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
- Department of Health Systems and Health Economics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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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.
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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
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Girma G, Tamire A, Edessa GJ, Dechasa M, Tefasa OK, Negash A, Dereje J, Masrie A, Shawel S, Mandefro M, Abraham G. Process Evaluation of Health System Responsiveness Level and Associated Factors Among Mothers Gave Birth at Obstetric Ward in a Tertiary Hospital, Southwest of Ethiopia: Mixed Study Methods. J Multidiscip Healthc 2023; 16:2291-2308. [PMID: 37601330 PMCID: PMC10439284 DOI: 10.2147/jmdh.s397735] [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: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
Background The term responsiveness emerged during the World Health Organization (WHO) report in 2000 as new and essential goals of the health systems to meet the needs of people to their expectations from different services being given in healthcare systems. Obstetric violence and childbirth mistreatment are global problems, but the worst obstetric violence usually occurs in underdeveloped countries. Thus, the main objective of this study was to evaluate the responsiveness of obstetric service at Jimma University Medical Center. Methods A single-case study design with quantitative and qualitative data collection was employed. Availability with 17 indicators and health system responsiveness with 24 indicators were used. Consecutive sampling technique was used to select the clients and qualitative data were collected from key informants. SPSS version 25 was used for the analysis of quantitative data, whereas thematic analysis was conducted for qualitative data. A multiple linear regression model was fitted after all assumptions were checked and fit to ensure the relation of the dependent variable with independent variables. Results The overall evaluation was 75.6% and judged good. The resource availability and health system responsiveness were 85.5% and 69.7%, which were judged very good and fair, respectively. A stethoscope and thermometer were not available, while 40% glucose, dexamethasone, and intravenous fluid were the most frequently stocked-out supplies. Dignity (72.1%), confidentiality (71.4%), and prompt attention (70%) were the top three good scores for the health system's responsiveness. Health system responsiveness significantly associated with the following: Not attending formal education, attending college and above, place of delivery (health center), mode of delivery (cesarean section), and being merchant. Conclusion & Recommendation The health system responsiveness of delivery service in study setting was good. All stakeholders should work for improving the health system's responsiveness in delivery service.
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Affiliation(s)
- Gezu Girma
- Department of Health Research, International Center for AIDS Care and Treatment Program (ICAP), Finfine, Ethiopia
| | - Aklilu Tamire
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Harari, Ethiopia
| | - Gebeyehu Jeldu Edessa
- Department of Health Policy and Management, Public Health Faculty, Institute of Health Jimma University, Jimma, Oromia, Ethiopia
| | - Mesay Dechasa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Obsan Kassa Tefasa
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Harari, Ethiopia
| | - Abraham Negash
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Jerman Dereje
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Awoke Masrie
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Harari, Ethiopia
| | - Samrawit Shawel
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Harari, Ethiopia
| | - Miheret Mandefro
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Harari, Ethiopia
| | - Gelila Abraham
- Department of Health Policy and Management, Public Health Faculty, Institute of Health Jimma University, Jimma, Oromia, Ethiopia
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Gebeyehu NA, Adella GA, Tegegne KD. Disrespect and abuse of women during childbirth at health facilities in Eastern Africa: systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1117116. [PMID: 37153101 PMCID: PMC10157168 DOI: 10.3389/fmed.2023.1117116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Background Disrespectful and abusive maternity care is a sign of poor treatment that influences women's choice to deliver their babies in institutions. Such malpractices continue to go unreported and are rarely exposed in developing countries, despite their serious burden. Therefore, this meta-analysis study aimed to estimate disrespect and abuse of women during childbirth in East Africa. Methods PubMed, Google Scholar, Scopus, and Science Direct databases were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Publication bias was checked by forest plot, Begg's rank test, and Egger's regression test. To look for heterogeneity, I2 was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by study region, sample size, and publication. The pooled odds ratio for associated factors was also computed. Results Out of 654 articles assessed, 18 met the criteria and were included in this study. There were a total of 12,434 study participants. The pooled prevalence of disrespect and abuse of women during childbirth in East Africa was 46.85% (95% CI: 45.26.72-66.98), I2 = 81.9%. It was lower in studies with sample size greater than 5000 (33%). The disrespect and abuse rates between community-based studies (44.96%) and institutional-based studies (47.35%) did not differ significantly, though. Instrumental delivery (AOR = 2.70; 95%CI: 1.79-4.08), presence of complications (AOR = 6.41; 95% CI: 1.36-30.14), receiving care at government hospitals (AOR = 3.66; 95% CI: 1.09-12.23), and poor wealth index (AOR = 2.16; 95% CI: 1.26-3.70) were associated factors. Conclusion In East Africa, disrespect and abuse of women during childbirth was high. Instrumental delivery, presence of complications during childbirth, receiving care at government hospitals and poor wealth index were predictors of maternal disrespect and abuse. Safe delivery practice should be promoted. Training in compassionate and respectful maternity care, particularly in public hospitals, has also been recommended.
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Affiliation(s)
- Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gtachew Asmare Adella
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Werdofa HM, Thoresen L, Lulseged B, Lindahl AK. 'I believe respect means providing necessary treatment on time' - a qualitative study of health care providers' perspectives on disrespect and abuse during childbirth in Southwest Ethiopia. BMC Pregnancy Childbirth 2023; 23:257. [PMID: 37069529 PMCID: PMC10108497 DOI: 10.1186/s12884-023-05567-9] [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: 12/17/2022] [Accepted: 03/31/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The majority of maternal deaths occur in low-income countries, and facility-based childbirth is recognised as a strategy to reduce maternal mortality. However, experiences of disrespect and abuse during childbirth are reported as deterrents to women's utilisation of health care facilities. Health care providers play a critical role in women's experiences during childbirth; yet, there is limited research on service providers' views of disrespect and abuse in Ethiopia. Therefore, this study aimed to explore providers' perspectives on disrespect and abuse during childbirth in a teaching hospital in Southwest Ethiopia. METHOD Qualitative study was conducted in a tertiary teaching hospital in Jimma Ethiopia. In-depth interviews were conducted with 32 purposefully selected health care providers, including midwives, obstetrics and genecology resident's, senior obstetricians and nurses. Interviews were audio-recorded, transcribed and thematically analysed using the qualitative data analysis software program MAXQDA. RESULTS Three major themes were identified from the health care providers' perspectives: (1) respectful and abuse-free care, (2) recognised disrespect and abuse; and (3) drivers of women's feelings of disrespect and abuse. The first theme indicates that most of the participants perceived that women were treated with respect and had not experienced abuse during childbirth. The second theme showed that a minority of the participants recognised that women experienced disrespect and abuse during childbirth. The third theme covered situations in which providers thought that drivers for women felt disrespected. CONCLUSION Most providers perceived women's experiences as respectful, and they normalized, and rationalized disrespect and abuse. The effect of teaching environment, the scarcity of resources has been reported as a driver for disrespect and abuse. To ensure respectful maternity care, a collaborative effort of administrators, teaching institutions, professional associations and researchers is needed. Such collaboration is essential to create a respectful teaching environment, ensure availability of resources, sustained in-service training for providers, and establishing an accountability mechanism for respectful maternity care.
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Affiliation(s)
- Hirut Megersa Werdofa
- School of Nursing, St. Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia.
| | - Lisbeth Thoresen
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Belayneh Lulseged
- School of Public Health, St. Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia
| | - Anne Karin Lindahl
- Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Nordbyhagen, Norway
- Akershus University Hospital, Nordbyhagen, Norway
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Kasaye HK, Dadi TL, Yilma MT, Jebena MG, Medhin G, Kassie GM, Bekele F, Nigatu F, Teklu AM. Does Combining Antenatal Care Visits at Health Posts and Health Centers Improve Antenatal Care Quality in Rural Ethiopia? Ethiop J Health Sci 2023; 33:37-48. [PMID: 38362475 PMCID: PMC10866290 DOI: 10.4314/ejhs.v33i1.5s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2024] Open
Abstract
Background Even though quality maternal care is crucial for the well-being of women and their newborns, the inferior quality of antenatal care in rural Ethiopia is a timely concern. This study aimed to investigate the effects of combining antenatal care visits at health posts and health centers on improving antenatal care quality in rural Ethiopia. Methods Using the 2019 Ethiopia Health Extension Program assessment done by MERQ, we extracted and analyzed the survey responses of 2,660 women who had received at least one antenatal visit from a primary health care unit. We measured the cumulative count of quality of antenatal care using the Donabedian model. To model the differences in the quality of antenatal care at health posts and health centers, we used zero-truncated Poisson regression and reported incidence risk ratios with their 95% confidence intervals. Results The quality of antenatal care increased by 20% (adjusted IRR= 1.20 [1.12-1.28]) when antenatal care reception was mixed at health posts and health centers, compared to those who received all antenatal care only from health posts. Quality differences based on socioeconomic status and setting variations were observed as predictors of quality of care, even if women received antenatal care at both health posts and health centers. Conclusions Combining antenatal care provision from health posts and health centers should be sustained as one of the antenatal care quality improvement strategies in rural parts of Ethiopia while ensuring the equitable provision of quality care across socioeconomic groups and between agrarian and pastoral settings.
