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Yohannes E, Moti G, Gelan G, Creedy DK, Gabriel L, Hastie C. Impact of disrespectful maternity care on childbirth complications: a multicentre cross-sectional study in Ethiopia. BMC Pregnancy Childbirth 2024; 24:380. [PMID: 38773395 PMCID: PMC11110437 DOI: 10.1186/s12884-024-06574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Globally, disrespectful, and abusive childbirth practices negatively impact women's health, create barriers to accessing health facilities, and contribute to poor birth experiences and adverse outcomes for both mothers and newborns. However, the degree to which disrespectful maternity care is associated with complications during childbirth is poorly understood, particularly in Ethiopia. AIM To determine the extent to which disrespectful maternity care is associated with maternal and neonatal-related complications in central Ethiopia. METHODS A multicentre cross-sectional study was conducted in the West Shewa Zone of Oromia, Ethiopia. The sample size was determined using the single population proportion formula. Participants (n = 440) were selected with a simple random sampling technique using computer-generated random numbers. Data were collected through face-to-face interviews with a pretested questionnaire and were entered into Epidata and subsequently exported to STATA version 17 for the final analysis. Analyses included descriptive statistics and binary logistic regression, with a 95% confidence interval (CI) and an odds ratio (OR) of 0.05. Co-founders were controlled by adjusting for maternal sociodemographic characteristics. The primary exposure was disrespectful maternity care; the main outcomes were maternal and neonatal-related complications. RESULTS Disrespectful maternity care was reported by 344 women (78.2%) [95% CI: 74-82]. Complications were recorded in one-third of mothers (33.4%) and neonates (30%). Disrespectful maternity care was significantly associated with maternal (AOR = 2.22, 95% CI: 1.29, 3.8) and neonatal-related complications (AOR = 2.78, 95% CI: 1.54, 5.04). CONCLUSION The World Health Organization advocates respectful maternal care during facility-based childbirth to improve the quality of care and outcomes. However, the findings of this study indicated high mistreatment and abuse during childbirth in central Ethiopia and a significant association between such mistreatment and the occurrence of both maternal and neonatal complications during childbirth. Therefore, healthcare professionals ought to prioritise respectful maternity care to achieve improved birth outcomes and alleviate mistreatment and abuse within the healthcare sector.
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Affiliation(s)
- Ephrem Yohannes
- School of Nursing and Midwifery, Griffith University, University Drive, Gold Coast, QLD, 4131, Australia.
- Midwifery Department, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia.
| | - Gonfa Moti
- Surgery Department, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Gemechu Gelan
- Midwifery Department, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University, University Drive, Gold Coast, QLD, 4131, Australia
| | - Laura Gabriel
- School of Nursing and Midwifery, Griffith University, University Drive, Gold Coast, QLD, 4131, Australia
| | - Carolyn Hastie
- School of Nursing and Midwifery, Griffith University, University Drive, Gold Coast, QLD, 4131, 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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Birie B, Niguse W. Experience of respectful maternity care during childbirth and associated factors in public hospitals of the South West Region of Ethiopia: an institution-based, cross-sectional study. BMJ Open 2023; 13:e066849. [PMID: 37433724 DOI: 10.1136/bmjopen-2022-066849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE To determine women's level of experience of respectful maternity care during childbirth and associated factors in public hospitals in the South West Region of Ethiopia. DESIGN Institution-based, cross-sectional study. SETTING The study was conducted at secondary-level healthcare institutions in the South West Region of Ethiopia from 1 June to 30 July 2021. PARTICIPANTS 384 postpartum women were sampled from four hospitals using a systematic random sampling technique, allocating a proportion to each health facility. Pretested structured questionnaires were used to collect data from the postnatal mothers through a face-to-face exit interview. OUTCOME MEASURES The level of respectful maternity care was measured according to the Mothers on Respect Index. P values of <0.05 and 95% CIs were used to determine statistical significance. RESULTS Of the 384 sampled women, 370 postnatal mothers participated in the study (response rate 96.3%). 11.6% (95% CI 8.4% to 15.1%), 39.7% (95% CI 34.3% to 44.6%), 20.8% (95% CI 17.3% to 25.1%), and 27.8% (95% CI 23.5% to 32.4%) of women experienced very low, low, moderate, and high levels of respectful maternal care during childbirth, respectively. Having no formal education was negatively associated with experience of respectful maternal care (adjusted OR (AOR)=0.51, 95% CI 0.294 to 0.899), while daytime delivery (AOR 8.53, 95% CI 5.032 to 14.47), giving birth through caesarean section (AOR 2.19, 95% CI 1.410 to 3.404) and future intention to give birth within the health facility (AOR 5.18, 95% CI 3.019 to 8.899) were positively associated with respectful maternal care. CONCLUSION In this study, only one-fourth of women experienced high-level respectful maternal care during childbirth. Responsible stakeholders must develop guidelines and strategies to monitor and harmonise respectful maternal care practices at all institutions.
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Affiliation(s)
- Bamlaku Birie
- Midwifery, Mizan Tepi University, Mizan-Aman, Ethiopia
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Adinew YM, Kelly J, Smith M, Marshall A. Women's perspectives on disrespect and abuse during facility-based childbirth in Ethiopia: a qualitative study. BMC Pregnancy Childbirth 2023; 23:444. [PMID: 37316792 DOI: 10.1186/s12884-023-05762-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Disrespect and abuse violates women's basic human rights and autonomy and can traumatize women who are already in a vulnerable position during childbirth and deter them from utilizing skilled care for future childbirth. This study explored women's perspectives on the acceptability of disrespect and abuse during facility-based childbirth in Ethiopia. METHODS A qualitative descriptive design using five focus group discussions and fifteen in-depth, semi-structured, interviews was conducted with women between October 2019 to January 2020 in north Showa zone of Oromia region, central Ethiopia. Using purposive sampling, women who had given birth at public health facilities of North Showa zone during the twelve months preceding data collection were recruited, regardless of birth outcome. Inductive thematic analysis using Open Code software was used to explore the perspectives of participants. RESULTS While women reject disrespectful and abusive acts during childbirth generally, they may consider some disrespectful acts as acceptable and or necessary under certain circumstances. Four emerging themes were identified. (1) Disrespect and abuse is not acceptable, (2) Disrespectful and abusive actions are acceptable only if intended to save lives, (3) Disrespectful and abusive actions are an accepted part of everyday practice to prevent complications and adverse outcomes, (4) Disrespectful and abusive actions are necessary to discipline disobedient women. CONCLUSION Women's perceptions of disrespectful and abusive acts of care providers is deeply rooted within the context of violence in Ethiopia and the societal hierarchies that have systematically disempowered women. Given the pervasiveness of disrespect and abusive actions during childbirth, policymakers, clinical managers and care providers must take these essential contextual and societal norms into account and devise comprehensive clinical interventions that addresses the root causes.
