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Abukari AS, Schmollgruber S. Perceived barriers of family-centred care in neonatal intensive care units: A qualitative study. Nurs Crit Care 2024; 29:905-915. [PMID: 38228405 DOI: 10.1111/nicc.13031] [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: 01/12/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Family-centered care (FCC) approach in neonatal intensive care units (NICUs) has been shown to improve family satisfaction and quality of care. However, several contextual barriers influence its use in NICUs, and these barriers are understudied in Ghana. AIM To describe FCC practice in Ghanaian NICUs in order to understand the contextual barriers. STUDY DESIGN The study employed a descriptive qualitative design. The researchers used a structured interview guide to collect the data in 24 interviews and 12 focus group discussions. We engaged families (n = 42), nurses and midwives (n = 33), and doctors (n = 9) to describe their perspectives on the barriers to FCC in two public tertiary hospital NICUs. The data were mapped, triangulated, and aggregated to inform the findings. Thematic analysis and MAXQDA qualitative software version 2020 were employed to analyse the data. This qualitative study followed the COREQ guidelines and checklist. RESULTS Perceived family barriers and perceived facility barriers to FCC were the two main themes. The perceived family barriers include family stress and anxiety, inadequate information sharing and education, culture and religion. The perceived facility barriers are inadequate space and logistics, workload and inadequate staff, restricted entry, and negative staff attitudes. CONCLUSION The findings of this study shed light on the barriers to FCC practice in neonatal care in Ghanaian NICUs. Family stress and anxiety, a lack of information sharing, cultures and religious beliefs, NICU workload and staffing shortages, restrictions on family entry into NICUs, and staff attitudes towards families are all contextual barriers to FCC practice. RELEVANCE TO CLINICAL PRACTICE Health facility managers and NICU staff may consider addressing these barriers to implement FCC in the NICU in order to enhance family satisfaction and quality neonatal care. The design of future NICUs should consider family comfort zones and subunits to accommodate families and their sick infants for optimal health care outcomes. The development of communication models and guidelines for respectful NICU care may aid in integrating families into ICUs and promoting quality health care outcomes.
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Affiliation(s)
- Alhassan Sibdow Abukari
- Department of Nursing Education, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
- Department of General Nursing, School of Nursing, Wisconsin International University College, Accra, Ghana
| | - Shelley Schmollgruber
- Department of Nursing Education, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Utalo D, Israel E, Lenjebo TL, Aynalem A, Darebo TD. Determinants of respectful maternity care among women who gave childbirth in Southern Ethiopia. BMC Health Serv Res 2024; 24:451. [PMID: 38600494 PMCID: PMC11007911 DOI: 10.1186/s12913-024-10813-7] [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: 03/30/2023] [Accepted: 03/01/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Having a good provision of respectful maternity care (RMC) to a woman who gives childbirth is a crucial component of maternal health care to result in positive maternal and neonatal outcomes. Disrespect and lack of women-centered care in birth discourage a woman from seeking healthcare during childbirth contributing to poor healthcare-seeking behaviour and dissatisfaction with the maternity service. The current study aimed to assess key determinants of RMC during childbirth at selected public health facilities of the Gofa zone, Southern Ethiopia. METHODS A cross-sectional study design was conducted from March to April 2021 among 390 women who gave birth in eight randomly selected public health facilities of Gofa zone, Southern Ethiopia. The level of RMC was measured using structured exit interview items. A structured-interviewer-administered questionnaire was used to collect data and then entered into Epi-data version 4.6 and exported to SPSS version 25 for further analysis. Bivariate and multivariate logistic regression analyses were used to identify determinants of RMC among women. RESULTS A total of 390 women responded to the exit interview making a response rate of 100%. The mean (± SD) age of the 390 women was 27.9 (± 4.85) years. The overall prevalence of women who received RMC was 40.5%, 95% CI (36-45%). Two hundred and ninety-seven (76.2%; n = 297/390) women had antenatal care (ANC) attendance in the index pregnancy. A woman who had planned pregnancy (AOR = 1.72, CI: 1.04, 2.85), planned to deliver in a health facility (AOR = 1.68, CI: 1.00, 2.81), presence of familial support (AOR = 2.04, CI: 1.20, 3.48), and had information about service availability (AOR = 4.44, CI: 2.09, 9.42) were associated with RMC among women. CONCLUSION The provision of respectful maternity care in the study area was low when compared with local studies. Planned pregnancy, plan to deliver in a health facility, family support, and presence of information about service availability were factors associated with RMC among women. More attention should be given to training and supportive supervision of health care professionals on respectful maternity care and its standards to increase service uptake and make service more women-centred.