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Affiliation(s)
| | - Tegene Legese Dadi
- School of Public Health, Hawassa University, Ethiopia
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Mekdes Tigistu Yilma
- Department of Public Health, Institute of Health Sciences, Wallaga University, Ethiopia
| | - Mulusew G Jebena
- Department of Epidemiology, Institute of Health, Jimma University
| | - Girmay Medhin
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
| | - Getnet Mitike Kassie
- International Institute for Primary Health Care- Ethiopia (IIfPHC-E)
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | | | - Frehiwot Nigatu
- International Institute for Primary Health Care- Ethiopia (IIfPHC-E)
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Sanga NE, Joho AA. Intrapartum violence during facility-based childbirth and its determinants: A cross-sectional study among postnatal women in Tanzania. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231189544. [PMID: 37650373 PMCID: PMC10475265 DOI: 10.1177/17455057231189544] [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: 12/08/2022] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Violence during childbirth indirectly contributes to maternal and neonatal morbidity and mortality. It also causes intrapartum health consequences such as prolonged labor, postpartum hemorrhage, and postpartum psychological problems, including postpartum depression, post-traumatic stress disorder, and other negative feelings that lead to a decreased desire for facility delivery and increase the events of home deliveries which reduce the quality of life. In Tanzania, several efforts have been made to promote respectful maternity care. However, violence during childbirth continues to create a critical barrier for facility-based delivery and is in need of considerable attention throughout the health system. OBJECTIVES This study aimed to assess types of intrapartum violence and its determinants among postnatal women in the Dodoma Region, Tanzania. DESIGN A cross-sectional study using a questionnaire to interview postnatal women at the exit point after being discharged from the health facility to assess intrapartum violence and its determinants. METHODS This study was conducted in Dodoma Region involving 307 postnatal women from April to June 2022. A simple random method was used to select respondents. The Chi-square and Fisher's exact tests were used to assess the association between the categorical variables. The predictors of intrapartum violence were determined using binary logistic regression analysis. Statistical analysis was performed using Statistical Package for Social Science version 25.0. P < 0.05 was considered to be significant. RESULTS Overall, 307 postnatal women participated in the study. Among them, 158 (51.5%) postnatal women experienced at least one form of intrapartum violence. The most common forms of intrapartum violence included breach of confidentiality 205 (66.8%), undignified care/verbal abuse 178 (58%), physical abuse 139 (45.3%), and denial or neglected care by midwives 113 (36.8%). Husband employment, urban residence, and being referred from primary hospitals were significant determinants associated with intrapartum violence (adjusted odds ratio = 0.233, 95% confidence interval = 0.057-0.952, p = 0.043, adjusted odds ratio = 2.67, 95% confidence interval = 1.13-10.93, p = 0.026 and adjusted odds ratio = 3.673, 95% confidence interval = 1.131-11.934, p = 0.030, respectively). CONCLUSION Violence during childbirth was highly prevalent in this study. Understanding the prevalence and types of intrapartum violence is important in order to promote changes in all levels of the health system. This study reveals the need for key interventions to effect change at many levels; including an interventional study to educate women and birth partners on client rights, and strengthening the health system to meet the needs of women during labor and childbirth. Policies and systems that support respectful maternity care are urgently needed in this setting, including universal training of health professionals in respectful maternity care.
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Affiliation(s)
- Neema Egid Sanga
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Angelina A Joho
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
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Mengesha EW, Tessema GA, Assefa Y, Alene GD. Social capital and its role to improve maternal and child health services in Northwest Ethiopia: A qualitative study. PLoS One 2023; 18:e0284592. [PMID: 37083885 PMCID: PMC10120927 DOI: 10.1371/journal.pone.0284592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Social capital is a set of shared values that allows individuals or groups receive emotional, instrumental or financial resources flow. In Ethiopia, despite people commonly involved in social networks, there is a dearth of evidence exploring whether membership in these networks enhances uptake of maternal and child health (MCH) services. This study aimed to explore perspectives of women, religious leaders and community health workers (CHWs) on social capital to improve uptake of MCH services in Northwest Ethiopia. METHODS We employed a qualitative study through in-depth interviews with key informants, and focus group discussions. A maximum variation purposive sampling technique was used to select 41 study participants (11 in-depth interviews and 4 FGDs comprising 7-8 participants). Data were transcribed verbatim and thematic analysis was employed using ATLAS.ti software. RESULTS Four overarching themes and 13 sub-themes of social capital were identified as factors that improve uptake of MCH services. The identified themes were social networking, social norms, community support, and community cohesion. Most women, CHWs and religious leaders participated in social networks. These social networks enabled CHWs to create awareness on MCH services. Women, religious leaders and CHWs perceived that existing social capital improves the uptake of MCH services. CONCLUSION The community has an indigenous culture of providing emotional, instrumental and social support to women through social networks. So, it would be useful to consider the social capital of family, neighborhood and community as a tool to improve utilization of MCH services. Therefore, policymakers should design people-centered health programs to engage existing social networks, and religious leaders for improving MCH services.
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Affiliation(s)
- Endalkachew Worku Mengesha
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew A Tessema
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Getu Degu Alene
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Understanding variation in person-centered maternity care: Results from a household survey of postpartum women in 6 regions of Ethiopia. AJOG GLOBAL REPORTS 2022; 3:100140. [PMID: 36594001 PMCID: PMC9803839 DOI: 10.1016/j.xagr.2022.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Effective communication, respect and dignity, and emotional support are critical for a positive childbirth experience that is responsive to the needs and preferences of women. OBJECTIVE This study evaluated the performance of a person-centered maternity care scale in a large, representative household sample of postpartum women, and it describes differences in person-centered maternity care across individuals and communities in Ethiopia. STUDY DESIGN The study used data from 2019 and 2020 from a representative sample of postpartum women in 6 regions of Ethiopia. It measured person-centered maternity care using a scale previously validated in other settings. To assess the scale validity in Ethiopia, we conducted cognitive interviews, measured internal consistency, and evaluated construct validity. Then, we fit univariable and multivariable linear regression models to test for differences in mean person-centered maternity care scores by individual and community characteristics. Lastly, multilevel modeling separated variance in person-centered maternity care scores within and between communities. RESULTS Effective communication and support of women's autonomy scored lowest among person-centered maternity care domains. Of 1575 respondents, 704 (44.7%) were never asked their permission before examinations and most said that providers rarely (n=369; 23.4%) or never (n=633; 40.2%) explained why procedures were done. Person-centered maternity care was significantly higher for women with greater wealth, more formal education, and those aged >20 years. Variation in person-centered maternity care scores between individuals within the same community (τ2=58.3) was nearly 3 times greater than variation between communities (σ2=21.2). CONCLUSION Ethiopian women reported widely varying maternity care experiences, with individuals residing within the same community reporting large differences in how they were treated by providers. Poor patient-provider communication and inadequate support of women's autonomy contributed most to poor person-centered maternity care.
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Kene C, Tekalegn Y, Dibaba D, Abdella M, Fikadu G, Atlaw D, Gomora D, Geta G, Seyoum K, Hailu S, Ejigu N, Sahiledengle B, Tasew A. Level of women-friendly care provision among mothers in immediate post-partum period at public hospitals of Southeast Ethiopia: a cross-sectional study. BMC Womens Health 2022; 22:475. [PMID: 36434654 PMCID: PMC9700868 DOI: 10.1186/s12905-022-02061-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The women-friendly care approach focuses on women's rights to have access to quality care for themselves as individuals, as mothers, and for their infants. However, access to quality health services is not guaranteed for many women, particularly in low and middle-income countries. Hence, this study aimed to assess the level of women-friendly care provision and associated factors among mothers in the immediate post-partum period at public hospitals of Bale Zone, Southeast Ethiopia 2021. METHODS An institutional-based cross-sectional survey was employed among mothers in the immediate post-partum period in public hospitals of Bale Zone from March 1-30, 2021. A total of 363 mothers were recruited by systematic random sampling technique in this study. Data was collected through pre-tested structured questionnaires. A 21-verified questionnaire was used to measure the outcome variable. The data were entered into Epi Data version 4.6.2.0 and exported to the statistical package of social science version 26.0 for analysis. A variable with a P value of less than 0.25 in the bi-variable binary logistic regression model was transferred to a multivariable binary logistics regression model. Hosmer and Lemeshow's goodness of fit model was checked. Adjusted odds ratio with 95% confidence intervals were used to estimate the strength of association between the outcome variable and independent variables. A p-value less than 0.05 was considered as significantly associated. RESULTS The level of women-friendly care provision among mothers in immediate post-partum at public hospitals of Bale Zone was found to be 61% [95% confidence interval (55.73-66.04)]. Being prim para mother [Adjusted odds ratio = 1.88(1.07-3.33)], having planned pregnancy [Adjusted odds ratio = 1.94(1.04-3.63)] and staying at a health facility after delivery [Adjusted odds ratio = 4.8(1.71-13.39)] were found to be statistically significant predictors of level of women-friendly care provision. CONCLUSION The women-friendly care provision among mothers in the immediate post-partum period in this study area was found to be low against most of the pre-existing findings. Strong counseling on planned pregnancy and staying at a health facility after delivery is recommended.