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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
| | - Morgan Smith
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Amy Marshall
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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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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Schaaf M, Jaffe M, Tunçalp Ö, Freedman L. A critical interpretive synthesis of power and mistreatment of women in maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000616. [PMID: 36962936 PMCID: PMC10021192 DOI: 10.1371/journal.pgph.0000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Labouring women may be subjected to physical and verbal abuse that reflects dynamics of power, described as Mistreatment of Women (MoW). This Critical Interpretive Synthesis on power and MoW consolidates current research and advances theory and practice through inter-disciplinary literature exploration. The review was undertaken in 3 phases. Phase 1 consisted of topic scoping; phase 2 entailed exploration of key power-related drivers emerging from the topic scoping; and phase 3 entailed data synthesis and analysis, with a particular focus on interventions. We identified 63 papers for inclusion in Phase 1. These papers utilized a variety of methods and approaches and represented a wide range of geographic regions. The power-related drivers of mistreatment in these articles span multiple levels of the social ecological model, including intrapersonal (e.g. lack of knowledge about one's rights), interpersonal (e.g. patient-provider hierarchy), community (e.g. widespread discrimination against indigenous women), organizational (e.g. pressure to achieve performance goals), and law/policy (e.g. lack of accountability for rights violations). Most papers addressed more than one level of the social-ecological model, though a significant minority were focused just on interpersonal factors. During Phase 1, we identified priority themes relating to under-explored power-related drivers of MoW for exploration in Phase 2, including lack of conscientization and normalization of MoW; perceptions of fitness for motherhood; geopolitical and ethnopolitical projects related to fertility; and pressure to achieve quantifiable performance goals. We ultimately included 104 papers in Phase 2. The wide-ranging findings from Phase 3 (synthesis and analysis) coalesce in several key meta-themes, each with their own evidence-base for action. Consistent with the notion that research on power can point us to "drivers of the drivers," the paper includes some intervention-relevant insights for further exploration, including as relating to broader social norms, health systems design, and the utility of multi-level strategies.
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Affiliation(s)
- Marta Schaaf
- Independent Consultant, Brooklyn, New York, United States of America
| | - Maayan Jaffe
- Independent Consultant, Brooklyn, New York, United States of America
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Lynn Freedman
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
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Bercu C, Jacobson LE, Gebrehanna E, Ramirez AM, Katz AJ, Filippa S, Baum SE. "I was afraid they will be judging me and even deny me the service": Experiences of denial and dissuasion during abortion care in Ethiopia. Front Glob Womens Health 2022; 3:984386. [PMID: 36386432 PMCID: PMC9663468 DOI: 10.3389/fgwh.2022.984386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/07/2022] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Disrespect and abuse are components of poor quality abortion care. This analysis aimed to understand negative experiences of care from perspectives of abortion clients in public and private facilities in Ethiopia. STUDY DESIGN We conducted 23 in-depth interviews with people who obtained abortion care in Addis Ababa, Ethiopia as well as Aksum and Mekele in Tigray State, Ethiopia. The interviews were coded using a priori and emergent codes and we conducted thematic analysis to understand negative interactions with providers from participant's perspectives. RESULTS Participants experienced denial of abortion services along their pathway to care and attempts by providers to dissuade them prior to providing an abortion. Underlying both the denial and the dissuasion were reports of disrespect and condemnation from providers. Participants described how providers doubted or forced them to justify their reasons for having an abortion, stigmatized them for seeking multiple abortions or later abortions, and ascribed misinformation about abortion safety. Despite reports of denial, dissuasion, and disrespect, abortion clients generally felt that providers had their best interest at heart and were grateful for having access to an abortion. CONCLUSIONS Participants in Ethiopia experienced providers as gatekeepers to legal abortion services, facing disrespect and judgment at facilities where they sought care. Interventions aimed at increasing awareness of abortion laws such that clients understand their rights and values clarification interventions for providers could help reduce barriers to accessing care and improve the quality of abortion services.
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Affiliation(s)
- Chiara Bercu
- Ibis Reproductive Health, Oakland, CA, United States
| | - Laura E. Jacobson
- School of Public Health, Oregon Health and Science University-Portland State University (OHSU-PSU), Portland, OR, United States
| | - Ewenat Gebrehanna
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Anna J. Katz
- Ibis Reproductive Health, Oakland, CA, United States
| | - Sofía Filippa
- Ibis Reproductive Health, Oakland, CA, United States
| | - Sarah E. Baum
- Ibis Reproductive Health, Oakland, CA, United States
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Abebe AH, Mmusi-Phetoe R. Respectful maternity care in health centers of Addis Ababa city: a mixed method study. BMC Pregnancy Childbirth 2022; 22:792. [PMID: 36289526 PMCID: PMC9598037 DOI: 10.1186/s12884-022-05129-5] [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: 06/18/2022] [Accepted: 10/12/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The study aims to assess quality of obstetric and newborn care including respectfulness of the maternity care. DESIGN The study used explanatory sequential mixed methods design . SETTING This study was conducted in 50 health centres in Addis Ababa city administration January 25 to April 31, 2021. METHODS During the quantitative phase 500 women in postpartum period were interviewed using structured questionnaire. In the second phase in-depth interview was conducted with 20 midwives and 13 health centre managers. The quantitative data was analysed using Statistical Package for Social Sciences (SPSS). The qualitative data was analysed using Colaizzi's seven step process. RESULTS Only 24.6% of women had respectful maternity care (RMC). Only 46% of women had effective communication during child birth. Only 9.6% of women had emotional support during child birth. Majority of women were encouraged to mobilize, take food and be on labor position of their choice. However, only 22.4 and 18.8% of women respectively had a companion of choice and any pharmacologic pain relief during child birth. One in seven women (15%) had one form of disrespect and abuse during child birth. CONCLUSION Ensuring respectful maternity care needs strong policy direction to health facilities, public education on their right to respectful maternity care, training of care givers and monitoring care through engagement of frontline staff and clients.
