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Kumari S, Sharma KA, Ghosh S, Suman BA, Bhardwaj A, Puri M, Chaudhary P, Chatterjee T, Dubey S, Karna P. Respectful Abortion Care initiative: How a large-scale virtual training for providers in India increased knowledge of the new 2021 Medical Termination of Pregnancy Act. Int J Gynaecol Obstet 2024; 164 Suppl 1:42-50. [PMID: 38360033 DOI: 10.1002/ijgo.15335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND In a historic move to ensure comprehensive abortion care, India amended the 1971 Medical Termination of Pregnancy (MTP) Act in 2021, creating an unprecedented opportunity for accelerating safe, respectful, and rights-based abortion services. The Federation of Obstetric and Gynecological Societies of India (FOGSI), together with World Health Organization (WHO) India and the Ministry of Health and Family Welfare, set up a flagship initiative "Respectful Abortion Care" (RAC) to provide training to obstetricians and gynecologists on the new Act, and also address their values and biases. METHODS Virtual training sessions were organized during the COVID-19 pandemic to disseminate the amendments made under the MTP Act and address provider values and biases. The primary focus was on private providers as they account for more than half of all abortion services in India (52.9%). The RAC modules were systematically designed and delivered by 690 Master Trainers, trained by FOGSI and WHO. RESULTS A total of 9051 FOGSI members (22%, with 50% from private clinics) completed the RAC trainings. Pretests and post-tests were conducted for impact assessment. Significant improvement was seen on knowledge of criteria for termination of pregnancy for significant birth defects (52%-83%). The post-training survey showed a high level of commitment to promote RAC: >95% were strongly motivated to perform or assist in abortion; 89% reported that the WHO value clarification exercises were helpful in facilitating open discussions on sensitive topics in a comfortable manner; 96% expressed a strong commitment to addressing the issue of respect and confidentiality in abortion care. CONCLUSION RAC was a unique initiative around the MTP Act amendment 2021 in India, which demonstrated that collaboration and leadership by professional associations can help motivate providers and lead to improved knowledge and commitment from public and private sector providers.
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Affiliation(s)
- Shantha Kumari
- Federation of Obstetric and Gynaecological Societies of India, Mumbai, India
| | - Kandala Aparna Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sumita Ghosh
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Barru Aruna Suman
- Federation of Obstetric and Gynaecological Societies of India, Mumbai, India
| | - Ajey Bhardwaj
- Federation of Obstetric and Gynaecological Societies of India, Mumbai, India
| | - Manju Puri
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
| | - Pushpa Chaudhary
- World Health Organization, Country Office for India, New Delhi, India
| | - Tapas Chatterjee
- World Health Organization, Country Office for India, New Delhi, India
| | - Sapna Dubey
- World Health Organization, Country Office for India, New Delhi, India
| | - Priya Karna
- World Health Organization, Country Office for India, New Delhi, India
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Haghdoost S, Iravani M, Rahmani AH, Montazeri S. Midwives' experience of respectful maternity care (RMC) globally: A meta-synthesis. Nurs Ethics 2023:9697330231218346. [PMID: 38113636 DOI: 10.1177/09697330231218346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Respectful maternity care (RMC) emphasizes the social and relational elements of maternity care and is a crucial part of initiatives to improve service accessibility and quality. Women's perceptions have influenced much of what we know about RMC and contempt in the labor ward. In order to understand midwives' perspectives of RMC, this meta-synthesis focused on them. METHOD For this inquiry, the databases PubMed/Medline, Embase, Web of Science, and Scopus were searched to find studies on midwives' perceptions of RMC written between 2011 and April 20th 2023. The included articles were to English language restriction. The results of the included research were examined using thematic analysis. Using the inclusion criteria, 84 potentially relevant articles were carefully reviewed, and only 22 were ultimately selected for synthesis. The quality of the qualitative study was assessed using the CASP, a tool for quality evaluation and PRISMA guidelines were followed. Using the MAXQDA program, the cited quotes and the original authors' interpretations were combined. RESULT There were 22 studies total, thematic synthesis was determined to be appropriate for a total of 22 research studies. Following are the topics which we summarized our analysis: in six major themes: Midwives' conceptualizations of RMC, Midwives commitment to woman's rights, The value and impact of RMC to midwives, Midwife's perception of disrespectful care, Challenges in providing respectful maternity care, and Midwives' recommendations for optimal RMC practice. CONCLUSION In addition to specific focus on promoting cooperation, policies to enhance health systems and strategic consideration of the midwifery profession's future are required.
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Affiliation(s)
| | - Mina Iravani
- Ahvaz Jondishapour University of Medical Sciences
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Tahara-Sasagawa E, Mochida K, Sadamori T, Suzuki M, Guerrero C, Haruna M, Misago C. Lessons from the "Humanization of Childbirth" Projects: Qualitative analysis of seven projects funded by the Japan International Cooperation Agency. Glob Health Med 2023; 5:301-305. [PMID: 37908509 PMCID: PMC10615027 DOI: 10.35772/ghm.2023.01054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 11/02/2023]
Abstract
The "Humanization of Childbirth" Project is one of the various maternity care models that respect women and their newborn children. For more than a quarter of a century, the Japan International Cooperation Agency (JICA) has been implementing technical cooperation projects worldwide that place the humanization of childbirth at the center of the concept. By reviewing the project reports, the following 11 key processes were found for the formulation and implementation of future projects for the humanized maternity care: i) project-finding/exploration of unmet needs, ii) identification of local key persons, iii) organization of a project team and a back-up committee, iv) development of an action plan, v) sharing of concepts, vi) development of local leadership, vii) organization of infrastructure, viii) final evaluation and wrap-up seminar, ix) ensuring sustainability, x) development of younger generation experts, and xi) sustainable and autonomous action.