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Affiliation(s)
- Chala Kene
- Midwifery Department, School of Health Science, Madda Walabu University, Bale-Goba, Ethiopia
| | - Yohannes Tekalegn
- Public Health Department, School of Health Science, Madda Walabu University, Bale-Goba, Ethiopia
| | - Diriba Dibaba
- Public Health Department, School of Health Science, Madda Walabu University, Bale-Goba, Ethiopia
| | - Mujib Abdella
- Midwifery Department, School of Health Science, Madda Walabu University, Bale-Goba, Ethiopia
| | - Genet Fikadu
- Midwifery Department, School of Health Science, Madda Walabu University, Bale-Goba, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, School of Medicine, Madda Walabu University, Bale-Goba, Ethiopia
| | - Degefa Gomora
- Midwifery Department, School of Health Science, Madda Walabu University, Bale-Goba, Ethiopia
| | - Girma Geta
- Midwifery Department, School of Health Science, Madda Walabu University, Bale-Goba, Ethiopia
| | - Kenbon Seyoum
- Midwifery Department, School of Health Science, Madda Walabu University, Bale-Goba, Ethiopia
| | - Sintayehu Hailu
- Public Health Department, School of Health Science, Madda Walabu University, Bale-Goba, Ethiopia
| | - Neway Ejigu
- Midwifery Department, School of Health Science, Madda Walabu University, Bale-Goba, Ethiopia
| | - Biniyam Sahiledengle
- Public Health Department, School of Health Science, Madda Walabu University, Bale-Goba, Ethiopia
| | - Alelign Tasew
- Public Health Department, School of Health Science, Madda Walabu University, Bale-Goba, Ethiopia
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Gebregziabher S, Hawulte B, Abera L, Goshu AT. Disrespect and abuse experienced by women giving birth in public health facilities of Eastern Ethiopia: a multicenter cross-sectional study. J Int Med Res 2022; 50:3000605221130015. [PMID: 36238988 PMCID: PMC9575459 DOI: 10.1177/03000605221130015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We assessed the magnitude of disrespect and abuse experienced by women giving birth at public health facilities in Dire Dawa, Eastern Ethiopia. METHODS We conducted a facility-based quantitative cross-sectional study in Dire Dawa City Administration from 21 October to 8 December 2020. We used a pre-tested structured questionnaire to interview 555 randomly selected women who gave birth in public health facilities during the study period. Bivariate and multivariate logistic regression analysis was performed in statistical analysis. RESULTS Among 555 women, 473 (85.2%) reported having experienced at least one form of disrespect and abuse. Giving birth at a hospital (adjusted odds ratio [AOR] = 4.15; 95% confidence interval [CI], 2.29-7.51) and being attended by male providers (AOR = 3.27; 95% CI, 1.57-6.81), as well as being attended by three or four providers (AOR = 0.44; 95% CI, 0.22-0.88) and delivering at night (AOR = 0.27; 95% CI, 0.15-0.48) were significantly associated with greater or less likelihood, respectively, of disrespect and abuse. CONCLUSION We revealed an unacceptable level of disrespect and abuse toward women giving birth at public health facilities. Health care providers must understand the importance of respectful maternity care. The city's health bureau should conduct provider training and enforce adherence to respectful care.
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Affiliation(s)
| | - Behailu Hawulte
- School of Public Health, College of Health and Medical Sciences,
Haramaya University, Harar, Ethiopia
| | - Legesse Abera
- Department of Midwifery, College of Medicine and Health
Sciences, Dire Dawa University, Dire Dawa City Administration, Ethipoia
| | - Abel Tibebu Goshu
- School of Nursing and Midwifery, College of Health and Medical
Sciences, Haramaya University, Harar, Ethiopia,Abel Tibebu Goshu, School of Nursing and
Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box
235 Harar, Ethiopia.
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Mengistie T, Mulatu T, Alemayehu A, Yadeta TA, Dheresa M. Respectful maternity care among women who gave birth at public hospitals in Hadiya Zone, Southern Ethiopia. Front Public Health 2022; 10:949943. [PMID: 36238243 PMCID: PMC9551054 DOI: 10.3389/fpubh.2022.949943] [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: 05/21/2022] [Accepted: 09/09/2022] [Indexed: 01/21/2023] Open
Abstract
Background A compassionate and respectful care during pregnancy and childbirth is one of the essential components of safe motherhood. However, most of the women in developing countries experience disrespectful and abusive maternity care during childbirth. Hence, this study assessed the status of respectful maternity care and associated factors to bridge the gap. Methodology Facility-based cross-sectional study was conducted among mothers who delivered in public Hospitals in the Hadiya Zone, South Ethiopia from March 01 to 30, 2020. Data were collected using a pretested questionnaire through face-to-face interviews. Descriptive statistics was computed and multivariable logistic regression was fitted to identify predictors. Adjusted Odds Ratio (AOR) with 95% Confidence Interval was used to show the strength of association and level of significance was declared at P-value < 0.05. Result This study showed that 67.8 % (95% CI: 62.4-70.8%) of mothers received respectful maternal care. Being married [AOR: 2.17, 95% CI (1.03-6.93)], Cesarean section delivery [AOR: 2.48, 95% CI (1.03-5.97)], and absence of complications during child birth [AOR: 4.37, 95% CI (1.41-13.56)], were significantly associated with respectful maternity care. Conclusions The level of RMC in this study was moderate. Being married, Cesarean section delivery, and absence of complications during child birth were identified predictors of respectful maternity care. Therefore, tailored interventions aimed at improving respectful maternity care should target unmarried women, and women with complications of labor regardless of mode of delivery.
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Affiliation(s)
- Tilahun Mengistie
- Department of Midwifery, Wochamo University College of Health Science, Hossana, Ethiopia
| | - Teshale Mulatu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia,*Correspondence: Teshale Mulatu
| | - Afework Alemayehu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Nwafor JI, Onwe BI, Ibo CC, Onuchukwu VU. Disrespectful Maternity Care and Abuse During Childbirth: Exploring Perceptions and Experiences of Women Delivered at a Tertiary Hospital in Abakaliki, Nigeria. Niger Med J 2022; 63:295-303. [PMID: 38863465 PMCID: PMC11163253 DOI: 10.60787/nmj-63-4-79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Background An important but little understood component of poor care that women receive during antenatal care and childbirth is disrespect and abuse perpetuated by health workers. Fear of experiencing disrespect and abuse has a negative influence on women's decision to seek care at health facility during pregnancy, labour and delivery. The objective of this study is to determine the prevalence, pattern and predictors of disrespect and abuse during labour and delivery. Methodology This is a questionnaire-based cross-sectional study conducted from February 1, 2019, to July 31, 2019 among postnatal women delivered at Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Data were analyzed using SPSS version 22. Results The prevalence of disrespectful maternity care and abuse was 47.6%. The forms of disrespect and abuse experienced by the participants were detention in the health facility (40.2%), physical abuse (34.1%), non-dignified care (37.2%), non-consented care (20.1%), abandonment of care (18.9%), non-confidential care (25%) and discriminatory care (15.2%). Lack of companionship during delivery (AOR: 7.01, 95%CI: 1.27-4.49; p = 0.007), unbooked status (AOR: 2.37, 95%Cl: 0.31 - 0.92; p = 0.01) and rural residence (AOR = 4.52 95% CI: 2.33-8.75, P<0.0001) were factors associated with disrespect and abuse during childbirth. Conclusion Disrespectful maternity care and abuse during childbirth among women seeking maternity care is still prevalent (47.6%) in our hospital. Educating health workers on the importance of respectful maternity care would ensure acceptable, quality and dignified care for all women seeking maternity care in our facility.
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Affiliation(s)
- Johnbosco Ifunanya Nwafor
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, South-East Nigeria
| | - Blessing Idzuinya Onwe
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, South-East Nigeria
| | - Chukwunenye Chukwu Ibo
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, South-East Nigeria
| | - Victor Uchenna Onuchukwu
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, South-East Nigeria
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Dzomeku VM, Mensah ABB, Nakua EK, Agbadi P, Okyere J, Donkor P, Lori JR. Promoting respectful maternity care: challenges and prospects from the perspectives of midwives at a tertiary health facility in Ghana. BMC Pregnancy Childbirth 2022; 22:451. [PMID: 35641939 PMCID: PMC9153163 DOI: 10.1186/s12884-022-04786-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Evidence shows that women in Ghana experience disrespectful care (slapping, pinching, being shouted at, etc.) from midwives during childbirth. Hence, evidence-based research is needed to advance the adoption of respectful maternity care (RMC) by midwives. We therefore sought to explore and document midwives’ perspectives concerning challenges faced and prospects available for promoting RMC in a tertiary health facility. Methods We employed an exploratory descriptive qualitative study design. In total, we conducted 12 interviews with midwives educated on RMC. All audio data were transcribed verbatim and exported to NVivo-12 for data management and analyses. We relied on the Consolidated Criteria for Reporting Qualitative Research guideline in reporting this study. Results The findings were broadly categorised into three themes: emotional support, dignified care and respectful communication which is consistent with the WHO’s quality of care framework. For each theme, the current actions that were undertaken to promote RMC, the challenges and recommendations to improve RMC promotion were captured. Overall, the current actions that promoted RMC included provision of sacral massages and reassurance, ensuring confidentiality and consented care, and referring clients who cannot pay to the social welfare unit. The challenges to providing RMC were logistical constraints for ensuring privacy, free movement of clients, and alternative birthing positions. Poor attitudes from some midwives, workload and language barrier were other challenges that emerged. The midwives recommended the appointment of more midwives, as well as the provision of logistics to support alternative birthing positions and privacy. Also, they recommended the implementation of continuous training and capacity building. Conclusion We conclude that in order for midwives to deliver RMC services that include emotional support, dignified care, and respectful communication, the government and hospital administration must make the required adjustments to resolve existing challenges while improving the current supporting activities. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04786-w.