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Affiliation(s)
- Amaha Haile Abebe
- Yeroam Consultancy and University of South Africa, Addis Ababa, Ethiopia
| | - Rose Mmusi-Phetoe
- Yeroam Consultancy and University of South Africa, Addis Ababa, 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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Obstetric violence and associated factors among women during facility based childbirth at Gedeo Zone, South Ethiopia. BMC Pregnancy Childbirth 2022; 22:565. [PMID: 35836139 PMCID: PMC9284803 DOI: 10.1186/s12884-022-04895-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/05/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Obstetric violence is a specific form of violence against women that violates their human rights. Conducted by obstetric care providers regarding the body and reproductive processes of the woman, being characterized by dehumanized assistance, abuse of interventionist actions, medicalization, and reversion of the process from natural to pathological. Objective To assess the magnitude of obstetric violence and associated factors among women during childbirth in Gedeo Zone, South Ethiopia. Method Community based cross-sectional study was conducted among randomly selected 661 mothers in Gedeo Zone, South Ethiopia, from May 1 to May 30 2020. Multi-stage sampling technique was used to get a total of 661 mothers from their kebeles. Data was collected by using face-to--to-face interview with a structured questionnaire and in-depth interview was also employed. Data entry and analysis was done by Epi data version 3.1 and SPSS 23.0 statistical software. Bivariate and multivariable logistic regression models were used to determine the important predictors of obstetric violence. Association between outcome and independent variables was presented by adjusted odds ratio with 95% CI. Results From the total of 661 mothers, about 79.7% (527) of mothers experienced obstetric violence with 95% CI (76.9–82.8). educational status (AOR = 2.2573, 95%CI = 1.44,3.54), ANC utilization (AOR = 2.365, 95%CI = 1.62–3.21), duration of stay (AOR = 0.5367,95%CI = 0.28,0.86)), and facing complication during labor and delivery (AOR = 3.1382, 95%CI = 2.34,5.17) were the major factors associated with obstetric violence. Conclusion The magnitude of obstetric violence was high. Non dignified care and non-consented care was the most common form of obstetric violence which may lead a woman to choose for home delivery instead of health facility care, this in turn leads to a great increase in maternal morbidity and mortality as supported by qualitative approach of the study.
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Eduardo Pereira Dutra P, Quagliato LA, Nardi AE. Improving the perception of respect for and the dignity of inpatients: a systematic review. BMJ Open 2022; 12:e059129. [PMID: 35568491 PMCID: PMC9109089 DOI: 10.1136/bmjopen-2021-059129] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this systematic review is to find evidence to determine which strategies are effective for improving hospitalised patients' perception of respect and dignity. METHODS A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The MEDLINE/PubMed, PsycINFO and Cochrane Library databases were searched on 9 March 2021. Observational studies, prospective studies, retrospective studies, controlled trials and randomised controlled trials with interventions focused on improving respect for patients and maintaining their dignity were included. Case reports, editorials, opinion articles, studies <10 subjects, responses/replies to authors, responses/replies to editors and review articles were excluded. The study population included inpatients at any health facility. Two evaluators assessed risk of bias according to the Cochrane Handbook of Systematic Reviews of Interventions criteria: allocation, randomisation, blinding and internal validity. The reviewers were blinded during the selection of studies as well as during the quality appraisal. Disagreements were resolved by consensus. RESULTS 2515 articles were retrieved from databases and 44 articles were included in this review. We conducted a quality appraisal of the studies (27 qualitative studies, 14 cross-sectional studies, 1 cohort study, 1 quali-quantitative study and 1 convergent parallel mixed-method study). DISCUSSION A limitation of this study is that it may not be generalisable to all cultures. Most of the included studies are of good quality according to the quality appraisal. To improve medical and hospital care in most countries, it is necessary to improve the training of doctors and other health professionals. CONCLUSION Many strategies could improve the perception of respect for and the dignity of the inpatient. The lack of interventional studies in this field has led to a gap in knowledge to be filled with better designed studies and effect measurements. PROSPERO REGISTRATION NUMBER CRD42021241805.
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Yismaw WS, Teklu TS, Panduragman H. Respectful maternity care during facility-based child birth and associated factors in public health facilities of Ilu AbaBor zone, Southwest Ethiopia. Reprod Health 2022; 19:98. [PMID: 35459182 PMCID: PMC9034589 DOI: 10.1186/s12978-022-01368-z] [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: 07/09/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current data suggest that far more women around the world are exposed to abuse by health care providers while receiving maternity care. This predisposes them to psychological distress; abstain from accessing health facilities for care and end up with avoidable death and disability. OBJECTIVE To assess the level of respectful care during delivery among mothers giving birth in public health facilities in Ilu AbaBor, Southwest Ethiopia, 2019. MATERIALS AND METHODS An institution-based cross-sectional study was conducted among 285 randomly selected mothers in the post-natal ward from 17 health facilities in 2019. Data were collected through interviewer-administered pre-tested questionnaires. The collected data were entered into Epi-data version 3.1 statistical and analyzed by SPSS version 21. Both bivariable and multivariable logistic regression models were employed. RESULTS The proportion of respectful care during maternity care in health care institutions of Ilu Ababor zone was 47.3%. In the multivariable logistic regression; age (AOR 0.25, 95% CI 0.08, 0.81), occupation (AOR 4.16: (1.34, 12.9)), planned pregnancy (AOR 0.28: (0.12, 0.67)), mode of delivery (AOR 0.05: (0.01, 0.33)), and receiving care from providers who had a compassionate and respectful care training (AOR 0.13: (0.06, 0.25)) were independent predictors of respectful care. CONCLUSIONS The proportion of respectful care of the health institution in the Ilu Ababor zone was low compared to the other studies. Variables like; age, occupational status, pregnancy plan, mode of delivery, facing complications during labor and delivery, and taking compassionate and respectful care training were independent predictors of respectful maternity care. This study recommended that the responsible stakeholders should strengthen monitoring and evaluation of the practice and mainstreaming of respectful maternity care, give training for health professionals, and develop guidelines used to monitor, report, and track barriers to the practice of maternity care.