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Affiliation(s)
- Emi Tahara-Sasagawa
- Graduate School of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | | | | | - Megumi Haruna
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chizuru Misago
- Department of International and Cultural Study, Tsuda University, Tokyo, Japan
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Afulani PA, Nakphong MK, Sudhinaraset M. Person-centred sexual and reproductive health: A call for standardized measurement. Health Expect 2023; 26:1384-1390. [PMID: 37232021 PMCID: PMC10349248 DOI: 10.1111/hex.13781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/26/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023] Open
Abstract
Person-centred sexual and reproductive health (PCSRH) care refers to care that is respectful of and responsive to people's preferences, needs, and values, and which empowers them to take charge of their own sexual and reproductive health (SRH). It is an important indicator of SRH rights and quality of care. Despite the recognition of the importance of PCSRH, there is a gap in standardized measurement in some SRH services, as well as a lack of guidance on how similar person-centred care measures could be applied across the SRH continuum. Drawing on validated scales for measuring person-centred family planning, abortion, prenatal and intrapartum care, we propose a set of items that could be validated in future studies to measure PCSRH in a standardized way. A standardized approach to measurement will help highlight gaps across services and facilitate efforts to improve person-centred care across the SRH continuum. PATIENT OR PUBLIC CONTRIBUTION: This viewpoint is based on a review of validated scales that were developed through expert reviews and cognitive interviews with services users and providers across the different SRH services. They provided feedback on the relevance, clarity, and comprehensiveness of the items in each scale.
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Affiliation(s)
- Patience A. Afulani
- Departments of Epidemiology and Biostatistics and Obstetrics, Gynecology, and Reproductive Sciences, School of MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Michelle K. Nakphong
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public HealthUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - May Sudhinaraset
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public HealthUniversity of California, Los AngelesLos AngelesCaliforniaUSA
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Altman MR, Cragg K, van Winkle T, Julian Z, Obedin-Maliver J, Tarasoff LA, Eagen-Torkko MK, Ferrell BL, Rubashkin NA, Lusero I, Vedam S. Birth includes us: Development of a community-led survey to capture experiences of pregnancy care among LGBTQ2S+ families. Birth 2023; 50:109-119. [PMID: 36625538 PMCID: PMC10332260 DOI: 10.1111/birt.12704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/04/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Limited research captures the intersectional and nuanced experiences of lesbian, gay, bisexual, transgender, queer, two-spirit, and other sexual and gender-minoritized (LGBTQ2S+) people when accessing perinatal care services, including care for pregnancy, birth, abortion, and/or pregnancy loss. METHODS We describe the participatory research methods used to develop the Birth Includes Us survey, an online survey study to capture experiences of respectful perinatal care for LGBTQ2S+ individuals. From 2019 to 2021, our research team in collaboration with a multi-stakeholder Community Steering Council identified, adapted, and/or designed survey items which were reviewed and then content validated by community members with lived experience. RESULTS The final survey instrument spans the perinatal care experience, from preconception to early parenthood, and includes items to capture experiences of care across different pregnancy roles (eg, pregnant person, partner/co-parent, intended parent using surrogacy) and pregnancy outcomes (eg, live birth, stillbirth, miscarriage, and abortion). Three validated measures of respectful perinatal care are included, as well as measures to assess experiences of racism, discrimination, and bias across intersections of identity. DISCUSSION AND CONCLUSIONS By centering diverse perspectives in the review process, the Birth Includes Us instrument is the first survey to assess the range of experiences within LGBTQ2S+ communities. This instrument is ready for implementation in studies that seek to examine geographic and identity-based perinatal health outcomes and care experiences among LGBTQ2S+ people.