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Affiliation(s)
- Veronica Millicent Dzomeku
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Adwoa Bemah Boamah Mensah
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Kweku Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pascal Agbadi
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, Hong Kong
| | - Joshua Okyere
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jody R Lori
- University of Michigan School of Nursing, Ann Arbor, USA
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Lendado TA, Bitew S, Elias F, Samuel S, Assele DD, Asefa M. Effect of hospital attributes on patient preference among outpatient attendants in Wolaita Zone, Southern Ethiopia: discrete choice experiment study. BMC Health Serv Res 2022; 22:661. [PMID: 35581592 PMCID: PMC9110630 DOI: 10.1186/s12913-022-07874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient preference has preceded the use of health care services, and it has been affected by different hospital attributes. Meanwhile, the number of patients receiving vital health intervention is particularly low in Ethiopia. Therefore, this study aimed to determine the effect of hospital attributes on patient preference for outpatients in the Wolaita area in September 2020. METHODS A discrete choice experimental study was applied to determine the effect of hospital attributes on patient preference with a sample size of 1077. The experimental survey was conducted among outpatient attendants selected through a systematic random sampling approach. Six key attributes (competence of healthcare providers; availability of medical equipment and supplies; cost of service; wait time; distance; and hospital reputation) deduced from various hospital attributes were used to elicit the patient preferences. The data was collected from participants through the Open Data Kit application. A random effect probit model with marginal willingness to pay measure and partially log-likelihood analysis was applied to extract important attributes. We used STATA version 15 software for analysis, and the fitness of the model was verified by the calculated p-value for the Wald chi-square with a cut-point value of 0.05. RESULT One thousand forty-five patients who received outpatient care participated in the study. The random effect probit results have shown that all hospital attributes included in the study were significantly valued by patients while choosing the hospital (p-value < 0.001). Meanwhile, based on marginal willingness to pay and partial log-likelihood analysis, the competence of health care providers was identified as the most important attribute followed by the availability of medical equipment and supplies in hospitals. CONCLUSION AND RECOMMENDATION The results suggested that the quality of health care providers and availability of medical equipment and supply in hospitals would be primary interventional points for improving the patient preference of hospitals. Assessment, education, and training are recommended for enhancing the quality of health care providers. And stock balance checks, inspections, and accreditation are believed to be valuable for improving the availability of equipment and supply in hospitals.
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Affiliation(s)
- Tigabu Addisu Lendado
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia.
| | - Shimelash Bitew
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia
| | - Fikadu Elias
- Department of Reproductive Health and Nutrition, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia
| | - Serawit Samuel
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia
| | - Desalegn Dawit Assele
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia
| | - Merid Asefa
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia
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Berhe ET, Gesesew HA, Ward PR, Gebremeskel TG. Neglected and non-consented care during childbirth in public health facilities in Central Tigray, Ethiopia. BMC Pregnancy Childbirth 2022; 22:386. [PMID: 35505295 PMCID: PMC9066857 DOI: 10.1186/s12884-022-04662-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study aimed to assess the magnitude and factors associated with neglected and non-consented care during childbirth in public health facilities in Central Tigray, Ethiopia. METHODS A health facility-based cross-sectional survey supplemented by a qualitative study was conducted from April to May 2020 among women giving birth. We included 415 participants and recruited via a systematic random sampling technique. To collect the data, a pre-tested, face-to-face exit interview using an interviewer-administered structured questionnaire was used. Neglected and non-consented care and its outcomes (yes and no) were the dependent variables, and Socio-demographic data such as (age, educational level, region, and income), and other variables associated with compassionate and respective maternity care were the independent variables. We applied bivariate and multivariate logistic regression to determine predictors for non-consented and non-confidential care components of disrespect or abuse. The in-depth interviews were analyzed using content analysis. RESULTS Among the participants, 82.4% and 78.6% had neglected care and non-consented care among women giving birth respectively. No formal education level (AOR: 0.37, 95%, CI (0.18-0.78)) and primary education level (AOR: 0.18, 95%, CI (0.05-0.57))., mode of delivery (AOR 3.79, 95% CI 1.42-10.09), sex of skilled healthcare providers (AOR: 0.56, 95%, CI (0.34-0.93)), number of deliveries in a health Centre (AOR: 1.89, 95% CI (1.03-3.47)) predicted non-consented care, and history ANC (AOR: 8.10, 95% CI (1.33-49.51)), and federal government employee (AOR: 0.24, 95% CI (0.07-0.78)) predicted neglected care during childbirth. In-depth interview result shows the mode of delivery and sex of healthcare providers were factor associated with non-consented care and women's stay at health facilities were factor associated with neglected care. CONCLUSION The level of neglected and non-consented care during delivery was high reflecting substantial mistreatment. Educational level, mode of delivery, sex of skilled healthcare providers, and the number of deliveries in a health Centre were associated with non-consented care, and history ANC and Federal Government employees were associated with neglected care during childbirth. These findings imply the urgent needs or intervention including strengthening of awareness of both patients and healthcare providers on patients' rights and responsibilities and training service providers in patient-centered care and interpersonal communication and relationships to minimize mistreatment.
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Affiliation(s)
- Elsa Tesfa Berhe
- Department of Reproductive Health, College of Health Sciences, Aksum University, Aksum, Ethiopia.
| | - Hailay Abrha Gesesew
- Department of Epidemiology, College of Health Sciences, Mekele University, Mekele, Ethiopia.,Centre for Research On Health Policy, Torrens University, Adelaide, South Australia, Australia
| | - Paul R Ward
- Centre for Research On Health Policy, Torrens University, Adelaide, South Australia, Australia
| | - Teferi Gebru Gebremeskel
- Department of Reproductive Health, College of Health Sciences, Aksum University, Aksum, Ethiopia. .,Discipline of Public Health, Flinders University, Adelaide, Australia.
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20
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Gogoi A, Manoranjini M, Ravi T, Kaur M, Gupta M, Rajagopal V. Determinants of respectful maternity care in India: A cross-sectional study. WHO South East Asia J Public Health 2022; 11:3-9. [PMID: 36308267 DOI: 10.4103/who-seajph.who-seajph_162_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Respectful maternity care (RMC) is a basic right of all pregnant women. The study identifies the sociodemographic and economic factors influencing disrespect and abuse (D&A) faced by women during pregnancy, childbirth, and immediate postpartum period in India. Methodology A cross-sectional study was conducted across six health facilities in three states of India from June 2019 to June 2020 among 401 women aged 18 years or more who had a live birth within the past 2 months of data collection. A validated structured interview schedule was used to capture data on sociodemographic and economic characteristics; antenatal, intranatal, and postnatal history; and incidences of D&A based on Bowser's seven domains of RMC. Ordered logistic regression was done to identify the determinant of high D&A. Results The composite score of D&A ranged from 0 to 48 with a median interquartile range of 13 (9-17). All women faced one or the other kind of D&A. Women with the lowest food security (odds ratio [OR] = 3.3; 95% confidence interval: 1.6-6.7), who did not avail any antenatal care from the facility (OR = 1.9 [1.1-3.2]), and in the lowest wealth index (OR = 2.2 [1.3-3.7]) faced more D&A than those with high food security, more than two ANC services from same health facility, and in the high wealth index, respectively. Women who had low mobility score experienced lower D&A (OR = 0.5 [0.3-0.8]) as compared to the women with a high mobility score. Nonconsented care, nonconfidential care, and physical discomfort were the most common types of D&A. Conclusions RMC is directly associated with socioeconomic status of women. Policy and program interventions are needed to address the inequity in health service care provision and expanding the social security net for women.
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Affiliation(s)
| | | | - Tina Ravi
- Centre for Catalyzing Change, New Delhi, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mamta Gupta
- Unit of Epidemiology and Biostatistics, Alchemist Research and Data Analysis, Chandigarh, India
| | - Vineeth Rajagopal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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21
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Mingude AB, Dejene TM, Habtegiorgis SD, Sahle F. Magnitude and associated factors of respectful maternity care in Tirunesh Beijing Hospital, Addis Ababa, Ethiopia, 2021. SAGE Open Med 2022; 10:20503121221137015. [DOI: 10.1177/20503121221137015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022] Open
Abstract
Objective: The main aim of this research was to assess the magnitude of respectful maternity care and associated factors during labour and delivery in Tirunesh Beijing General Hospital, 2021. Methods: Facility-based cross-sectional research was employed among 319 postnatal mothers who were selected by systematic random sampling technique. Bi-variable and multi-variable logistic regression analysis was used to identify associated factors. Variables whose p-value < 0.05 in the multivariable model with 95% confidence interval were considered as statically significant. Results: A total of 319 respondents participated in the research with a response rate of 100%. The overall prevalence of respectful maternity care was 87.8%. Type of delivery in which caesarean section (adjusted odds ratio = 10.4, 95% confidence interval: (1.8, 61) and spontaneous vaginal delivery (adjusted odds ratio = 2.9, 95% CI: 1.4, 6). Getting delivery service by the provider of their preference (adjusted odds ratio = 2.6, 95% CI: 1.3, 5.2), still birth (AOR = 5.8 95% CI: 1.3, 25.8) and sex of delivery attendant (adjusted odds ratio = 3.6, 95% CI: 1.8, 7.5) were associated factors RMC. Conclusion and recommendation: In our research area, a sizable number of women have received respectful maternity care, but abuse and disrespect are still complaints. Therefore, emphasis should be placed on respectful maternity care by every healthcare professional and health service manager.