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Affiliation(s)
- Worke Sisay Yismaw
- Department of Nursing, College of Health Sciences, Mettu University, Mettu, Ethiopia.
| | - Tigist Shayi Teklu
- Department of Nursing, College of Health Sciences, Mettu University, Mettu, Ethiopia
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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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Okedo-Alex IN, Akamike IC, Eze II, Onwasigwe CN. Does disrespect and abuse during childbirth differ between public and private hospitals in Southeast Nigeria. BMC Pregnancy Childbirth 2021; 21:852. [PMID: 34972518 PMCID: PMC8719415 DOI: 10.1186/s12884-021-04298-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disrespect and Abuse (D&A) during childbirth represents an important barrier to skilled birth utilization, indicating a problem with quality of care and a violation of women's human rights. This study compared prevalence of D&A during childbirth in a public and a private hospital in Southeast Nigeria. METHODS This study was a cross-sectional study among women who gave birth in two specialized health facilities: a public teaching and a private-for-profit faith-based hospital in Southeast Nigeria. In each facility, systematic random sampling was used to select 310 mothers who had given birth in the facility and were between 0-14 weeks after birth. Study participants were recruited through the immunization clinics. Semi-structured, interviewer-administered questionnaires using the Bowser and Hills classification of D&A during childbirth were used for data collection. Data were analyzed using SPSS version 20 at 95% significance level. RESULTS Mean age of the participants in the public hospital was 30.41 ± 4.4 and 29.31 ± 4.4 in the private hospital. Over three-fifths (191; 61.6%) in the public and 156 women (50.3%) in the private hospital had experienced at least one form of D&A during childbirth [cOR1.58; 95% CI 1.15, 2.18]. Abandonment and neglect [Public153 (49.4%) vs. Private: 91 (29.4%); cOR2.35; 95% CI. 1.69, 3.26] and non-consented care [Public 45 (14.5%) vs. Private 67(21.6%): cOR0.62; 95% CI. 0.41, 0.93] were the major types of D&A during childbirth. Denial of companionship was the most reported subtype of D&A during childbirth in both facilities [Public 135 (43.5%) vs. Private66 (21.3%); cOR2.85; 95% CI. 2.00, 4.06]. Rural residents were less likely to report at least one form of D&A during childbirth (aOR 0.53; CI 0.35-0.79). CONCLUSION Although prevalence was high in both facilities, overall prevalence of D&A during childbirth and most subtypes were higher in the public health facility. There is a need to identify contextual factors enabling D&A during childbirth in public and private health care settings.
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Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria. .,African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.
| | - Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
| | - Irene Ifeyinwa Eze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
| | - Chika Nwamma Onwasigwe
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
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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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17
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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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Kebede AA, Taye BT, Wondie KY, Tiguh AE, Eriku GA, Mihret MS. Adherence to respectful maternity care guidelines during COVID-19 pandemic and associated factors among healthcare providers working at hospitals in northwest Ethiopia: A multicenter, observational study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 12:100830. [PMID: 34545344 PMCID: PMC8443386 DOI: 10.1016/j.cegh.2021.100830] [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: 05/13/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background Respectful maternity care is one of the facilitators of women's access to maternity healthcare services. However, it has been evidenced that maternal healthcare services are compromised during the pandemic of coronavirus disease 19 (COVID-19). Moreover, there was a dearth of evidence on healthcare provider's adherence to respectful maternity care guidelines through direct observation. Hence, this study intended to assess healthcare provider's adherence to respectful maternity care guidelines during COVID-19 in northwest Ethiopia. Methods A multicenter observational cross-sectional study was conducted at hospitals in northwest Ethiopia from November 15th/2020 to March 10th/2021. A simple random sampling technique was employed to select 406 healthcare providers. Data were collected through face-to-face interviews and direct observation using a structured questionnaire and standardized checklist respectively. The data were entered into Epi Info 7.1.2 and exported to SPSS version 25 for analysis. A binary logistic regression model was fitted. Both bivariable and multivariable logistic regression analyses were undertaken. The level of significance was claimed based on the adjusted odds ratio (AOR) with a 95% confidence interval (CI) at a p-value of ≤0.05. Results The proportion of healthcare providers adhering to respectful maternity care guidelines during COVID-19 was 63.8% (95% CI: 59.1, 68.4). Job satisfaction (AOR = 1.82; 95% CI: 1.04, 3.18), professional work experience of 3–5 years (AOR = 2.84; 95% CI: 1.74, 4.6) and ≥6 years (AOR = 2.21; 95% CI: 1.11, 4.38), and having education parallel to work (AOR = 0.33; 95% CI: 0.21, 0.51) have an independent statistical significant association with adherence to respectful maternity care guidelines. Conclusion In this study, six out of ten healthcare providers had good adherence to respectful maternity care guidelines. Ensuring health worker's job satisfaction and providing education opportunities by the government would improve healthcare provider's adherence to respectful maternity care standards.