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Affiliation(s)
- Molly R. Altman
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Kase Cragg
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Teresa van Winkle
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Zoë Julian
- Department of Obstetrics and Gynecology, Wellstar Kennestone Regional Medical Center, Marietta, Georgia, USA
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Lesley A. Tarasoff
- Department of Health & Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Meghan K. Eagen-Torkko
- University of Washington Bothell School of Nursing & Health Studies, Bothell, Washington, USA
| | - Brittany L. Ferrell
- Washington University in St. Louis, Goldfarb School of Nursing, St. Louis, Missouri, USA
| | - Nicholas A. Rubashkin
- Division of Hospitalist Medicine, Department of Obstetrics, Gynecology& Reproductive Sciences, Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | | | - Saraswathi Vedam
- Birth Place Lab, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Dagnaw FT, Kehali KY, Agago TA, Hailemeskel HS. Person-centered Maternity Care Among Mothers Who Gave Birth in South Wollo Zone Public Hospitals, Northeastern Ethiopia: A Mixed-method Study. Health Serv Insights 2022; 15:11786329221127946. [PMID: 36211716 PMCID: PMC9536102 DOI: 10.1177/11786329221127946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Globally, less attention has been given to the abuse and disrespect observed during maternity care. Person-centered maternity care is providing care that is respectful and responsive to individual women's preferences and needs and that their values guide all clinical decisions during childbirth. In Ethiopia, person-centered health care is one of the factors that increase client satisfaction and health service utilization. Therefore, we aimed to determine the level of person-centered maternity care among mothers who gave birth in health facilities of South Wollo Zone public hospitals, Northeastern, Ethiopia, 2019 using a mixed-method study. Methods An institution-based cross-sectional study was conducted using both qualitative and quantitative data collection methods. Three hundred sixty-nine study participants were selected for the quantitative study using simple random sampling. Twelve study participants were selected for the qualitative study using purposive sampling. The quantitative data was coded and entered into Epi data 4.4 version and the analysis was carried out using Statistical Package for Social Sciences version 23. Descriptive statics was presented using tables and figures. Thematic analysis was used for qualitative data and presented with the quantitative result through triangulation. Result The Percentage mean score of the person-centered maternity care scale of the respondents was 64% of the total expected score. Whereas, the percentage means score sub-scales were 81.9%, for dignity and respect, 56.4% for communication and autonomy and 61.6% for supportive care. Most mothers who participated in an in-depth interview reported that there is not enough bed, delivery coach and bedpan in government hospitals. Conclusion and recommendations Person-centered maternity care in health facilities of South Wollo Zone public hospitals is low. Therefore, responsible health sectors should work to improve the quality of care through effective communication between clients and providers and a supportive environment is crucial to succeeding in increasing the uptake of high-quality facility-based births.
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Affiliation(s)
- Fentaw Teshome Dagnaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kiddus Yitbarek Kehali
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Tesfamichael Alaro Agago
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Habtamu Shimels Hailemeskel
- Department of Pediatrics and neonatal nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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7
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Altman MR, Afulani PA, Melbourne D, Kuppermann M. Factors associated with person-centered care during pregnancy and birth for Black women and birthing people in California. Birth 2022; 50:329-338. [PMID: 36005865 DOI: 10.1111/birt.12675] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In the United States, adverse birth outcomes are most prevalent among Black women and birthing people, who are known to experience increased mistreatment and disrespect in care. The purpose of this paper is to describe findings from a study that used two validated scales to examine factors associated with experiences of person-centered care during pregnancy and birth among Black birthing people in California. METHODS We used data from 234 Black women and birthing people who were recruited between January and September 2020 as part of a validation study for the Person-Centered Prenatal Care (PCPC) and the Person-Centered Maternity Care (PCMC-US) scales. Bivariate and multivariate analyses were conducted to examine the associations between PCPC and PCMC-US scores and sociodemographic, health-related, and care-related factors. RESULTS The factors associated with lower PCPC scores were having foreign-born parents, having public or no insurance, part-time employment, unstable housing, late start of prenatal care (in the second or third trimester), poorer self-rated health (less than very good), and lack of continuity of care with prenatal providers. Factors associated with lower PCMC-US scores were having public insurance, late start of prenatal care, longer length of stay in facility following birth, poorer self-rated health, lack of continuity of care between prenatal care and birth providers, and racial discordance with birth provider. CONCLUSIONS Our analysis highlights the contributions of intersecting identities as well as health-related and care-related factors to Black birthing people's experiences of care in California. Continuity of care and provider racial concordance, in particular, were shown to improve pregnancy and birth experiences.
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Affiliation(s)
- Molly R Altman
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Patience A Afulani
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.,Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California, USA
| | - Daphina Melbourne
- Alameda County Perinatal Equity Initiative, Alameda County Public Health Department, Oakland, California, USA
| | - Miriam Kuppermann
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.,Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California, USA.,California Preterm Birth Initiative, University of California, San Francisco, California, USA
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8
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Combellick JL, Basile Ibrahim B, Julien T, Scharer K, Jackson K, Powell Kennedy H. Birth during the Covid-19 pandemic: What childbearing people in the United States needed to achieve a positive birth experience. Birth 2022; 49:341-351. [PMID: 35218067 PMCID: PMC9111370 DOI: 10.1111/birt.12616] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/09/2021] [Accepted: 01/26/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The COVID pandemic exposed many inadequacies in the maternity care system in the United States. Maternity care protocols put in place during this crisis often did not include input from childbearing people or follow prepandemic guidelines for high-quality care. Departure from standard maternity care practices led to unfavorable and traumatic experiences for childbearing people. This study aimed to identify what childbearing people needed to achieve a positive birth experience during the pandemic. METHODS This mixed-methods, cross-sectional study was conducted among individuals who gave birth during the COVID pandemic from 3/1/2020 to 11/1/2020. Participants were sampled via a Web-based questionnaire that was distributed nationally. Descriptive and bivariate statistics were analyzed. Thematic and content analyses of qualitative data were based on narrative information provided by participants. Qualitative and convergent quantitative data were reported. RESULTS Participants (n = 707) from 46 states and the District of Columbia completed the questionnaire with 394 contributing qualitative data about their experiences. Qualitative findings reflected women's priorities for (a) the option of community birth, (b) access to midwives, (c) the right to an advocate at birth, and (d) the need for transparent and affirming communication. Quantitative data reinforced these findings. Participants with a midwife provider felt significantly better informed. Those who gave birth in a community setting (at home or in a freestanding birth center) also reported significantly higher satisfaction and felt better informed. Participants of color (BIPOC) were significantly less satisfied and more stressed while pregnant and giving birth during the pandemic. CONCLUSIONS High-quality maternity care places childbearing people at the center of care. Prioritizing the needs of childbearing people, in COVID times or otherwise, is critical for improving their experiences and delivering efficacious and safe care.