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Affiliation(s)
- Alemu Basazin Mingude
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Tadesse Mamo Dejene
- Department of Public Health, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Samuel Derbie Habtegiorgis
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Fiseha Sahle
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
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22
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Ibrahim IM, Mohammed OA, Mare KU, Mohammed MW, Aychiluhm SB. Disrespect and abuse during focused antenatal care and associated factors among pregnant women who visited public health facilities in Awsi Rasu of Afar Region Northeast Ethiopia. SAGE Open Med 2022; 10:20503121221139563. [DOI: 10.1177/20503121221139563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives: Maternal disrespect and abuse are the top significant barriers to the use of maternal health services. However, poor attention has been given to the hospitality and suitability of care provided to women in the facilities where they have been moved to utilize health services. This study is aimed to assess the prevalence of maternal disrespect and abuse during focused antenatal care and its associated factors among pregnant women who visit public health facilities in Awsi Rasu of Afar Region Northeast Ethiopia. Methods: Institution-based cross-sectional study design was employed from March 1 to 30, 2022 in selected health facilities of the Awsi Rasu of Afar Region, Northeast Ethiopia. A total of 1278 mothers were included using consecutive sampling techniques. The data were entered into Epi-data version 3.1 and exported to SPSS version 23.0 for statistical analysis. Statistical significance is declared using adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI). Results: The overall prevalence of disrespect and the abusive experience was 56.7% (95% CI: 54–59.3%). A low average monthly income of less than or equal to 3000 Ethiopian birrs (AOR = 0.72; 95% CI: 0.55–0.94), Age (20–25) years (AOR = 2.33; 95% CI 1.72–3.2), having no formal education (AOR = 2.01; 95% CI: 1.35–3.15), and having unplanned pregnancy (AOR = 1.6; 95% CI: 1.21–2.01) were significantly associated with disrespect and abuse during focused antenatal care. Conclusion: The prevalence of disrespect and abusive experience during antenatal care in the study area was high relative to other studies. In the multivariable logistic regression model age of the mother (20–25 years), no formal education, low family income, and unplanned pregnancy are the predictors of disrespect and abusive care. Providing respectful health care during antenatal care with a suitable approach for all mothers irrespective of their age, unplanned pregnancies, and educational status is the most substantial to encourage maternal service use.
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Affiliation(s)
- Ibrahim Mohammed Ibrahim
- Department of Midwifery, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Osman Ahmed Mohammed
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Mohammed Wagris Mohammed
- Department of Public health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Setognal Birara Aychiluhm
- Department of Public health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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Mehretie Adinew Y, Kelly J, Marshall A, Smith M. Care Providers' Perspectives on Disrespect and Abuse of Women During Facility-Based Childbirth in Ethiopia: A Qualitative Study. Int J Womens Health 2021; 13:1181-1195. [PMID: 34876861 PMCID: PMC8643202 DOI: 10.2147/ijwh.s333863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background It is increasingly evident that disrespect and abuse of women during facility-based childbirth is a violation of a woman’s rights and a deterrent to the use of life-saving maternity care. Understanding care providers’ perspectives of disrespect and abuse during facility-based childbirth is an essential element to aid in fully comprehending the problem and its underlying complexities. Objective To explore care providers’ perspectives of disrespect and abuse during facility-based childbirth. Methods This study used a qualitative descriptive design involving fifteen in-depth, semi-structured, interviews conducted between 5 October 2019 and 25 January 2020 in north Showa zone of Oromia region, central Ethiopia. Purposive sampling enabled health care professionals working in maternity units of health facilities who have direct involvement in care of women during pregnancy and labor to be recruited. Thematic analysis using Open Code software was used to explore the perspectives of participants. Results Four themes were identified. 1) Disrespect and abuse breaches professional standards, 2) Disrespectful and abusive actions are justified at times to save the mother and her baby, 3) Disrespect and abuse is used as a tool to assert power, and 4) Disrespect and abuse arise from health system deficiencies. Conclusion Disrespect and abuse is triggered by underlying beliefs about risk versus care, provider attitudes, stress and burnout, and health service structural issues including a lack of medicines and supplies. A number of strategies could improve the quality of maternity care, including training providers how to manage difficult and complex situations, addressing root causes of disrespect and abuse, and increasing access to resources.
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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
| | - Amy Marshall
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Morgan Smith
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
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24
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Maldie M, Egata G, Chanie MG, Muche A, Dewau R, Worku N, Alemu MD, Ewunetie GE, Birhane T, Addisu E, Ayele WM, Adane M. Magnitude and associated factors of disrespect and abusive care among laboring mothers at public health facilities in Borena District, South Wollo, Ethiopia. PLoS One 2021; 16:e0256951. [PMID: 34793460 PMCID: PMC8601571 DOI: 10.1371/journal.pone.0256951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recent studies have indicated that disrespectful/abusive/coercive service by skilled care providers in health facilities that results in actual or perceived poor quality of care is directly and indirectly associated with adverse maternal and newborn outcomes. According to the 2016 Ethiopian Demography and Health Survey, only 26% of births were attended by qualified clinicians, with a maternal mortality rate of 412 per 100,000 live-births. Using seven categories developed by Bowser and Hill (2010), this study looked at disrespect and abuse experienced by women in labor and delivery rooms in health facilities of Borena Ddistrict, South Wollo, Ethiopia. METHODS A facility-based cross-sectional study was conducted among 374 immediate postpartum women in Borena District from January 12 to March 12, 2020. Systematic sampling was used to access respondents to participate in a structured, pre-tested face-to-face exit interview. Data were entered into EpiData version 4.6 and exported to SPSS version 25 for analysis. Finally, bivariable and multivariable logistic regression analysis were performed to declare statistically significant factors related to maternal disrespect and abusive care in Borena District at a p-value of < 0.05 and at 95% CI. RESULT Almost four out of five (79.4%) women experienced at least one type of disrespect and abuse during facility-based childbirth. The most frequently reported type of disrespect and abuse was non-consented care 63.7%. Wealth index [AOR = 3.27; 95% CI: (1.47, 7.25)], type of health facility [AOR = 1.96; 95% CI: (1.01, 3.78)], presence of companion(s) [AOR = 0.05; 95% CI: (0.02, 0.12)], and presence of complications [AOR = 2.65; 95% CI: (1.17, 5.99)] were factors found to be significantly related to women experiencing disrespect and abuse. CONCLUSION The results showed that wealth index, type of health facility, presence of companion(s), and birth complications were found to be significant factors. Therefore, health personnel need to develop interventions that integrate provider's behavior on companionship and prevention of complications across facilities to reduce the impact of disrespectful and abusive care for laboring women.
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Affiliation(s)
- Mulusew Maldie
- Borena Woreda Health Office, South Wollo Ethiopia, Borena, Ethiopia
| | - Gudina Egata
- Schools of Public Health, Haramaya University, Harar, Ethiopia
| | - Muluken Genetu Chanie
- Department of Health Systems and Policy, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amare Muche
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Nigusu Worku
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mamo Dereje Alemu
- Health Systems Strengthening Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Tesfaye Birhane
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Elsabeth Addisu
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Wolde Melese Ayele
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Metadel Adane
- Department of Environmental Health Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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25
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Bobo FT, Asante A, Woldie M, Dawson A, Hayen A. Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa. BMJ Glob Health 2021; 6:bmjgh-2021-007074. [PMID: 34716145 PMCID: PMC8559094 DOI: 10.1136/bmjgh-2021-007074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/17/2021] [Indexed: 11/04/2022] Open
Abstract
Background Improved access to and quality obstetric care in health facilities reduces maternal and neonatal morbidity and mortality. We examined spatial patterns, within-country wealth-related inequalities and predictors of inequality in skilled birth attendance and caesarean deliveries in sub-Saharan Africa. Methods We analysed the most recent Demographic and Health Survey data from 25 sub-Saharan African countries. We used the concentration index to measure within-country wealth-related inequality in skilled birth attendance and caesarean section. We fitted a multilevel Poisson regression model to identify predictors of inequality in having skilled attendant at birth and caesarean section. Results The rate of skilled birth attendance ranged from 24.3% in Chad to 96.7% in South Africa. The overall coverage of caesarean delivery was 5.4% (95% CI 5.2% to 5.6%), ranging from 1.4% in Chad to 24.2% in South Africa. The overall wealth-related absolute inequality in having a skilled attendant at birth was extremely high, with a difference of 46.2 percentage points between the poorest quintile (44.4%) and the richest quintile (90.6%). In 10 out of 25 countries, the caesarean section rate was less than 1% among the poorest quintile, but the rate was more than 15% among the richest quintile in nine countries. Four or more antenatal care contacts, improved maternal education, higher household wealth status and frequently listening to the radio increased the rates of having skilled attendant at birth and caesarean section. Women who reside in rural areas and those who have to travel long distances to access health facilities were less likely to have skilled attendant at birth or caesarean section. Conclusions There were significant within-country wealth-related inequalities in having skilled attendant at birth and caesarean delivery. Efforts to improve access to birth at the facility should begin in areas with low coverage and directly consider the needs and experiences of vulnerable populations.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia .,School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Oromia, Ethiopia.,Fenot Project, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
| | - Angela Dawson
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
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26
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Hunie Asratie M, Mohammed Assfaw H, Abuhay M. Labor Companionship in Labor and Delivery at Debremarkos Town Public Health Facilities: Magnitude and Associated Factors. Int J Womens Health 2021; 13:815-827. [PMID: 34526827 PMCID: PMC8437416 DOI: 10.2147/ijwh.s327753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Labor companionship is a human interactive process that provides social support during the childbirth process. Despite it being one component of respectful maternity care (RMC) that is used for quality assurance to achieve the sustainable goal of maternal and neonatal mortality reduction, there is limited evidence about the current status of birth companionship. The study was aimed to assess labor companion and its associated factors at Debremarkos town public health facilities. Methods An institution-based cross-sectional study design was conducted. The study was conducted at Debremarkos town from February 1/2021 to March 30/2021. From the 559 sample size, 548 women participated in the study. A systematic random sampling technique was used. A pre-tested interviewer-administered questioner was used, data were entered and analyzed with Epi-data version 4.60 and SPSS version 25.0. Bivariable regression was done and variables with p-value </= 0.20 were analyzed with multivariable logistic regression. Variables with p-value </= 0.05 were considered significantly associated with labor companionship. Hosmer–Lemeshow goodness of fit was checked and all multi-collinearity of variables with variance inflation factors (VIF) up to 10 was tolerated. Results A total of 548 participants were involved in the study with a 98.03% response rate. The magnitude of labor companionship was found to be 14.6% (11.7–17.5). Women who had complicated pregnancy (adjusted odds ratio [AOR]=5.53; 95% CI: 3.09–9.92), women's desire for a labor companion (AOR=3.63; 95% CI: 1.51–8.69), being primipara (AOR=3.49; 95% CI: 1.93–6.35), labor followed by female skilled birth attendant (AOR=0.37;95% CI: 0.17–0.82), and women’s perceived busyness of skilled birth attendant (AOR=0.13;95% CI: 0.07–0.23) were significantly associated with labor companionship. Conclusions Labor companionship was found to be low. Giving emphasis on the desire, primipara, complicated pregnancy, sex of skilled birth attendant and women perceived busy skilled birth attendant were suggested for the improvement of labor companionship.