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Affiliation(s)
- Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhan Tsegaw Taye
- Department of Midwifery, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Kindu Yinges Wondie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Agumas Eskezia Tiguh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Azeze Eriku
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ghimire NP, Joshi SK, Dahal P, Swahnberg K. Women's Experience of Disrespect and Abuse during Institutional Delivery in Biratnagar, Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189612. [PMID: 34574536 PMCID: PMC8469242 DOI: 10.3390/ijerph18189612] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 12/02/2022]
Abstract
Worldwide, a large number of women experience disrespectful and abusive behavior from care providers during childbirth. This violates the rights of women to attain respectful care. This study aimed to find out the women’s experience of disrespect and abuse during institutional delivery. A cross-sectional study was conducted in two hospitals of Morang district situated in eastern Nepal. Two hundred eighteen women from a public hospital and 109 women from a private hospital (N = 327) with normal vaginal delivery were selected purposively for this study. Data were collected through face-to-face interviews using a structured questionnaire based on the Disrespectful and Abusive Scale by Bowser and Hill. All women had experienced at least one type of disrespect and/or abuse during labor and delivery, most common being non-consented care (100%), non-dignified care (72%), and non-confidential care (66.6%), respectively. Discriminatory care and physical abuse were experienced by 32.33% and 13.23%, respectively. Ethnicity, religion, place of delivery, and numbers of living children were the main predictors of reporting disrespect and abuse. Overall, the occurrence of disrespect and abuse during institutional delivery was found to be very high.
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Affiliation(s)
| | - Sunil Kumar Joshi
- Head of Department, Community Medicine, Kathmandu Medical College, Kathmandu 44600, Nepal;
| | - Pranab Dahal
- Department of Health and Caring Sciences, Linnaeus University, 39182 Kalmar, Sweden; (P.D.); (K.S.)
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Linnaeus University, 39182 Kalmar, Sweden; (P.D.); (K.S.)
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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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Mengistu B, Alemu H, Kassa M, Zelalem M, Abate M, Bitewulign B, Mathewos K, Njoku K, Prose NS, Magge H. An innovative intervention to improve respectful maternity care in three Districts in Ethiopia. BMC Pregnancy Childbirth 2021; 21:541. [PMID: 34362332 PMCID: PMC8343890 DOI: 10.1186/s12884-021-03934-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from attending skilled birth. In Ethiopia, mistreatment occurs in up to 49.4% of mothers giving birth in health facilities. This study describes the development, implementation and results of interventions to improve respectful maternity care. As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed respectful maternity care training module with three core components: testimonial videos developed from key themes identified by staff as experiences of mothers, skills-building sessions on communication and onsite coaching. Respectful maternity care training was conducted in February 2017 in three districts within three regions. METHODS Facility level solutions applied to enhance the experience of care were documented. Safe Childbirth Checklist data measuring privacy and birth companion offered during labor and childbirth were collected over 27 months from 17 health centers and three hospitals. Interrupted time series and regression analysis were conducted to assess significance of improvement using secondary routinely collected programmatic data. RESULTS Significant improvement in the percentage of births with two elements of respectful maternal care-privacy and birth companionship offered- was noted in one district (with short and long-term regression coefficient of 18 and 27% respectively), while in the other two districts, results were mixed. The short-term regression coefficient in one of the districts was 26% which was not sustained in the long-term while in the other district the long-term coefficient was 77%. Testimonial videos helped providers to see their care from their clients' perspectives, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions. This includes organizing tour to the birthing ward and allowing cultural celebrations. CONCLUSION This study demonstrated effective way of improving respectful maternity care. Use of a multipronged approach, where the respectful maternity care intervention was embedded in quality improvement approach helped in enhancing respectful maternity care in a comprehensive manner.
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Affiliation(s)
- Birkety Mengistu
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia.
| | - Haregeweyni Alemu
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia
| | - Munir Kassa
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Mehiret Abate
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia
| | - Befikadu Bitewulign
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia
| | | | - Kendra Njoku
- Institute for Healthcare Improvement, Abuja, Nigeria
| | | | - Hema Magge
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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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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Ameyaw EK, Amoah RM, Njue C, Tran NT, Dawson A. Women's experiences and satisfaction with maternal referral service in Northern Ghana: A qualitative inquiry. Midwifery 2021; 101:103065. [PMID: 34161917 DOI: 10.1016/j.midw.2021.103065] [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: 12/07/2020] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To gain insights and improve existing referral structures with maternity care in Northern region of Ghana, this study explored the referral experiences and satisfaction of women. RESEARCH DESIGN Twenty women referred to the Tamale Teaching Hospital for maternal health conditions were interviewed along with three husdands of these women between January and April 2020. An interview guide was used in individual face-to-face semi-structured interviews. The transcripts were inductively coded using content analysis. The study was guided by the three delays model and the availability, accessibility, acceptability and quality framework. FINDINGS The study revealed seven key themes. These are women's involvement in referral decision; available health workers and care at the first facility; inadequate transportation; communication between facilities; quality of care at the receiving hospital; worth the time and money; and women's companions during referral. While several women acknowledged and appreciated the care and emotional support they received in the hospitals they first presented to, some women reported poor attitudes of healthcare providers. Most women acknowledged that there was no communication between the facilities for the referral. A woman's socioeconomic status appeared to determine the respect and support she received from healthcare providers. KEY CONCLUSIONS To ensure a responsive and efficient referral service, the central government of Ghana should commit to ensuring that each district hospital has at least one ambulance for effective emergency transportation. Career progression opportunities need to be explored for health workers in northern Ghana to attract and retain more professionals. To prevent abuse and ensure empathetic and supportive care, testimonial videos may help health providers to assess the services they provide to women. During referral, inter-facility communication can be strengthened through effective supervision and dedicated mobile phones for communication between health facilities.
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Affiliation(s)
- Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Australia.
| | - Roberta Mensima Amoah
- Department of Public Health, School of Allied Sciences, University for Development Studies, Tamale, Northern Region, Ghana.
| | - Carolyne Njue
- School of Public Health, Faculty of Health, University of Technology Sydney, Australia.
| | - Nguyen Toan Tran
- School of Public Health, Faculty of Health, University of Technology Sydney, Australia.
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Australia.