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Affiliation(s)
- Dawit Utalo
- Departement of Public Health, Consortium Project at Women Empowerment-Amref Health Africa, Wolaita Sodo, Ethiopia
| | - Eskinder Israel
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Tsegaye Lolaso Lenjebo
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amdehiwot Aynalem
- School of Nursing, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Tadele Dana Darebo
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Kasaye H, Scarf V, Sheehy A, Baird K. The mistreatment of women during maternity care and its association with the maternal continuum of care in health facilities. BMC Pregnancy Childbirth 2024; 24:129. [PMID: 38350892 PMCID: PMC10863180 DOI: 10.1186/s12884-024-06310-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Mistreatment of childbearing women continues despite global attention to respectful care. In Ethiopia, although there have been reports of mistreatment of women during maternity care, the influence of this mistreatment on the continuum of maternity care remains unclear. In this paper, we report the prevalence of mistreatment of women from various dimensions, factors related to mistreatment and also its association to the continuum of maternity care in health facilities. METHODS We conducted an institution-based cross-sectional survey among women who gave birth within three months before the data collection period in Western Ethiopia. A total of 760 women participated in a survey conducted face-to-face at five health facilities during child immunization visits. Using a validated survey tool, we assessed mistreatment in four categories and employed a mixed-effects logistic regression model to identify its predictors and its association with the continuum of maternity care, presenting results as adjusted odds ratios (AORs) with their 95% confidence intervals (CIs). RESULTS Over a third of women (37.4%) experienced interpersonal abuse, 29.9% received substandard care, 50.9% had poor interactions with healthcare providers, and 6.2% faced health system constraints. The odds of mistreatment were higher among women from the lowest economic status, gave birth vaginally and those who encountered complications during pregnancy or birth, while having a companion of choice during maternity care was associated to reduced odds of mistreatment by 42% (AOR = 0.58, 95% CI: [0.42-0.81]). Women who experienced physical abuse, verbal abuse, stigma, or discrimination during maternity care had a significantly reduced likelihood of completing the continuum of care, with their odds decreased by half compared to those who did not face such interpersonal abuse (AOR = 0.49, 95% CI: [0.29-0.83]). CONCLUSIONS Mistreatment of women was found to be a pervasive problem that extends beyond labour and birth, it negatively affects upon maternal continuum of care. Addressing this issue requires an effort to prevent mistreatment through attitude and value transformation trainings. Such interventions should align with a system level actions, including enforcing respectful care as a competency, enhancing health centre functionality, improving the referral system, and influencing communities to demand respectful care.
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Affiliation(s)
- Habtamu Kasaye
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Vanessa Scarf
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Annabel Sheehy
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Kathleen Baird
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Wang D, Sacks E, Odiase OJ, Kapula N, Sarakki A, Munson E, Afulani PA, Requejo J. A scoping review, mapping, and prioritisation process for emergency obstetric and neonatal quality of care indicators: Focus on provision and experience of care. J Glob Health 2023; 13:04092. [PMID: 37824168 PMCID: PMC10569369 DOI: 10.7189/jogh.13.04092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Background Globally, approximately 800 women and 6400 newborns die around the time of childbirth each day. Many of these deaths could be prevented with high-quality emergency obstetric and newborn care (EmONC). The Monitoring Emergency Obstetric Care: A handbook guides strengthening EmONC services. However, the handbook contains limited quality of care measures. Our study identified and prioritised quality of care indicators for potential inclusion in the handbook, which is undergoing revision. Methods We conducted a consultative scoping review, mapping, and prioritisation exercise to select a short list of indicators on facility-based maternal and newborn quality of care. Indicators were identified from literature searches and expert suggestions and organised by the categories of structure, process, and outcomes as defined in the World Health Organization's Standards for Improving Quality of Maternal and Newborn Care in Health Facilities. We focused on process indicators, encompassing the provision of care and experience of care during the intrapartum period, and developed a priority list of indicators using the selection criteria of relevance and feasibility. Experience of care indicators were also mapped against the Person-Centered Maternity Care (PCMC) scale. Results We extracted a total of 3023 quality of care indicators. After removing out-of-scope and duplicate indicators and applying our selection criteria, we identified 20 provision of care indicators for possible inclusion in the revised EmONC handbook. We recommend including a score for experience of care that could be measured with the 30-item or the 13-item PCMC scale. We also identified 29 experience of care items not covered by the PCMC scale that could be used. Provider experience, patient safety, and quality of abortion care were identified as areas for which no or few indicators were found through our scoping review. Conclusions Through a rigorous, consultative, and multi-step process, we selected a short list of process-related, facility-based quality of care indicators for emergency obstetric and newborn care. This list could be included in the EmONC handbook or used for other monitoring purposes. Country consultations to assess the utility and feasibility of the proposed indicators and their adaptation to local contexts will support their refinement and uptake. Registration https://osf.io/msxbd (Open Science Framework).