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Affiliation(s)
- Melaku Hunie Asratie
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hussien Mohammed Assfaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulunesh Abuhay
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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27
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Singh S, Goel R, Gogoi A, Caleb-Varkey L, Manoranjini M, Ravi T, Rawat D. Presence of birth companion-a deterrent to disrespectful behaviours towards women during delivery: an exploratory mixed-method study in 18 public hospitals of India. Health Policy Plan 2021; 36:1552-1561. [PMID: 34427637 DOI: 10.1093/heapol/czab098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/13/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Birthing women require support, particularly emotional support, during the process of labour and delivery. Traditionally, across cultures, this support was made available by the continuous presence of a companion during labour, childbirth and the immediate post-partum period. However, this practice is not universal, especially in health facilities in low- and middle-income countries. This cross-sectional study was conducted in 18 tertiary health care facilities of India using a mixed-method approach. The quantitative data were collected to document the number of birthing women, birth companions and healthcare providers in the labour rooms, and the typology of disrespect and abuse (D&A) faced by women. This was followed by in-depth interviews with 55 providers to understand their perspective on the various dimensions of D&A and the challenges they face to provide respectful care. This article explores the status of birth companionship in India and its plausible associations with D&A faced by birthing women in public facilities. Our study reveals that birth companionship is still not a common practice in Indian public hospitals. Birth companions were present during less than half of the observational period, also less than half of the birthing women were accompanied by a birth companion. Lack of hospital policy, space constraints, overcrowding and privacy concerns for other patients were cited as reasons for not allowing birth companions in the labour rooms, whose supportive roles, both for women and providers, were otherwise widely acknowledged during the qualitative interviews. Also, the presence of birth companions was found to be critically negatively associated with occurrences of D&A of birthing women. We contend that owing to the high pressure on the public hospitals in India, birth companions can be a low-cost intervention model for promoting respectful maternity care. However, adequate infrastructure is a critical aspect to be taken care of.
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Affiliation(s)
- Shalini Singh
- Indian Council of Medical Research, New Delhi, India
| | - Richa Goel
- Indian Council of Medical Research, New Delhi, India
| | - Aparajita Gogoi
- Centre for Catalyzing Change, National Secretariat for White Ribbon Alliance, New Delhi, India
| | - Leila Caleb-Varkey
- Centre for Catalyzing Change, National Secretariat for White Ribbon Alliance, New Delhi, India
| | - Mercy Manoranjini
- Centre for Catalyzing Change, National Secretariat for White Ribbon Alliance, New Delhi, India
| | - Tina Ravi
- Centre for Catalyzing Change, National Secretariat for White Ribbon Alliance, New Delhi, India
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Adinew YM, Hall H, Marshall A, Kelly J. Disrespect and abuse during facility-based childbirth in central Ethiopia. Glob Health Action 2021; 14:1923327. [PMID: 34402769 PMCID: PMC8382021 DOI: 10.1080/16549716.2021.1923327] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Respectful maternity care is a fundamental human right, and an important component of quality maternity care. Objective The aim of this study was to quantify the frequency and categories of D&A and identify factors associated with reporting D&A among women in north Showa zone of Ethiopia. Method A cross-sectional study was conducted with 435 randomly selected women who had given birth at public health facility within the previous 12 months in North Showa zone of Ethiopia. A digital (tablet-based) structured and researcher administered tool was used for data collection. Frequencies of D&A items organised around the Bowser and Hill categories of D&A and presented in the White Ribbon Alliance’s Universal Rights of Childbearing Women Framework were calculated. Multivariable logistic regression was used to identify the association between experience of disrespect and abuse and interpersonal and structural factors at p-value <0.05 and odds ratio values with 95% confidence interval. Results All participants reported at least one form of disrespect and abuse during childbirth. Types of disrespect and abuse experienced by participants were physical abuse 435 (100%), non-consented care 423 (97.2%), non-confidential care 288 (66.2%), abandonment/neglect (34.7%), non-dignified care 126 (29%), discriminatory care 99 (22.8%) and detention 24 (5.5%). Hospital birth [AOR: 3.04, 95% CI: 1.75, 5.27], rural residence [AOR: 1.44, 95% CI: 0.76, 2.71], monthly household income less than 1,644 Birr (USD 57) [AOR: 2.26, 95% CI: 1.20, 4.26], being attended by female providers [AOR: 1.74, 95% CI: 1.06, 2.86] and midwifery nurses [AOR: 2.23, 95% CI: 1.13, 4.39] showed positive association with experience of disrespect and abuse. Conclusion Hospital birth showed consistent association with all forms of disrespect and abuse. Expanding the size and skill mix of professionals in the hospitals, sensitizing providers consequences of disrespect and abuse could promote dignified and respectful care.
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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
| | - Helen Hall
- Monash Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Amy Marshall
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Janet Kelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
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29
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Birhanu Z, Abamecha F, Berhanu N, Dukessa T, Beharu M, Legesse S, Kebede Y. Patients' healthcare, education, engagement, and empowerment rights' framework: Patients', caretakers' and health care workers' perspectives from Oromia, Ethiopia. PLoS One 2021; 16:e0255390. [PMID: 34383786 PMCID: PMC8360507 DOI: 10.1371/journal.pone.0255390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 07/15/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Successful health care and clinical services essentially depend on patients' realization of ones' rights, and health workers' and facilities' fulfillments and protections of these rights. However, little is documented about how patients and health workers perceive patients' rights during care-seeking practices. METHODS A qualitative study was conducted in four hospitals in Ethiopia through 8 focus group discussions with patients and 14 individual interviews with diverse groups of patients, caretakers, and 14 interviews with health workers. Participants were recruited through a purposive sampling method to meet the saturation of ideas about patients' rights. The sampled patients, caretakers, and professionals were enlisted from various departments in the hospitals. The data analysis was assisted by ATLAS.ti 7.1.4. RESULTS The study identified three major categories of healthcare rights (clinical, socio-cultural, and organizational), incorporating supporting elements of education, engagement, and empowerment. Study participants reported detailed rights the patients would have during hospital visits which included the right to timely access to care and treatment, adequate medications) with full respect, dignity, and without any discrimination. Patients widely perceived that they had the right to tell their illness history and know their illness in the language they can understand. It was also widely agreed that patients have the right to be educated and guided to make informed choices of services, procedures, and medications. Additionally, patients reported that they had the right to be accompanied by caretakers together with the right to use facilities and resources and get instructions on how to utilize these resources, the right to be protected from exposure to infections and unsafe conditions in hospitals, right to get a diet of their preference, and right to referral for further care. Nevertheless, there was a common concern among patients and caretakers that these rights were mostly non-existent in practice which were due to barriers related to patients (fear of consequence; a sense of dependency, feeling of powerlessness, perceptions of low medical literacy), health workers (negligence, lack of awareness and recognition of patient rights, undermining patients), and facilities' readiness and support, including lack of guiding framework. CONCLUSIONS Perceived patients' rights in the context of hospital visits were profoundly numerous, ranging from the right to access clinical and non-clinical services that are humanely respectful, fulfilling socio-cultural contexts, and in a manner that is organizationally coordinated. Nonetheless, the rights were not largely realized and fulfilled. Engaging, educating, and empowering patients, caretakers, and health care providers supported with policy framework could help to move towards patient-centered and right-based healthcare whereby patients' rights are protected and fulfilled in such resource-limited settings.