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Affiliation(s)
| | | | - Tamika Julien
- School of NursingYale UniversityOrangeConnecticutUSA
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9
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Atkins B, Blencowe H, Boyle FM, Sacks E, Horey D, Flenady V. Is care of stillborn babies and their parents respectful? Results from an international online survey. BJOG 2022; 129:1731-1739. [PMID: 35289061 DOI: 10.1111/1471-0528.17138] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To quantify parents' experiences of respectful care around stillbirth globally. DESIGN Multi-country, online, cross-sectional survey. SETTING AND POPULATION Self-identified bereaved parents (n = 3769) of stillborn babies from 44 high- and middle-income countries. METHODS Parents' perspectives of seven aspects of care quality, factors associated with respectful care and seven bereavement care practices were compared across geographical regions using descriptive statistics. Respectful care was compared between country-income groups using multivariable logistic regression. MAIN OUTCOME MEASURES Self-reported experience of care around the time of stillbirth. RESULTS A quarter (25.4%) of 3769 respondents reported disrespectful care after stillbirth and 23.5% reported disrespectful care of their baby. Gestation less than 30 weeks and primiparity were associated with disrespect. Reported respectful care was lower in middle-income countries than in high-income countries (adjusted odds ratio 0.35, 95% CI 0.29-0.42, p < 0.01). In many countries, aspects of care quality need improvement, such as ensuring families have enough time with providers. Participating respondents from Latin America and southern Europe reported lower satisfaction across all aspects of care quality compared with northern Europe. Unmet need for memory-making activities in middle-income countries was high. CONCLUSIONS Many parents experience disrespectful care around stillbirth. Provider training and system-level support to address practical barriers are urgently needed. However, some practices (which are important to parents) can be readily implemented such as memory-making activities and referring to the baby by name.
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Affiliation(s)
- Bethany Atkins
- EGA Institute for Women's Health, University College London, London, UK
| | - Hannah Blencowe
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Frances M Boyle
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia.,NHMRC Centre of Research Excellence, Mater Research Institute-The University of Queensland, South Brisbane, Queensland, Australia
| | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Dell Horey
- NHMRC Centre of Research Excellence, Mater Research Institute-The University of Queensland, South Brisbane, Queensland, Australia.,Department of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence, Mater Research Institute-The University of Queensland, South Brisbane, Queensland, Australia
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10
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Govule P, Baumann S, Dossou JP, Calvert C, Goufodji S, Mehrtash H, Tuncalp Ö, Adu-Bonsaffoh K, Compaore R, Filippi V. Experiences of women seeking care for abortion complications in health facilities: Secondary analysis of the WHO Multi-Country Survey on Abortion in 11 African countries. Int J Gynaecol Obstet 2021; 156 Suppl 1:44-52. [PMID: 34866183 DOI: 10.1002/ijgo.13987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Despite evidence of acute and long-term consequences of suboptimal experiences of care, standardized measurements across countries remain limited, particularly for postabortion care. We aimed to determine the proportion of women reporting negative experiences of care for abortion complications, identify risk factors, and assess the potential association with complication severity. METHODS Data were sourced from the WHO Multi-Country Survey on Abortion for women who received facility-based care for abortion complications in 11 African countries. We measured women's experiences of care with eight questions from an audio computer-assisted self-interview related to respect, communication, and support. Multivariable generalized estimating equations were used for analysis. RESULTS There were 2918 women in the study sample and 1821 (62%) reported at least one negative experience of postabortion care. Participants who were aged under 30 years, single, of low socioeconomic status, and economically dependent had higher odds of negative experiences. Living in West or Central Africa, rather than East Africa, was also associated with reportedly worse care. The influence of complication severity on experience of care appeared significant, such that women with moderate and severe complications had 12% and 40% higher odds of reporting negative experiences, respectively. CONCLUSION There were widespread reports of negative experiences of care among women receiving treatment for abortion complications in health facilities. Our findings contribute to the scant understanding of the risk factors for negative experiences of postabortion care and highlight the need to address harmful provider biases and behaviors, alleviate health system constraints, and empower women in demanding better care.
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Affiliation(s)
- Philip Govule
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Sasha Baumann
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Bénin
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Scotland, UK
| | - Sourou Goufodji
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Bénin
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tuncalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana.,Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Rachidatou Compaore
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Véronique Filippi
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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11
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Summerton JV, Mtileni TR, Moshabela ME. Experiences and perceptions of birth companions supporting women in labour at a District Hospital in Limpopo, South Africa. Curationis 2021; 44:e1-e7. [PMID: 34797104 PMCID: PMC8603091 DOI: 10.4102/curationis.v44i1.2186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/06/2021] [Accepted: 09/14/2021] [Indexed: 12/03/2022] Open
Abstract
Background South Africa has included birth companions in its national guidelines for maternity care and the revised Maternity Case Record, in and effort to improve the quality and experience of care. However, reservations amongst healthcare providers remain about the acceptability of birth companions in the labour ward. Objectives To document the experiences and perceptions of birth companions who supported women in labour in a rural hospital in Limpopo Province where a Respectful Maternity Care (RMC) project was piloted. Method An institution-based cross-sectional study design was employed. Purposive sampling was employed where all birth companions who supported a woman during labour and birth were included in the study. The experiences and perceptions of birth companions were captured using a birth companion feedback book during the period of 1st April to 30th August 2019. Thematic analysis was used to analyse the data. Results Seventy-one (71) of the 73 birth companions only had positive responses about the birthing experience and how both the birth companion and woman in labour were treated. Two birth companions were dissatisfied with the treatment provided by the midwife that supported the birth. Conclusion It is important for healthcare providers to understand the far reaching emotional and psychological impact of their attitudes and behaviour on, not only women in labour but also on others who witness their (healthcare providers) behaviour. Mechanisms to obtain feedback from birth companions should be integrated into strategies to improve the quality and experience of care for women during childbirth.