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Affiliation(s)
- Dee Wang
- Division of Data Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, New York, USA
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Emma Sacks
- Division of Data Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, New York, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Osamuedeme J Odiase
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Ntemena Kapula
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Alisha Sarakki
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Erica Munson
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Patience A Afulani
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jennifer Requejo
- Division of Data Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, New York, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Revisioning Emergency Obstetric and Newborn Care (EmONC) quality of care workstreamCreangaAndreeaMorganAlisonMoranAllisynMaliqiBlertaWarthinCaitlinKamkongCatherine BreenWalkerDilysMonetJean-PierreHillKathleenBenovaLenkaMuzigabaMoiseDayLouise TinaBaileyPatriciaLobisSamanthaSodzi-TetteySodziDegefie HailegebrielTedbabe
- Division of Data Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, New York, USA
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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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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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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Kasaye HK, Dadi TL, Yilma MT, Jebena MG, Medhin G, Kassie GM, Bekele F, Nigatu F, Teklu AM. Does Combining Antenatal Care Visits at Health Posts and Health Centers Improve Antenatal Care Quality in Rural Ethiopia? Ethiop J Health Sci 2023; 33:37-48. [PMID: 38362475 PMCID: PMC10866290 DOI: 10.4314/ejhs.v33i1.5s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2024] Open
Abstract
Background Even though quality maternal care is crucial for the well-being of women and their newborns, the inferior quality of antenatal care in rural Ethiopia is a timely concern. This study aimed to investigate the effects of combining antenatal care visits at health posts and health centers on improving antenatal care quality in rural Ethiopia. Methods Using the 2019 Ethiopia Health Extension Program assessment done by MERQ, we extracted and analyzed the survey responses of 2,660 women who had received at least one antenatal visit from a primary health care unit. We measured the cumulative count of quality of antenatal care using the Donabedian model. To model the differences in the quality of antenatal care at health posts and health centers, we used zero-truncated Poisson regression and reported incidence risk ratios with their 95% confidence intervals. Results The quality of antenatal care increased by 20% (adjusted IRR= 1.20 [1.12-1.28]) when antenatal care reception was mixed at health posts and health centers, compared to those who received all antenatal care only from health posts. Quality differences based on socioeconomic status and setting variations were observed as predictors of quality of care, even if women received antenatal care at both health posts and health centers. Conclusions Combining antenatal care provision from health posts and health centers should be sustained as one of the antenatal care quality improvement strategies in rural parts of Ethiopia while ensuring the equitable provision of quality care across socioeconomic groups and between agrarian and pastoral settings.