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Affiliation(s)
- Zewdie Birhanu
- Department of Health, Behavior, and Society, Faculty of Public Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Fira Abamecha
- Department of Health, Behavior, and Society, Faculty of Public Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Nimona Berhanu
- Department of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Oromia, Ethiopia
| | - Tadesse Dukessa
- Department of Internal Medicine, Faculty of Medical Sciences, Jimma University, Jimma, Oromia, Ethiopia
| | - Mesfin Beharu
- Department of Nursing and Midwifery, Faculty of Public Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Shimelis Legesse
- Jimma University Medical Center, Jimma University, Jimma, Oromia, Ethiopia
| | - Yohannes Kebede
- Department of Health, Behavior, and Society, Faculty of Public Health, Jimma University, Jimma, Oromia, Ethiopia
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Tiruneh GT, Demissie M, Worku A, Berhane Y. Community's experience and perceptions of maternal health services across the continuum of care in Ethiopia: A qualitative study. PLoS One 2021; 16:e0255404. [PMID: 34347800 PMCID: PMC8336848 DOI: 10.1371/journal.pone.0255404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Continuum of care is an effective strategy to ensure that every woman receives a series of maternal health services continuously from early pregnancy to postpartum stages. The community perceptions regarding the use of maternal services across the continuum of care are essential for utilization of care in low-income settings but information in that regard is scanty. This study explored the community perceptions on the continuum of care for maternal health services in Ethiopia. METHODS This study employed a phenomenological qualitative research approach. Four focus group discussions involving 26 participants and eight in-depth interviews were conducted with women who recently delivered, community health workers, and community leaders that were purposively selected for the study in West Gojjam zone, Amhara region. All the interviews and discussions were audio-taped; the records were transcribed verbatim. Data were coded and analyzed thematically using ATLAS.ti software. RESULTS We identified three primary themes: practice of maternal health services; factors influencing the decision to use maternal health services; and reasons for discontinuation across the continuum of maternal health services. The study showed that women faced multiple challenges to continuously uptake maternal health services. Late antenatal care booking was the main reasons for discontinuation of maternal health services across the continuum at the antepartum stage. Women's negative experiences during care including poor quality of care, incompetent and unfriendly health providers, disrespectful care, high opportunity costs, difficulties in getting transportation, and timely referrals at healthcare facilities, particularly at health centers affect utilization of maternal health services across the continuum of care. In addition to the reverberation effect of the intrapartum care factors, the major reasons mentioned for discontinuation at the postpartum stage were lack of awareness about postnatal care and service delivery modality where women are not scheduled for postpartum consultations. CONCLUSION This study showed that rural mothers still face multiple challenges to utilize maternal health services as recommended by the national guidelines. Negative experiences women encountered in health facilities, community perceptions about postnatal care services as well as challenges related to service access and opportunity costs remained fundamental to be reasons for discontinuation across the continuum pathways.
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Affiliation(s)
- Gizachew Tadele Tiruneh
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | - Meaza Demissie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Berger BO, Strobino DM, Mehrtash H, Bohren MA, Adu-Bonsaffoh K, Leslie HH, Irinyenikan TA, Maung TM, Balde MD, Tunçalp Ö. Development of measures for assessing mistreatment of women during facility-based childbirth based on labour observations. BMJ Glob Health 2021; 5:e004080. [PMID: 34362791 PMCID: PMC8353173 DOI: 10.1136/bmjgh-2020-004080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Mistreatment of women during childbirth is increasingly recognised as a significant issue globally. Research and programmatic efforts targeting this phenomenon have been limited by a lack of validated measurement tools. This study aimed to develop a set of concise, valid and reliable multidimensional measures for mistreatment using labour observations applicable across multiple settings. METHODS Data from continuous labour observations of 1974 women in Nigeria (n=407), Ghana (n=912) and Guinea (n=655) were used from the cross-sectional WHO's multicountry study 'How women are treated during facility-based childbirth' (2016-2018). Exploratory factor analysis was conducted to develop a scale measuring interpersonal abuse. Two indexes were developed through a modified Organisation for Economic Co-operation and Development approach for generating composite indexes. Measures were evaluated for performance, validity and internal reliability. RESULTS Three mistreatment measures were developed: a 7-item Interpersonal Abuse Scale, a 3-item Exams & Procedures Index and a 12-item Unsupportive Birth Environment Index. Factor analysis results showed a consistent unidimensional factor structure for the Interpersonal Abuse Scale in all three countries based on factor loadings and interitem correlations, indicating good structural construct validity. The scale had a reliability coefficient of 0.71 in Nigeria and approached 0.60 in Ghana and Guinea. Low correlations (Spearman correlation range: -0.06-0.19; p≥0.05) between mistreatment measures supported our decision to develop three separate measures. Predictive criterion validation yielded mixed results across countries. Both items within measures and measure scores were internally consistent across countries; each item co-occurred with other items in a measure, and scores consistently distinguished between 'high' and 'low' mistreatment levels. CONCLUSION The set of concise, comprehensive multidimensional measures of mistreatment can be used in future research and quality improvement initiatives targeting mistreatment to quantify burden, identify risk factors and determine its impact on health and well-being outcomes. Further validation and reliability testing of the measures in other contexts is needed.
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Affiliation(s)
- Blair O Berger
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Donna M Strobino
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hedieh Mehrtash
- Department of Sexual and Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Meghan A Bohren
- Centre for Health Equity, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, University of Ghana, Accra, Greater Accra, Ghana
| | - Hannah H Leslie
- Division of Prevention Science, University of California, San Francisco, San Francisco, California, USA
| | | | - Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Mamadou Dioulde Balde
- Cellulle de Recherche en Sante de la Reproduction en Guinee (CERREGUI), University National Hospital-Donka, Conakry, Guinea
| | - Özge Tunçalp
- UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
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Ogbuabor DC, Nwankwor C. Perception of Person-Centred Maternity Care and Its Associated Factors Among Post-Partum Women: Evidence From a Cross-Sectional Study in Enugu State, Nigeria. Int J Public Health 2021; 66:612894. [PMID: 34335137 PMCID: PMC8284591 DOI: 10.3389/ijph.2021.612894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 05/07/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study validated a person-centred maternity care (PCMC) scale and assessed perception of PCMC and its associated factors among post-partum women. Methods: A cross-sectional study was conducted among 450 post-partum women in two districts in Enugu State, Nigeria, using a 30-item PCMC scale. Exploratory and confirmatory factor analyses, descriptive, bivariate and Generalized Linear Models analyses were conducted. Results: Twenty-two items were retained in the PCMC scale with high internal reliability and goodness-of-fit indices. About 25% of women received high PCMC. Marrying at 20–29 years (β = 3.46, ρ = 0.017) and 30–49 years (β = −5.56, ρ = 0.020); self-employment (β = −7.50, ρ = 0.005); marrying government worker (β = 7.12, ρ = 0.020); starting antenatal care in the third trimester (β = −6.78, ρ = 0.003); high participation in decision-making (β = −10.41, ρ < 0.001); domestic violence experience (β = 3.60, ρ = 0.007); delivery at health centre (β = 18.10, ρ < 0.001), private/mission hospital (β = 4.01, ρ = 0.003), by non-skilled attendant (β = −16.55, ρ < 0.001) and community health worker (β = −10.30, ρ < 0.001); and pregnancy complication (β = 4.37, ρ = 0.043) influenced PCMC. Conclusion: The PCMC scale is valid and reliable in Nigeria. PCMC requires improvement in Enugu State. This study identified factors that may be considered for inclusion in intervention strategies.
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Affiliation(s)
- Daniel C Ogbuabor
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Health Systems and Policy, Sustainable Impact Resource Agency, Enugu, Nigeria
| | - Chikezie Nwankwor
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria
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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.
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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
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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
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Yosef A, Kebede A, Worku N. Respectful Maternity Care and Associated Factors Among Women Who Attended Delivery Services in Referral Hospitals in Northwest Amhara, Ethiopia: A Cross-Sectional Study. J Multidiscip Healthc 2020; 13:1965-1973. [PMID: 33364778 PMCID: PMC7751605 DOI: 10.2147/jmdh.s286458] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Disrespectful and abusive care is a violation of women rights to self-determination, health, life, body integrity, and privacy. Providing respectful maternity care (RMC) during labour and delivery is one of the enhancing factors and targets in the Ethiopian health sector strategic plan to promote facility delivery. However, providing respectful maternity care is still a major challenge in the Ethiopia health-care system. This study aimed to assess respectful maternity care and associated factors among women who attended delivery services in Northwest Amhara, referral hospitals, Ethiopia. Methods Health-facility-based cross-sectional study was conducted at Northwest Amhara, referral hospitals from March 1 to April 1, 2020. A systematic random sampling technique was used to identify study participants in the referral hospitals. A total of 410 women who gave birth were enrolled in the study. A pre-tested and structured questionnaire was used for data collection. The data were collected during the exit interview. Data were cleaned and entered into Epi data version 3.1 and exported to SPSS version 23 for further analysis. Both bi-variable and multi-variable logistic regressions were employed in the analysis. Variables with a p-value of less than 0.05 were used to declare as statistically significantly associated with the dependent variable. Results The overall magnitude of women who have received respectful maternity care was 56.3%. Four and above antenatal care follow-up adjusted odds ratio (AOR) 3.092 (95% CI: 1.676, 5.725), previous history of facility delivery AOR 2.53 (95% CI: 1.094, 5.867), and delivery time AOR 2.46 (95% CI: 1.349, 4.482) were found significantly associated with respectful maternity care. Conclusion The overall magnitude of respectful maternity care was low as compared to international and national standards. This study showed that respectful maternity care among women who gave birth was influenced by the number of antenatal care visits, previous history of facility delivery, and delivery time.