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Mehretie Adinew Y, Kelly J, Marshall A, Hall H. "I Would Have Stayed Home if I Could Manage It Alone": A Case Study of Ethiopian Mother Abandoned by Care Providers During Facility-Based Childbirth. Int J Womens Health 2021; 13:501-507. [PMID: 34079387 PMCID: PMC8163623 DOI: 10.2147/ijwh.s302208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022] Open
Abstract
Background Every woman is entitled to respectful care during pregnancy and childbirth as a basic human right. However, not all women are being treated equally well. Case Presentation This case study highlights some of the common disrespectful practices that women face. This is a testimony of a 28-year-old mother of two, narrated in her own words. The data were collected during an in-depth interview in November 2019. The interview was conducted in her house and her name has been changed to protect her identity. The interview was audio-taped using a digital voice recorder, later transcribed, and translated verbatim from the local language – Amharic, to English. Conclusion This woman’s story highlights the unfortunate reality for some women. Five themes emerged from her narrative: denial of care: the provider left her unattended at a critical moment and denied her the care that she came for; non-consented care: she did not consent to the episiotomy; non-dignified care: she was carried by her arms and legs to the delivery couch, and left naked and bleeding on the couch after birth; taking a sick baby home without medical assistance: she was forced to leave the hospital even though her child had breathing difficulties and was not able to suck or breastfeed; and loss of trust in care providers: for her second birth this woman went to a facility where a relative works, as she no longer trusted these providers.
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Affiliation(s)
- Yohannes Mehretie Adinew
- College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia.,Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Janet Kelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Amy Marshall
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Helen Hall
- Monash Nursing and Midwifery, Monash University, Melbourne, Australia
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Adane D, Bante A, Wassihun B. Respectful focused antenatal care and associated factors among pregnant women who visit Shashemene town public hospitals, Oromia region, Ethiopia: a cross-sectional study. BMC WOMENS HEALTH 2021; 21:92. [PMID: 33663472 PMCID: PMC7934531 DOI: 10.1186/s12905-021-01237-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Focused antenatal care is the most significant and inclusive care given to pregnant women to promote and maintain the optimal health of the mother and the fetus. Providing respectful care during focused antenatal care is believed to be the most important cost-effective interventions to increase maternity service utilization. Therefore, this study was aimed to assess respectful focused antenatal care and associated factors among pregnant women who visit Shashemene town public hospitals, Oromia region, Ethiopia, 2019. METHODS Institution-based cross-sectional study was conducted from July-August, 2019. A total of 423 pregnant mothers were selected using a systematic sampling technique. Data were collected using structured and pre-tested interviewer-administered questionnaires. Data entry and analysis were made using Epi Info version™ 7 and Statistical Package for Social Science (SPSS) version 24.0 respectively. Both bivariate and multivariate logistic regression analyses were used to identify associated factors. Statistical significance was declared at a p value of < 0.05 with a 95% confidence level. RESULTS A total of 420 women have participated in the study, making a response rate of 99.5%. About 63% of participants received respectful care during focused antenatal care. Having no formal education [AOR = 8.3(95%CI 9.85-17.47)], low average monthly income [AOR = 3.16 (95%CI 1.52-6.57)], having unplanned pregnancy [AOR = 9.90 (95%CI 3.48-8.16)] and being multigravida [AOR = 8.82 (95%CI 2.90-6.80)] were significantly associated with respectful focused antenatal care. CONCLUSIONS The study findings indicate that respondents' respectful focused antenatal care is mainly affected by educational level, average family monthly income, having an unplanned pregnancy, and gravidity. Providing acceptable, quality, and honorable care for all women regardless of educational status, family income, and status of pregnancy is very crucial to entice more mothers to the health facility.
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Affiliation(s)
- Daniel Adane
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia.
| | - Agegnehu Bante
- Department of Nursing, College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
| | - Biresaw Wassihun
- Department of Midwifery, College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
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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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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: 19] [Impact Index Per Article: 4.8] [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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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: 24] [Impact Index Per Article: 6.0] [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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Asefa A, Morgan A, Gebremedhin S, Tekle E, Abebe S, Magge H, Kermode M. Mitigating the mistreatment of childbearing women: evaluation of respectful maternity care intervention in Ethiopian hospitals. BMJ Open 2020; 10:e038871. [PMID: 32883738 PMCID: PMC7473661 DOI: 10.1136/bmjopen-2020-038871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES There is a lack of evidence on approaches to mitigating mistreatment during facility-based childbirth. This study compares the experiences of mistreatment reported by childbearing women before and after implementation of a respectful maternity care intervention. DESIGN A pre-post study design was undertaken to quantify changes in women's experiences of mistreatment during facility-based childbirth before and after the respectful maternity care intervention. INTERVENTION A respectful maternity care intervention was implemented in three hospitals in southern Ethiopia between December 2017 and September 2018 and it included training of service providers, placement of wall posters in labour rooms and post-training supportive visits for quality improvement. OUTCOME MEASURES A 25-item questionnaire asking women about mistreatment experiences was administered to 388 women (198 in the pre-intervention, 190 in the post-intervention). The outcome variable was the number of mistreatment components experienced by women, expressed as a score out of 25. Multilevel mixed-effects Poisson modelling was used to assess the change in mistreatment score from pre-intervention to post-intervention periods. RESULTS The number of mistreatment components experienced by women was reduced by 18% when the post-intervention group was compared with the pre-intervention group (adjusted regression coefficient (Aβ)=0.82, 95% CI 0.74 to 0.91). Women who had a complication during pregnancy (Aβ=1.17, 95% CI 1.01 to 1.34) and childbirth (Aβ=1.16, 95% CI 1.03 to 1.32) experienced a greater number of mistreatment components. On the other hand, women who gave birth by caesarean birth after trial of vaginal birth (Aβ=0.76, 95% CI 0.63 to 0.92) and caesarean birth without trial of vaginal birth (Aβ=0.68, 95% CI 0.47 to 0.98) experienced a lesser number of mistreatment components compared with those who had vaginal birth. CONCLUSIONS Women reported significantly fewer mistreatment experiences during childbirth following implementation of the intervention. Given the variety of factors that lead to mistreatment in health facilities, interventions designed to mitigate mistreatment need to involve structural changes.