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Affiliation(s)
- Joy V Summerton
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Limpopo, Polokwane.
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Odiase O, Akinyi B, Kinyua J, Afulani P. Community Perceptions of Person-Centered Maternity Care in Migori County, Kenya. Front Glob Womens Health 2021; 2:668405. [PMID: 34816219 PMCID: PMC8593945 DOI: 10.3389/fgwh.2021.668405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Community perceptions of quality of maternal healthcare services-including Person-centered maternity care (PCMC)-influences the health-seeking behavior of women. Yet few studies have examined this quantitatively. This study aims to examine community perceptions of PCMC and its associated factors. Materials and Methods: We used data from a survey on community perceptions of PCMC in Migori County, Kenya conducted in August 2016. Community members were relatives or friends of women aged 15 to 49 years who gave birth in the 9 wk preceding the survey (N = 198). PCMC was measured using a 30-item scale with three sub-scales for dignity and respect, communication and autonomy, and supportive care. PCMC scores were standardized to range from 0 to 100, with higher scores indicative of higher PCMC. Descriptive, bivariate, and multivariate analyses were performed in STATA (version 14). Results: The average total PCMC score was 62 (SD = 15.7), with scores of 74, 63, and 53 for dignity and respect, supportive care, and communication and autonomy, respectively. Controlling for other factors, respondents who were employed and literate had higher PCMC perception scores than those who were less literate and unemployed. Respondents who rated their health as very good had higher PCMC perception scores than those who rated their health as poor. Female respondents who previously gave birth at a health facility had lower perceptions of dignity and respect than those with no prior facility birth. Conclusion: The findings imply that community perceptions of PCMC, particularly related to communication and autonomy, are poor. Given the effects of these perceptions on use of maternal health services, there is a need to improve PCMC.
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Affiliation(s)
- Osamuedeme Odiase
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Beryl Akinyi
- Global Programs for Research and Training, Nairobi, Kenya
| | | | - Patience Afulani
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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13
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Alonso C. Integrating the midwifery model of care into abortion services. Sex Reprod Health Matters 2021; 28:1795448. [PMID: 32729381 PMCID: PMC7888103 DOI: 10.1080/26410397.2020.1795448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Cristina Alonso
- Doctoral Fellow, Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA. Correspondence :
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14
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Green CL, Perez SL, Walker A, Estriplet T, Ogunwole SM, Auguste TC, Crear-Perry JA. The Cycle to Respectful Care: A Qualitative Approach to the Creation of an Actionable Framework to Address Maternal Outcome Disparities. Int J Environ Res Public Health 2021; 18:ijerph18094933. [PMID: 34066381 PMCID: PMC8141109 DOI: 10.3390/ijerph18094933] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022]
Abstract
Despite persistent disparities in maternity care outcomes, there are limited resources to guide clinical practice and clinician behavior to dismantle biased practices and beliefs, structural and institutional racism, and the policies that perpetuate racism. Focus groups and interviews were held in communities in the United States identified as having higher density of Black births. Focus group and interview themes and codes illuminated Black birthing individual’s experience with labor and delivery in the hospital setting. Using an iterative process to refine and incorporate qualitative themes, we created a framework in close collaboration with birth equity stakeholders. This is an actionable, cyclical framework for training on anti-racist maternity care. The Cycle to Respectful Care acknowledges the development and perpetuation of biased healthcare delivery, while providing a solution for dismantling healthcare providers’ socialization that results in biased and discriminatory care. The Cycle to Respectful Care is an actionable tool to liberate patients, by way of their healthcare providers, from biased practices and beliefs, structural and institutional racism, and the policies that perpetuate racism.
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Affiliation(s)
- Carmen L. Green
- National Birth Equity Collaborative, New Orleans, LA 20026, USA; (A.W.); (T.E.)
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA 94143, USA
- Correspondence: (C.L.G.); (S.L.P.); (J.A.C.-P.)
| | - Susan L. Perez
- National Birth Equity Collaborative, New Orleans, LA 20026, USA; (A.W.); (T.E.)
- Department of Public Health, California State University, Sacramento, CA 95819, USA
- Correspondence: (C.L.G.); (S.L.P.); (J.A.C.-P.)
| | - Ashlee Walker
- National Birth Equity Collaborative, New Orleans, LA 20026, USA; (A.W.); (T.E.)
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70118, USA
| | - Tracey Estriplet
- National Birth Equity Collaborative, New Orleans, LA 20026, USA; (A.W.); (T.E.)
| | - S. Michelle Ogunwole
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Tamika C. Auguste
- MedStar Washington Hospital Center, Council on Patient Safety in Women’s Health Care, ACOG, Washington, DC 20010, USA;
| | - Joia A. Crear-Perry
- National Birth Equity Collaborative, New Orleans, LA 20026, USA; (A.W.); (T.E.)