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Affiliation(s)
| | - Tegene Legese Dadi
- School of Public Health, Hawassa University, Ethiopia
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Mekdes Tigistu Yilma
- Department of Public Health, Institute of Health Sciences, Wallaga University, Ethiopia
| | - Mulusew G Jebena
- Department of Epidemiology, Institute of Health, Jimma University
| | - Girmay Medhin
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
| | - Getnet Mitike Kassie
- International Institute for Primary Health Care- Ethiopia (IIfPHC-E)
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | | | - Frehiwot Nigatu
- International Institute for Primary Health Care- Ethiopia (IIfPHC-E)
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Werdofa HM, Lindahl AK, Lulseged B, Thoresen L. Women’s perspectives on disrespect and abuse experiences during childbirth in a teaching hospital in Southwest Ethiopia: a qualitative study. Sex Reprod Health Matters 2022; 30:2088058. [PMID: 35848504 PMCID: PMC9302010 DOI: 10.1080/26410397.2022.2088058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is evidence that women in Ethiopia often face disrespect and abuse in health care facilities during childbirth. Disrespect and abuse (D&A) violate women’s right to dignified, respectful health care and decrease their trust in health care facilities. There is a need for more insight into women’s perspectives on D&A during childbirth in different contexts. Therefore, this study aimed to explore women’s perspectives on D&A during childbirth in a teaching hospital in South-West Ethiopia. A qualitative study was conducted from November 2017 to February 2018 using in-depth interviews and focus group discussions. Postnatal women were purposively chosen and scheduled for interviews six weeks postpartum. Data saturation occurred once 32 women were interviewed, and four focus group discussions were conducted. A thematic analysis method was used to analyse the data using MAXQDA qualitative analysis software. Three main themes emerged from the data: disrespect and abuse, its contributors, and perceived consequences. The subthemes of D&A include neglected care, non-consented care, physical abuse, lack of privacy, loss of autonomy, objectification, lack of companionship, and verbal abuse. The subthemes of contributors include health care provider-related, health care system-related, and women-related contributors. The subthemes of perceived consequences include the fear of using health care facilities. Women in Ethiopia experienced D&A. Health system factors, such as the teaching environment and scarcity of supplies, contribute the most to the identified D&A. Therefore, providers, administrators, training institutions, and researchers must collaborate to address these health system factors to reduce disrespect and abuse during childbirth in teaching hospitals.
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Affiliation(s)
- Hirut Megersa Werdofa
- Lecturer, School of Nursing, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia and PhD student at Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Karin Lindahl
- Associate Professor, Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway, and Head of Division of Surgery, Akershus University Hospital, Nordbyhagen, Norway
| | - Belayneh Lulseged
- Senior Lecturer, School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lisbeth Thoresen
- Associate Professor, Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Ellis C, Larson CP, Bicaba F, Bicaba A, Nguyen A, Ramdé J, Otis A. Measurement of self-reported, facility-based labour and birth experiences: The Perinatal Experience Assessment Tool (PEAT). J Glob Health 2022; 12:04103. [PMID: 36579597 PMCID: PMC9798243 DOI: 10.7189/jogh.12.04103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Women and their families make decisions on accessing perinatal care based on their experiences in the health care system and on the experience of others around them. Receiving supportive maternity care which demonstrates respect is an essential part of quality care. Globally, and in low- and middle-income countries in particular, women report receiving mistreatment and a lack of respect during labour, childbirth and the early postnatal period. These experiences, if negative, may influence choices around place of birth, thus hindering the scale-up of facility-based births. Methods We conducted a focussed review of the literature between 2010 and 2019 to identify recent research addressing the assessment of women's experiences during childbirth in low- and middle-income country facilities. The World Health Organization (WHO) and White Ribbon Alliance themes and concepts of respectful maternity care served as a guide. Themes included disrespectful or abusive experiences such as verbal abuse or rudeness, abandonment, corruption, lack of privacy, failure to respect traditional practices, discrimination, and physical or sexual abuse. Experienced midwives in two low-resource countries contributed to the identification of appropriate indicators of respectful, non-abusive care, and eventual agreement as to which to include in an assessment tool monitoring women's experiences. Results Our review of the literature identified 18 publications meeting pre-established criteria. This resulted in the eventual selection of 33 indicators of respectful care sub-grouped under 9 domains: 1) communication/verbal interaction, 2) supportive care, 3) physical abuse, 4) non-consented care, 5) non-confidential care/lack of privacy, 6) stigma and discrimination, 7) abandonment/neglect, 8) detention/inability to pay, and 9) health facility conditions. We converted these indicators into questions to be asked by an interviewer during a short interview following discharge to assess the childbirth experience. Conclusions The Perinatal Experience Assessment Tool (PEAT) may be used to monitor or evaluate the experiences that women report after facility-based childbirth. It can be administered by trained, independent interviewers in the facility following discharge. The PEAT enables maternity leaders to assess the extent to which maternity services are conducted in a respectful, non-abusive manner and modify practices and procedures as feasible and appropriate.