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Affiliation(s)
- Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Samson Gebremedhin
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Tekle
- Maternal and Child Health Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Hema Magge
- Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
- Division of Global Health Equity, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michelle Kermode
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Bulto GA, Demissie DB, Tulu AS. Respectful maternity care during labor and childbirth and associated factors among women who gave birth at health institutions in the West Shewa zone, Oromia region, Central Ethiopia. BMC Pregnancy Childbirth 2020; 20:443. [PMID: 32746788 PMCID: PMC7398399 DOI: 10.1186/s12884-020-03135-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 07/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background Skilled assistance during pregnancy and childbirth is one of the key interventions in reducing maternal morbidity and mortality. But studies have shown that many women across the globe experience disrespectful and abusive treatment during labor and childbirth in institutions, which forms an important barrier to improving skilled care utilization and improving maternal health outcomes. Although there are few studies done in Ethiopia, information on the status of respectful maternity care (RMC) among women during childbirth at health institutions in the West-Shewa zone is lacking. Therefore, the study aimed to assess RMC during Labor and Childbirth and associated factors among women who gave-birth at health-institutions in the West Shewa zone, Central Ethiopia. Methods Cross-sectional study was conducted at Health institutions in the West Shewa zone, Oromia region, Central Ethiopia. A systematic random sampling technique that uses women’s delivery registration number was used to collect data. Data was collected through an exit-interview. Both bivariate and multivariable logistic regressions were used to identify associated factors. Results From a total of 567 women who fully responded, only 35.8% received RMC. From categories of RMC, 76.5% of the woman is protected from physical harm/ill-treatment and 89.2% received equitable care free of discrimination. But, only 39.3% of woman’s right to information, informed consent and preferences were protected. Giving birth at health center (AOR:5.44), discussion on the place of delivery (AOR:4.42), daytime delivery (AOR:5.56), longer duration of stay (≥ 13 h) (AOR:2.10), involvement in decision-making (AOR:8.24), asking for consent before the procedure(AOR:3.45), current pregnancy unintended (AOR:5.56), the presence of < 3 health-workers during childbirth (AOR:2.23) and satisfied on waiting-time to be seen (AOR:2.08) were found to be significantly associated with RMC. Conclusions The proportion of RMC during labor and childbirth in the study area was low. Type of institution, discussion during ANC, time of delivery, duration of stay, involvement in decision-making, the number of health workers, waiting time and consent were identified factors. Therefore, giving emphasis to creating awareness of care providers on the standards and categories of RMC, improving care provider-client discussion, monitor and reinforcing accountability mechanisms for health workers to avoid mistreatments during labor and childbirth were recommended.
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Affiliation(s)
- Gizachew Abdissa Bulto
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia.
| | - Dereje Bayissa Demissie
- Department of Neonatal Nursing, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abera Shibru Tulu
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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Asefa A, Morgan A, Bohren MA, Kermode M. Lessons learned through respectful maternity care training and its implementation in Ethiopia: an interventional mixed methods study. Reprod Health 2020; 17:103. [PMID: 32615999 PMCID: PMC7331171 DOI: 10.1186/s12978-020-00953-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 06/18/2020] [Indexed: 11/12/2022] Open
Abstract
Background Improving respectful maternity care (RMC) is a recommended practice during childbirth as a strategy to eliminate the mistreatment of women and improve maternal health. There is limited evidence on the effectiveness of RMC interventions and implementation challenges, especially in low-resource settings. This study describes lessons learned in RMC training and its implementation from the perspectives of service providers’ perceptions and experiences. Methods Our mixed methods study employed a pre- and post-intervention quantitative survey of training participants to assess their perceptions of RMC and focus group discussions, two months following the intervention, investigated the experiences of implementing RMC within birthing facilities. The intervention was a three-day RMC training offered to 64 service providers from three hospitals in southern Ethiopia. We performed McNemar’s test to analyse differences in participants’ perceptions of RMC before and after the training. The qualitative data were analysed using hybrid thematic analysis. Integration of the quantitative and qualitative methods was done throughout the design, analysis and reporting of the study. Results Mistreatment of women during childbirth was widely reported by participants, including witnessing examinations without privacy (39.1%), and use of physical force (21.9%) within the previous 30 days. Additionally, 29.7% of participants reported they had mistreated a woman. The training improved the participants’ awareness of the rights of women during childbirth and their perceptions and attitudes about RMC were positively influenced. However, participants believed that the RMC training did not address providers’ rights. Structural and systemic issues were the main challenges providers reported when trying to implement RMC in their contexts. Conclusion Training alone is insufficient to improve the provision of RMC unless RMC is addressed through a lens of health systems strengthening that addresses the bottlenecks, including the rights of providers of childbirth care.
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Affiliation(s)
- Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia. .,Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Meghan A Bohren
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Galle A, Manaharlal H, Cumbane E, Picardo J, Griffin S, Osman N, Roelens K, Degomme O. Disrespect and abuse during facility-based childbirth in southern Mozambique: a cross-sectional study. BMC Pregnancy Childbirth 2019; 19:369. [PMID: 31640603 PMCID: PMC6805678 DOI: 10.1186/s12884-019-2532-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/24/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Evidence suggests that many women experience mistreatment during childbirth in health facilities across the world, but the magnitude of the problem is unknown. The occurrence of disrespect and abuse (D&A) in maternity care services affects the overall quality of care and may undermine women's trust in the health system. Studies about the occurrence of disrespect and abuse in Mozambican health facilities are scarce. The aim of this study was to explore the experience of women giving birth in hospital in different settings in Maputo City and Province, Mozambique. METHODS A cross sectional descriptive survey was conducted between April and June 2018 in the Central Hospital of Maputo (HCM) and district hospitals of Manhiça and Marracuene, Maputo Province, Mozambique. Five hundred seventy-two exit interviews were conducted with women leaving the hospital after delivery. The questionnaire consisted of the following components: socio-demographic characteristics, the occurrence of disrespect and abuse, male involvement during labor and childbirth and intrapartum family planning counselling and provision. RESULTS Prevalence of disrespect and abuse ranged from 24% in the central hospital to 80% in the district hospitals. The main types of D&A reported were lack of confidentiality/privacy, being left alone, being shouted at/scolded, and being given a treatment without permission. While very few women's partners attended the births, the majority of women (73-80%) were in favor of involving their partner as a birth companion. Intrapartum counseling of family planning was very low (9-17%). CONCLUSION The occurrence of disrespect and abuse was much higher in the district hospitals compared to the central hospital, emphasizing the high need for interventions outside Maputo City. Allowing male partners as birth companions should be explored further, as women seem in favor of involving their partners. Investing in intrapartum counselling for family planning is currently a missed opportunity for improving the uptake of contraception in the country.