- Correspondence: (C.L.G.); (S.L.P.); (J.A.C.-P.)
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15
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Altman MR, Gavin AR, Eagen-Torkko MK, Kantrowitz-Gordon I, Khosa RM, Mohammed SA. Where the System Failed: The COVID-19 Pandemic's Impact on Pregnancy and Birth Care. Glob Qual Nurs Res 2021; 8:23333936211006397. [PMID: 33869668 PMCID: PMC8020401 DOI: 10.1177/23333936211006397] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 01/22/2023] Open
Abstract
The COVID-19 pandemic created a massive shift in health care systems, including within pregnancy and birth care. To explore how experiences of pregnancy and birth were impacted, 15 patient participants and 14 nurse participants were interviewed and transcripts analyzed using critical thematic analysis. Patients highlighted how adaptations to care were inadequate to meet their needs, a desire for support in response to stress, and the impact of COVID on patients’ experiences. Nurses identified how inconsistencies in policies impacted nurses’ ability to care for patients, the impact on nurses from hospital actions, and the impact on patients from hospital actions. Both groups discussed how system changes had disparate impacts on marginalized communities, leading to racially-biased care. This pandemic will continue to have lasting impact on pregnant and birthing families, and the nurses who care for them, and it is imperative that hospitals examine their role and any potential impacts.
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Affiliation(s)
- Molly R Altman
- University of Washington School of Nursing, Seattle, USA
| | - Amelia R Gavin
- University of Washington School of Social Work, Seattle, USA
| | | | | | | | - Selina A Mohammed
- University of Washington School of Nursing and Health Studies, Bothell, USA
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16
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Diniz CSG, Bussadori JCDC, Lemes LB, Moisés ECD, Prado CADC, McCourt C. A change laboratory for maternity care in Brazil: Pilot implementation of Mother Baby Friendly Birthing Initiative. Med Teach 2021; 43:19-26. [PMID: 32672483 DOI: 10.1080/0142159x.2020.1791319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Disrespectful and abusive treatment of women during childbirth is a worldwide problem. This research aimed to develop and implement a Mother Baby-Friendly Hospital Initiative (MBFHI) in an academic maternity hospital in Brazil and evaluate how change could be sustained. Change Laboratory principles guided a process of action research, which was conducted between 2017 and 2019. Clinicians and managers joined the researchers in discussion sessions to redesign routines and care pathways. Observation, interviews, focus groups, and historical and documentary analysis provided information about the existing activity system, which we analysed qualitatively using MBFHI criteria to identify themes. Evidence of inappropriate obstetric interventions and impersonal interactions between clinicians and patients stimulated us to devise innovative solutions. The challenges identified by this exercise included: poor infrastructure and ambience; difficulty adhering to evidence-based protocols; social and professional hierarchies; and clinicians being poorly educated about women's rights. Although challenges remained, positive changes included a friendlier environment, improved patient privacy, and fewer unnecessary procedures. Resources released by these changes allowed us, collaboratively, to track the further implementation and sustainability of change. We conclude that the Change Laboratory can help motivated clinicians and managers humanise patients' experiences, make care more evidence-based, and expand learning of mother-friendly maternity care. Tensions and contradictions between education and patient care reported here may resonate in settings other than maternity care.
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Affiliation(s)
| | | | | | - Elaine Christine Dantas Moisés
- Department of Gynecology & Obstetrics, Ribeirão Preto School of Medicine (FMRP), University of São Paulo, Ribeirão Preto, Brazil
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Lusambili A, Wisofschi S, Shumba C, Obure J, Mulama K, Nyaga L, Wade TJ, Temmerman M. Health Care Workers' Perspectives of the Influences of Disrespectful Maternity Care in Rural Kenya. Int J Environ Res Public Health 2020; 17:ijerph17218218. [PMID: 33172160 PMCID: PMC7664382 DOI: 10.3390/ijerph17218218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 01/19/2023]
Abstract
While disrespectful treatment of pregnant women attending health care facilities occurs globally, it is more prevalent in low-resource countries. In Kenya, a large body of research studied disrespectful maternity care (DMC) from the perspective of the service users. This paper examines the perspective of health care workers (HCWs) on factors that influence DMC experienced by pregnant women at health care facilities in rural Kisii and Kilifi counties in Kenya. We conducted 24 in-depth interviews with health care workers (HCWs) in these two sites. Data were analyzed deductively and inductively using NVIVO 12. Findings from HCWs reflective narratives identified four areas connected to the delivery of disrespectful care, including poor infrastructure, understaffing, service users' sociocultural beliefs, and health care workers' attitudes toward marginalized women. Investments are needed to address health system influences on DMC, including poor health infrastructure and understaffing. Additionally, it is important to reduce cultural barriers through training on HCWs' interpersonal communication skills. Further, strategies are needed to affect positive behavior changes among HCWs directed at addressing the stigma and discrimination of pregnant women due to socioeconomic standing. To develop evidence-informed strategies to address DMC, a holistic understanding of the factors associated with pregnant women's poor experiences of facility-based maternity care is needed. This may best be achieved through an intersectional approach to address DMC by identifying systemic, cultural, and socioeconomic inequities, as well as the structural and policy features that contribute and determine peoples' behaviors and choices.