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Affiliation(s)
- Amanuel Yosef
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adane Kebede
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nigusu Worku
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Disrespect and Abuse during Childbirth in Ethiopia: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8186070. [PMID: 33150181 PMCID: PMC7603554 DOI: 10.1155/2020/8186070] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 10/03/2020] [Indexed: 11/22/2022]
Abstract
Background Disrespect and abuse are recognized for the restricting impact of women from seeking maternal care, psychological humiliations, grievances, and unspoken sufferings on women during childbirth. Individual primary studies are limited in explaining of extent of disrespect and abusive care. Hence, this review considers the synthesis of comprehensive evidence on the extent, contributing factors, and consequences of disrespectful and abusive intrapartum care from the women's and providers' perspectives in Ethiopia. Methods Articles had been systematically searched from the databases of PubMed, Cochrane Library, POPLINE, Google Scholar, HINARI, African Journals Online, and WHO Global Health Library. A qualitative and quantitative synthesis was performed using the Bowser and Hill landscape analytical framework. Result Twenty-two studies comprised of the 16 quantitative; 5 qualitative and one mixed studies were included. The most repeatedly dishonored right during facility-based childbirth in Ethiopia was nondignified care, and the least commonly reported abuse was detention in health facilities. These behaviors were contributed by normalization of care, lack of empowerment and education of women, weak health system, and lack of training of providers. Women subjected to disrespectful and abusive behavior distanced themselves from the use of facility-based childbirth-related services and have endured psychological humiliations. Conclusion Disrespectful and abusive care of women during childbirth is repeatedly practiced care in Ethiopia. This result specifically described the contributing factors and their effects as a barrier to the utilization of facility-based childbirth. Therefore, to overcome this alarming problem, health systems and care providers must be responsive to the specific needs of women during childbirth, and implementing policies for standard care of respectful maternity care must be compulsory. In addition, observational, qualitative, and mixed types of studies are required to provide comprehensive evidences on disrespect and abusive behavior during childbirth in Ethiopia.
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Mihret H, Atnafu A, Gebremedhin T, Dellie E. Reducing Disrespect and Abuse of Women During Antenatal Care and Delivery Services at Injibara General Hospital, Northwest Ethiopia: A Pre-Post Interventional Study. Int J Womens Health 2020; 12:835-847. [PMID: 33116933 PMCID: PMC7568622 DOI: 10.2147/ijwh.s273468] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/25/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Disrespect and abuse during pregnancy and childbirth continue to be a barrier for the utilization and quality of care in maternal health services. This study was therefore aimed at reducing the disrespect and abuse of mothers during antenatal care and delivery services at Injibara general hospital, northwest Ethiopia. Materials and Methods A pre–post interventional mixed method design was conducted among a total of 738 randomly selected mothers who attended antenatal care and delivery services from November 1, 2018 to May 20, 2019. To collect the data, exit interview using an interviewer-administered structured questionnaire was used. Provision of training, preparation of standard written guidelines and protocols, waiting room construction, availing screening or curtain, equipment, essential drugs and supplies, supportive supervision and mentoring, and staff motivation were the lists of interventions applied to decrease disrespect and abuse. Descriptive statistics and independent t-test were computed. The independanet t-test is used because the study populations at the baseline and endline were different. A p-value of <0.05 and a mean difference with 95% CI was used to test the significance of the interventions. Results The study revealed that disrespect and abuse during pregnancy and childbirth decreased from 71.8% at baseline to 15.9% at the end-line with a 55.9% change (mean difference: 0.56, 95% CI: 0.55–0.57). Alongside, the magnitude on the subscales of disrespect and abuse (physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination and neglected care) was decreased at post-intervention, compared with the baseline. Conclusion Respectful maternal healthcare after the intervention was significantly improved. The finding suggests that provision of training to healthcare providers, written policies and procedures that describe the responsibilities of healthcare providers in the respectful maternal care process, improving facility infrastructure, availing supplies, regular supportive supervision and mentoring and motivation of high-performance employees have the potential to enhance respectful maternal care. Therefore, incorporating such training into pre-service curricula and in‐service training of healthcare workers may indorse the practice of respectful maternal care.
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Affiliation(s)
- Habtamu Mihret
- Injibara General Hospital, Awi Zone administration, Amhara National Regional State, Injibara, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaye Gebremedhin
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endalkachew Dellie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Kassa ZY, Tsegaye B, Abeje A. Disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa: a systematic review and meta-analysis. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:23. [PMID: 32894127 PMCID: PMC7487593 DOI: 10.1186/s12914-020-00242-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 08/31/2020] [Indexed: 12/30/2022]
Abstract
Background Disrespectful and abusive treatment of women by health care providers during the process of childbirth at health facility is an international problem. There is a lack of data on disrespect and abuse of women during the process of childbirth at health facilities in Sub-Saharan Africa. The purpose of this study was to determine the prevalence of disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa. Methods The PRISMA guideline protocol was followed to write the systematic review and meta-analysis. Published studies were searched from Medline, PubMed, CINAHL, EMBASE, Maternal and infant care, science direct, and PsycINFO. Articles were accessed by three reviewers (ZY, BT and AA) using the following key terms, “attitude of health personnel” AND “delivery obstetrics*/nursing” OR “maternity care” AND “disrespect” OR “abuse” OR “professional misconduct” AND “parturition” AND “prevalence” AND “professional-patient relations” AND “Sub-Saharan Africa”. Additional articles were retrieved by cross referencing of reference. The heterogeneity of studies were weighed using Cochran’s Q test and I2 test statistics. Publication bias was assessed by Egger’s test. Results Thirty three studies met the inclusion and included in this systematic review and meta–analysis of disrespect and abuse of women during the process of childbirth at health facilities. The pooled prevalence of disrespect and abuse women during the process of childbirth at health facilities in Sub-Saharan Africa was 44.09% (95% CI: 29.94–58.24).Particularly physical abuse was 15.77% (95% CI: 13.38–18.15), non-confidential care was 16.87% (95% CI: 14.49–19.24), abandonment was 16.86% (95% CI: 13.88–19.84) and detention was 4.81% (95% CI: 3.96–5.67). Conclusion In this study disrespect and abuse of women during the process of childbirth at health facilities are high compared with other studies, particularly non-confidential care and abandonment his high compared with other studies. This study points out that the ministry of health, health care providers, maternal health experts shall due attention to women’s right during the process of childbirth at health facilities.
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Affiliation(s)
- Zemenu Yohannes Kassa
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Berhan Tsegaye
- 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
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Bekele W, Bayou NB, Garedew MG. Magnitude of disrespectful and abusive care among women during facility-based childbirth in Shambu town, Horro Guduru Wollega zone, Ethiopia. Midwifery 2020; 83:102629. [PMID: 31981935 DOI: 10.1016/j.midw.2020.102629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 11/13/2019] [Accepted: 01/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Disrespectful care during childbirth causes suffering and discourages women from seeking facility-based care. It is one of the silent causes of maternal mortality and morbidity worldwide, but not yet well recorded especially in developing countries. The aim of this study was to measure the magnitude of disrespect and abusive behaviors of health professionals during childbirth and associated factors. METHOD Community based cross-sectional study design was employed among 321 women who gave birth in public health facilities of Shambu town, Ethiopia, between January 01 and December 31, 2018. Simple random sampling was used to select the study participants. Data were collected using a semi-structured interviewer administered questionnaire. Prevalence of disrespect and abuse was measured by using seven categories of disrespect and abuse with their respective verification criteria. The data were entered into Epi-data 3.1 and then transported to SPSS version 23.0. Logistic regression models were fitted to determine the presence of statistically significant associations between the dependent and independent variables at p-value <0.05 and AOR values with 95% confidence interval. RESULTS Out of 321 sampled respondents, 316 participated in this study with response rate of 98.4%. The overall prevalence of disrespect and abuse was 78.2% (95% CI: 73.5-83.2). The most common forms disrespect and abuse encountered by the mothers were: unconsented care (86.1%), non-dignified care (37.3%), lack of privacy (33.9%), physical abuse (21.5%) and neglectful care (13.3%). Mother's occupational status, increasing number of antenatal care visits and giving birth in a hospital setting were significantly associated with disrespect and abuse during facility-based childbirth. CONCLUSION Though government interventions are in place, excessive levels of disrespect and abusive practices during facility-based childbirth persisted to be important problems in the study area. To address the unnecessary suffering, health policy makers and program designers should develop strategies to enhance respectful maternity care approaches. Health managers and health professionals should do their best to provide high quality, client-centered care in health facilities so that women are not discouraged from using them. We also recommend knowledge exchange with development partners to determine which practices will be adaptable and helpful to address the problem of mistreatment of women in health care facilities.
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Affiliation(s)
- Workineh Bekele
- Zonal Health Department of Horro Guduru Wollega, Oromia regional Health Bureau, Ethiopia
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Mihret MS. Obstetric violence and its associated factors among postnatal women in a Specialized Comprehensive Hospital, Amhara Region, Northwest Ethiopia. BMC Res Notes 2019; 12:600. [PMID: 31533858 PMCID: PMC6751597 DOI: 10.1186/s13104-019-4614-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/06/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Obstetric violence is an often overlooked obstacle to quality maternal health care service utilization. In the study setting, there was limited evidence on obstetric violence. Hence, this study aimed at assessing the prevalence and associated factors of obstetric violence among women who gave birth in Gondar University Specialized Comprehensive Hospital, Northwest Ethiopia. Results A total of 409 women had been participated in the study with a response rate of 100%. Three in four (75.1%) women reported that they had been subjected to at least one form of obstetric violence during labor and delivery with 95% CI (70.9–79.0). The reported forms of obstetric violence include non-consented care—260 (63.6%), non-dignified care—226 (55.3%), physical abuse—192 (46.9%), non-confidential care—132 (32.3%, neglected care—52 (12.7%) and discriminated care—38 (9.3%). On the contrary, none of the respondent had reported detention for failure to pay in the hospital. The multivariable logistic regression analysis demonstrated that urban residents (AOR = 1.89; 95% CI 1.11, 3.22) and primary school attendants (AOR = 0.49; 95% CI 0.27, 0.91) were significantly associated with experiencing obstetric violence. This study indicated the high prevalence of obstetric violence. Thus, interventions need to be undertaken by taking the reported forms of obstetric violence and participants’ sociodemographic status in to account.
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Affiliation(s)
- Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Po. Box 196, Gondar, Ethiopia.
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