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Affiliation(s)
- Cathryn Ellis
- Midwifery Program, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles P Larson
- Canadian Coalition for Global Health Research, Ottawa, Ontario, Canada,Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Frank Bicaba
- Société d'Études et de Recherche en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherche en Santé Publique, Ouagadougou, Burkina Faso
| | - An Nguyen
- HealthBridge Vietnam, Hanoi, Vietnam
| | - Jean Ramdé
- Direction en santé mondiale, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - Alexandra Otis
- Canadian Coalition for Global Health Research, Ottawa, Ontario, Canada
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Understanding variation in person-centered maternity care: Results from a household survey of postpartum women in 6 regions of Ethiopia. AJOG GLOBAL REPORTS 2022; 3:100140. [PMID: 36594001 PMCID: PMC9803839 DOI: 10.1016/j.xagr.2022.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Effective communication, respect and dignity, and emotional support are critical for a positive childbirth experience that is responsive to the needs and preferences of women. OBJECTIVE This study evaluated the performance of a person-centered maternity care scale in a large, representative household sample of postpartum women, and it describes differences in person-centered maternity care across individuals and communities in Ethiopia. STUDY DESIGN The study used data from 2019 and 2020 from a representative sample of postpartum women in 6 regions of Ethiopia. It measured person-centered maternity care using a scale previously validated in other settings. To assess the scale validity in Ethiopia, we conducted cognitive interviews, measured internal consistency, and evaluated construct validity. Then, we fit univariable and multivariable linear regression models to test for differences in mean person-centered maternity care scores by individual and community characteristics. Lastly, multilevel modeling separated variance in person-centered maternity care scores within and between communities. RESULTS Effective communication and support of women's autonomy scored lowest among person-centered maternity care domains. Of 1575 respondents, 704 (44.7%) were never asked their permission before examinations and most said that providers rarely (n=369; 23.4%) or never (n=633; 40.2%) explained why procedures were done. Person-centered maternity care was significantly higher for women with greater wealth, more formal education, and those aged >20 years. Variation in person-centered maternity care scores between individuals within the same community (τ2=58.3) was nearly 3 times greater than variation between communities (σ2=21.2). CONCLUSION Ethiopian women reported widely varying maternity care experiences, with individuals residing within the same community reporting large differences in how they were treated by providers. Poor patient-provider communication and inadequate support of women's autonomy contributed most to poor person-centered maternity care.
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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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Yalew M, Nigatu D, Yasin T, Kefale B, Damtie Y. Respectful delivery care and associated factors among mothers delivered in public health facilities of Dessie city, Northeast Ethiopia: a cross-sectional study. BMC Womens Health 2022; 22:127. [PMID: 35449044 PMCID: PMC9026676 DOI: 10.1186/s12905-022-01713-1] [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: 11/24/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background The government of Ethiopia has been implementing compassionate, respectful, and caring strategies to increase institutional delivery and decrease maternal mortality in recent years. There is limited evidence on respectful delivery care and associated factors in low-income countries like Ethiopia. Therefore, this study aimed to assess the proportion of respectful delivery care and associated factors among mothers delivered in the health facilities of Dessie city, Northeast Ethiopia. Methods A health facility-based cross-sectional study was conducted among a total of 390 mothers from April 16 to May 30, 2018. A pretested structured interviewer-administered questionnaire was used to collect the data. The data were entered into Epidata and analyzed using Stata/SE 14. Binary logistic regression analysis was used to identify associated factors. Variables having P-value less than 0.2 in the bivariable regression were selected as a candidate for multi-variable regression. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was estimated to measure the strength and direction of the association respectively. Results The proportion of respectful delivery care among mothers delivered in public health facilities of Dessie city was 43.4%, 95% CI (39.1%, 47.6%). It was found to be 34.9% in hospital and 74.1 in health center. Respectful delivery care was associated with day time delivery [AOR = 2.23, 95% CI (1.30, 3.82)], any maternal and/or fetal complications [AOR = 0.50, 95% CI (0.27, 0.94)], gave birth in health center [AOR = 3.22, 95% CI (1.61, 6.46)] and educated mothers [AOR = 2.87, 95% CI (1.18, 7.01)]. Conclusions The proportion of respectful delivery care in the study area was low as compared to the government emphasis and other works of literature. This study indicated that any maternal and/or newborn complications, daytime delivery, giving birth in a health center, and maternal education were associated with respectful delivery care. Women empowerment through education could be a recalled intervention for respectful care. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01713-1.