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Affiliation(s)
- Adelaide Lusambili
- Department of Population Health (DPH), Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya;
- Correspondence:
| | - Stefania Wisofschi
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (S.W.); (J.O.); (K.M.); (L.N.); (T.J.W.); (M.T.)
| | - Constance Shumba
- Department of Population Health (DPH), Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya;
| | - Jerim Obure
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (S.W.); (J.O.); (K.M.); (L.N.); (T.J.W.); (M.T.)
| | - Kennedy Mulama
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (S.W.); (J.O.); (K.M.); (L.N.); (T.J.W.); (M.T.)
| | - Lucy Nyaga
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (S.W.); (J.O.); (K.M.); (L.N.); (T.J.W.); (M.T.)
| | - Terrance J. Wade
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (S.W.); (J.O.); (K.M.); (L.N.); (T.J.W.); (M.T.)
- Department of Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (S.W.); (J.O.); (K.M.); (L.N.); (T.J.W.); (M.T.)
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19
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Azevedo MA, Dall'Agnol D. An agency model of consent and the standards of disclosure in health care: Knowing-how to reach respectful shared decisions among real persons. J Eval Clin Pract 2020; 26:389-396. [PMID: 31502732 DOI: 10.1111/jep.13281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/18/2019] [Accepted: 08/24/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In this article, we evaluate and compare the frailties of two different standards of disclosure of information regarding the risks of medical procedures applied in recent judicial decisions in the United Kingdom. As an alternative, we present the tenets and philosophical grounds of an agency model of consent and a person-based standard of disclosure. METHODS Critical philosophical analysis of the background assumptions of two standards of disclosure and their relative "tests of negligence" applied in recent legal judgements in the United Kingdom. RESULTS Both standards, the "Professional Practice Standard" (the traditional standard employed in Sidaway versus Board of Governors of the Bethlem Royal Hospital, 1985) and the allegedly new "Reasonable Person Standard" (mentioned in Montgomery versus Lanarkshire Health Board, 2015), can lead to malpractice if the medical-patient relationship is not guided by attitudes of respectful care. The traditional standard is disrespectful as it does not take patients as full agents, presupposing that the patient's right is only a negative right to refuse what was deliberated only by the practitioner. The "new" standard can be disrespectful if the practitioner, concerned only with what a hypothetical reasonable individual would take as relevant for choosing between alternatives of treatment, does not know how to respect their real patient in a genuine shared decision-making process. CONCLUSION We conclude that in order to know how to obtain valid informed consent, doctors need to engage in real conversations with their patients, revealing as much information as they, taken as real persons, need to be part of a genuine shared and respectful decision-making process.
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Affiliation(s)
- Marco Antonio Azevedo
- School of Humanities, Graduate Program in Philosophy, University of Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
| | - Darlei Dall'Agnol
- Department of Philosophy/CNPq, Federal University of Santa Catarina, Florianόpolis, SC, Brazil
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20
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Azevedo MA, Andrade B. Tying care and respect into a single bioethical principle: On Dall'Agnol's respectful care theory. J Eval Clin Pract 2019; 25:985-990. [PMID: 31087718 DOI: 10.1111/jep.13150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/26/2019] [Accepted: 03/30/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE In this article, we offer an extended critical review of a new conception of bioethics, presented by Darlei Dall'Agnol, in the book Care and Respect in Bioethics. METHODS Critical philosophical analysis of background assumptions of a new approach to bioethics, enriched with critical discussion of related philosophical literature. RESULTS In Care and Respect in Bioethics, through an approach filled with hard cases, Dall'Agnol argues that the metaethics of respectful care has theoretical advantages over the intuitionist metaethics of principlism and the particularism of casuistry, offering an original comprehensive approach that crosses the three dimensions of ethical inquiry: metaethical, normative, and applied ethics. CONCLUSIONS Dall'Agnol offers an insightful and persuasive account of how the single attitude of respectful care can express practical moral knowledge in healthcare. In this paper, we evaluate, criticize, and suggest refinements. One of them concerns Dall'Agnol's interpretation about Stephen Darwall's views on care and respect as two attitudes supported, respectively, by a third- and a second-personal moral point-of-view. Other is about the Dall'Agnol's Wittgensteinian description of the moral language-games of Clinical Bioethics, adding to the approach the "language-game of rights."
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Affiliation(s)
| | - Bianca Andrade
- University of Vale do Rio dos Sinos, São Leopoldo, Brazil
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Bishanga DR, Massenga J, Mwanamsangu AH, Kim YM, George J, Kapologwe NA, Zoungrana J, Rwegasira M, Kols A, Hill K, Rijken MJ, Stekelenburg J. Women's Experience of Facility-Based Childbirth Care and Receipt of an Early Postnatal Check for Herself and Her Newborn in Northwestern Tanzania. Int J Environ Res Public Health 2019; 16:ijerph16030481. [PMID: 30736396 PMCID: PMC6388277 DOI: 10.3390/ijerph16030481] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 11/23/2022]
Abstract
Negative experiences of care may act as a deterrent to current and/or future utilization of facility-based health services. To examine the situation in Tanzania, we conducted a sub-analysis of a cross-sectional household survey conducted in April 2016 in the Mara and Kagera regions of Tanzania. The sample included 732 women aged 15–49 years who had given birth in a health facility during the previous two years. Log binomial regression models were used to investigate the association between women’s experiences of care during childbirth and the receipt of early postnatal checks before discharge. Overall, 73.1% of women reported disrespect and abuse, 60.1% were offered a birth companion, 29.1% had a choice of birth position, and 85.5% rated facility cleanliness as good. About half of mothers (46.3%) and newborns (51.4%) received early postnatal checks before discharge. Early postnatal checks for both mothers and newborns were associated with no disrespect and abuse (RR: 1.23 and 1.14, respectively) and facility cleanliness (RR: 1.29 and 1.54, respectively). Early postnatal checks for mothers were also associated with choice of birth position (RR: 1.18). The results suggest that a missed opportunity in providing an early postnatal check is an indication of poor quality of the continuum of care for mothers and newborns. Improved quality of care at one stage can predict better care in subsequent stages.