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Affiliation(s)
- Anna Galle
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, entrance 75, UZP 114, 9000 Ghent, Belgium
| | - Helma Manaharlal
- International Centre for Reproductive Health – Mozambique, Rua das Flores no 34, Impasse 1085, /87 Maputo, Mozambique
| | - Emidio Cumbane
- International Centre for Reproductive Health – Mozambique, Rua das Flores no 34, Impasse 1085, /87 Maputo, Mozambique
| | - Joelma Picardo
- International Centre for Reproductive Health – Mozambique, Rua das Flores no 34, Impasse 1085, /87 Maputo, Mozambique
| | - Sally Griffin
- International Centre for Reproductive Health – Mozambique, Rua das Flores no 34, Impasse 1085, /87 Maputo, Mozambique
| | - Nafissa Osman
- International Centre for Reproductive Health – Mozambique, Rua das Flores no 34, Impasse 1085, /87 Maputo, Mozambique
- Faculty of Medicine, Department of Obstetrics/Gynecology, Eduardo Mondlane University, Av. Salvador Allende, 57 Maputo, Mozambique
| | - Kristien Roelens
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, entrance 75, UZP 114, 9000 Ghent, Belgium
| | - Olivier Degomme
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, entrance 75, UZP 114, 9000 Ghent, Belgium
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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: 19] [Impact Index Per Article: 3.8] [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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Sheferaw ED, Kim YM, van den Akker T, Stekelenburg J. Mistreatment of women in public health facilities of Ethiopia. Reprod Health 2019; 16:130. [PMID: 31455400 PMCID: PMC6712647 DOI: 10.1186/s12978-019-0781-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022] Open
Abstract
Background Recent evidence suggests that mistreatment of women during childbirth is a global challenge facing health care systems. This study seeks to explore the prevalence of mistreatment of women in public health facilities of Ethiopia, and identify associated factors. Methods A two-stage cross sectional sampling design was used to select institutions and women. The study was conducted in hospitals and health centers across four Ethiopian regions. Quantitative data were collected from postpartum women. Mistreatment was measured using four domains: (1) physical abuse, (2) verbal abuse, (3) failure to meet professional standards of care, and (4) poor rapport between women and providers. Percentages of mistreatment and odds ratios for the association between its presence and institutional and socio demographic characteristics of women were calculated using bivariate and multivariable logistic regression modeling. Results A total of 379 women were interviewed, of whom 281 (74%) reported any mistreatment. Physical and verbal abuse were reported by 7 (2%) and 31 (8%) women interviewed respectively. Failure to meet professional standards of care and poor rapport between women and providers were reported by 111 (29%) and 274 (72%) women interviewed respectively. Multivariable logistic regression analysis revealed that the odds of reporting mistreatment were higher among women with four or more previous births (aOR = 3.36 95%CI 1.22,9.23, p = 0.019) compared to women with no previous childbirth, Muslim women (aOR = 3.30 95%CI 1.4,7.77, p = 0.006) and women interviewed in facilities with less than 17 births per MNH staff in a month (aOR = 3.63 95%CI 1.9,6.93, p < 0.001). However, the odds of reporting mistreatment were lower among women aged 35 and older (aOR = 0.22 95%CI 0.06, 0.73, p = 0.014) and among women interviewed between 8 and 42 days after childbirth (aOR = 0.37 95%CI 0.15, 0.9, p = 0.028). Conclusion Mistreatment during childbirth in Ethiopia is commonly reported. Health workers need to consider provision of individualized care for women and monitor their experiences in order to adjust quality of their services. Electronic supplementary material The online version of this article (10.1186/s12978-019-0781-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ephrem D Sheferaw
- Jhpiego Ethiopia, Addis Ababa, Ethiopia. .,Department of Health Sciences, University of Groningen, University Medical Centre Groningen, Global Health, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands.
| | - Young-Mi Kim
- Department of Health Sciences, University of Groningen, University Medical Centre Groningen, Global Health, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands.,Jhpiego, Baltimore, USA
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, University of Groningen, University Medical Centre Groningen, Global Health, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Henri Dunantweg 2, 8934, AD, Leeuwarden, The Netherlands
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Kassa ZY, Husen S. Disrespectful and abusive behavior during childbirth and maternity care in Ethiopia: a systematic review and meta-analysis. BMC Res Notes 2019; 12:83. [PMID: 30760318 PMCID: PMC6375170 DOI: 10.1186/s13104-019-4118-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/06/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Disrespectful and abusive behavior during childbirth and maternity care is violation of fundamental right of women and unborn child. There is scarce of data on disrespectful and abusive behavior during childbirth and maternity care in Ethiopia. The aim of this study was to determine disrespectful and abusive behavior during childbirth and maternity care in Ethiopia. Results Seven studies were included in this meta-analysis of disrespectful and abusive behavior during childbirth and maternity care. The pooled prevalence of disrespect and abuse care during childbirth and maternity care was 49.4% (95% CI 30.9–68.1). Whereas physical abuse was 13.6% (95% CI 5.2–31.2), non-confidential care was 14.1% (95% CI 7.3–25.4), abandonment care was 16.4% (95% CI 14.7–18.2), and detention was 3.2% (95% CI 0.9–11.5). This study showed that disrespectful and abusive behavior during child birth and maternity care is high. Whereas, abandonment care is high. This study indicates that health care providers shall not leave women during childbirth and maternity care and listen women, federal minister of health and regional health bureau also identifying root of cause disrespect and abuse and to alleviate mistreatment during childbirth and maternity care. Electronic supplementary material The online version of this article (10.1186/s13104-019-4118-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zemenu Yohannes Kassa
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Siraj Husen
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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