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Affiliation(s)
- Melaku Yalew
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia. .,Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Dabere Nigatu
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Toyeb Yasin
- Department of Health Service Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Adu-Bonsaffoh K, Tamma E, Maya E, Vogel JP, Tunçalp Ö, Bohren MA. Health workers’ and hospital administrators’ perspectives on mistreatment of women during facility-based childbirth: a multicenter qualitative study in Ghana. Reprod Health 2022; 19:82. [PMID: 35351161 PMCID: PMC8966263 DOI: 10.1186/s12978-022-01372-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Globally, mistreatment of women during facility-based childbirth continues to impact negatively on the quality of maternal healthcare provision and utilization. The views of health workers are vital in achieving comprehensive understanding of mistreatment of women, and to design evidence-based interventions to prevent it. We explored the perspectives of health workers and hospital administrators on mistreatment of women during childbirth to identify opportunity for improvement in the quality of maternal care in health facilities. Methods A qualitative study comprising in-depth interviews (IDIs) with 24 health workers and hospital administrators was conducted in two major towns (Koforidua and Nsawam) in the Eastern region of Ghana. The study was part of a formative mixed-methods project to develop an evidence-based definition, identification criteria and two tools for measuring mistreatment of women in facilities during childbirth. Data analysis was undertaken based on thematic content via the inductive analytic framework approach, using Nvivo version 12.6.0. Result Health workers and hospital administrators reported mixed feelings regarding the quality of care women receive. Almost all respondents were aware of mistreatment occurring during childbirth, describing physical and verbal abuse and denial of preferred birthing positions and companionship. Rationalizations for mistreatment included limited staff capacity, high workload, perceptions of women’s non-compliance and their attitudes towards staff. Health workers had mixed responses regarding the acceptability of mistreatment of women, although most argued against it. Increasing staff strength, number of health facilities, refresher training for health workers and adequate education of women about pregnancy and childbirth were suggestions to minimize such mistreatment. Conclusion Health workers indicated that some women are mistreated during birth in the study sites and provided various rationalizations for why this occurred. There is urgent need to motivate, retrain or otherwise encourage health workers to prevent mistreatment of women and promote respectful maternity care. Further research on implementation of evidence-based interventions could help mitigate mistreatment of women in health facilities. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01372-3. Respectful maternity care is vital to achieving positive pregnancy and childbirth experiences for women and their families. Mistreatment of women during childbirth at facilities can negatively impact women’s future health seeking behaviors and utilization of maternal care services. The experiences and perspectives of doctors, midwives and nurses working in labour wards are vital in understanding how women are treated during childbirth, and what measures can be taken to prevent it. In this study, we explored the opinions of health workers and hospital administrators on how women are treated during childbirth to determine the gaps in the quality of maternal care in health facilities in Ghana. Participants expressed mixed feelings concerning mistreatment of women during childbirth. Most were aware of the occurrence of mistreatment in health facilities including physical and verbal abuse, and denial of preferred position for childbirth and companionship. The reasons provided for mistreatment included low staff capacity, high workload, non-compliance by women and poor attitudes towards health workers. Most health workers were against mistreatment during childbirth. Participants thought mistreatment could be minimized by improving staff skills, refresher training, and childbirth preparation education for women. Our study indicates the need to motivate, retrain or encourage health professionals to provide respectful care to women during childbirth to improve their experience of care. Further research to help implement better maternity care devoid of mistreatment in health facilities in Ghana is needed.