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Affiliation(s)
- Dunstan R Bishanga
- Jhpiego Tanzania, Dar es Salaam, Tanzania.
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
| | | | | | | | - John George
- USAID's Maternal and Child Survival Program/Jhpiego Tanzania, Dar es Salaam, Tanzania.
| | - Ntuli A Kapologwe
- President's Office-Regional Administration and Local Government, Dodoma, Tanzania.
| | | | | | | | - Kathleen Hill
- USAID's Maternal and Child Survival Program/Jhpiego, Baltimore, MD 21231, USA.
| | - Marcus J Rijken
- Department of Obstetrics and Gynecology, Division of Woman and Baby, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, 8934 AD Leeuwarden, The Netherlands.
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22
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Gebremichael MW, Worku A, Medhanyie AA, Berhane Y. Mothers' experience of disrespect and abuse during maternity care in northern Ethiopia. Glob Health Action 2018; 11:1465215. [PMID: 29860934 PMCID: PMC5990935 DOI: 10.1080/16549716.2018.1465215] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/11/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The provision of respectful and satisfactory maternity care is essential for promoting timely care-seeking behaviour, and ultimately ensuring the health and well-being of mothers and their babies. Disrespectful and abusive care has been recognized as one of the barriers to seeking timely maternity health services. However, the issue has not been adequately researched in community settings in low- and middle-income countries using validated measurement tools. OBJECTIVE This study was conducted to assess the extent of, and factors associated with, disrespectful and abusive maternity care reported by women who utilized facility-based delivery services in northern Ethiopia. METHODS We conducted a community-based cross-sectional study in Tigray, northern Ethiopia. Women who gave birth in the preceding year and visited health institutions for these deliveries were selected using a multistage cluster sampling procedure. Data were collected using a pretested questionnaire. Six domains of disrespect and abuse (D and A) were included in the questionnaire. Socio-demographic and obstetric related factors associated with D and A were tested using a negative binomial regression model. RESULTS Of the 1125 women in the sample, 248 (22%; 95% CI: 19.8%, 24.4%) reported at least one incident of D and A during delivery at a public health facility in northern Ethiopia. Higher incidents of D and A were reported by women who were older than 19 years at the time of delivery (aIRR = 2.649 (95% CI: 1.455, 4.825) compared to younger women. Incidents of D and A were reported more by women residing in urban areas, by women educated to the ninth grade and above, by women who experienced longer labour duration, and also by women who were not permitted to have support persons attend labour and delivery. CONCLUSIONS A fifth of the women reported D and A while receiving care during labour and delivery. Policies and practices aimed at ensuring universal coverage for institutional deliveries need to promote respectful maternity care for women in all facilities.
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Affiliation(s)
| | - Alemayehu Worku
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | | | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Bhattacharyya S, Srivastava A, Avan BI. Delivery should happen soon and my pain will be reduced: understanding women's perception of good delivery care in India. Glob Health Action 2013; 6:22635. [PMID: 24267316 PMCID: PMC3838967 DOI: 10.3402/gha.v6i0.22635] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 10/28/2013] [Accepted: 11/03/2013] [Indexed: 12/02/2022] Open
Abstract
Background Understanding a woman's perspective and her needs during childbirth and addressing them as part of quality-improvement programmes can make delivery care safe, affordable, and respectful. It has been pointed out that the patient's judgement on the quality and goodness of care is indispensible to improving the management of healthcare systems. Objective The objective of the study is to understand the aspects of care that women consider important during childbirth. Design Individual in-depth interviews (IDIs) and focus-group discussions (FGDs) with women who recently delivered were the techniques used. Seventeen IDIs and four FGDs were conducted in Jharkhand state in east India between January and March 2012. Women who had normal deliveries with live births at home and in primary health centres were included. To minimise recall bias, interviews were conducted within 42 days of childbirth. Using the transcripts of interviews, the data were analysed thematically. Results Aspects of care most commonly cited by women to be important were: availability of health providers and appropriate medical care (primarily drugs) in case of complications; emotional support; privacy; clean place after delivery; availability of transport to reach the institution; monetary incentives that exceed expenses; and prompt care. Other factors included kind interpersonal behaviour, cognitive support, faith in the provider's competence, and overall cleanliness of the facility and delivery room. Conclusions Respondents belonging to low socio-economic strata with basic literacy levels might not understand appropriate clinical aspects of care, but they want care that is affordable and accessible, along with privacy and emotional support during delivery. The study highlighted that healthcare quality-improvement programmes in India need to include non-clinical aspects of care as women want to be treated humanely during delivery – they desire respectful treatment, privacy, and emotional support. Further research into maternal satisfaction could be made more policy relevant by assessing the relative strength of various factors in influencing maternal satisfaction; this could help in prioritising appropriate interventions for improved quality of care (QoC).
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