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Amsalu B, Aragaw A, Sintayehu Y, Sema A, Belay Y, Tadese G, Kassie N, Guta A, Tibebu A, Tiruye G. Respectful maternity care among laboring women in public hospitals of Benishangul Gumuz Region, Ethiopia: A mixed cross-sectional study with direct observations. SAGE Open Med 2022; 10:20503121221076995. [PMID: 35173967 PMCID: PMC8841920 DOI: 10.1177/20503121221076995] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Promoting respectful maternity care is a fundamental strategy for enhancing facility birth, which significantly reduces maternal and newborn mortality and morbidity. Despite these effects, disrespect and abusive childbirth care remain a challenge in Ethiopia. Therefore, this study aimed to determine the prevalence of respectful maternity care and its associated factors among laboring women in public hospitals of Benishangul Gumuz region, Ethiopia. Methods: A facility-based cross-sectional study design was employed, and trained external assessors observed the care provided to 404 laboring women in public hospitals using structured observation checklists. A focus group discussion and two key informant interviews were also conducted. A structured pre-tested questionnaire and a semi-structured guide were used to generate quantitative and qualitative data, respectively. Seven verification criteria were employed, and the mean value and above for each criterion were used to measure respectful maternity care. Results: Of the 404 client–provider interaction observations during childbirth, only 12.6% ( n = 51) participants received respectful maternity care. Being from an urban area (adjusted odds ratio = 3.34, 95% confidence interval: 1.39, 8.08), giving childbirth at daytime (adjusted odds ratio = 2.59, 95% confidence interval: 1.26, 5.33), receiving the service from compassionate and respectful care trained provider (adjusted odds ratio = 4.54, 95% confidence interval: 1.63, 12.66), giving childbirth at general hospital (adjusted odds ratio = 3.03, 95% confidence interval: 1.39, 6.65) were positively associated with respectful maternity care. Staff workload, shortage of supply and equipment, partiality in providing timely care, yelling and insulting at clients and birth companions were also barriers to respectful maternity care. Conclusion: The observed respectful maternity care practices were low in the study area. Therefore, the findings of this study suggest that addressing respectful maternity care would require increased compassionate and respectful care trained providers, and sustained efforts to improve access to basic equipment and supply for maternity care with an emphasis on primary hospitals. Tailored interventions aimed at improving respectful maternity care should also target rural residents and nighttime parturients.
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Affiliation(s)
- Bezabh Amsalu
- Department of Midwifery, College of Medicine & Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Amanu Aragaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yitagesu Sintayehu
- Department of Midwifery, College of Medicine & Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Alekaw Sema
- Department of Midwifery, College of Medicine & Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Yalelet Belay
- Department of Midwifery, College of Medicine & Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Getasew Tadese
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Nigus Kassie
- Department of Midwifery, College of Medicine & Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Alemu Guta
- Department of Midwifery, College of Medicine & Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Abel Tibebu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Getahun Tiruye
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, 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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Miani C, Batram-Zantvoort S, Wandschneider L, Spallek J, Razum O. Potential of Standard Perinatal Data for Measuring Violation of Birth Integrity. Front Glob Womens Health 2021; 1:581244. [PMID: 34816160 PMCID: PMC8594012 DOI: 10.3389/fgwh.2020.581244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/10/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Measuring the phenomenon of violation of birth integrity (vBI) (e.g., obstetric violence) relies in part on the availability and content of maternity care providers' data. The population coverage and linkage possibilities that these data provide make for a yet untapped potential. Although vBI is a complex phenomenon best measured with dedicated instruments, we argue that maternity care providers' data could contribute to enhance our knowledge of the manifestations and frequency of vBI, and allow for analyses across different sub-groups of the population. Looking into the German standardized perinatal data, we investigate which variables are relevant to vBI-related research, and how complete their reporting is. Methods: First, we analyse state-of-the-art frameworks and recommendations, and, for each vBI-related domain, we search for and list corresponding variables in the perinatal data which could contribute to a better understanding of vBI issues. Second, we use an example and analyse the content of perinatal data obtained between 2013 and 2016 in the context of the BaBi birth cohort study set in Bielefeld, Germany. We use descriptive statistics to assess the completeness of the data. Results: The vBI-related variables can be classified in three main categories: discrimination based on specific patient socio-demographic attributes (e.g., height and weight to calculate BMI before pregnancy, foreign origin), indication for medical interventions (i.e., medicalization-related variables: indication for cesarean sections and induction), and supportive care, in particular the mobilization dimension (e.g., continuous fetal heartbeat monitoring). The data analyses included 876 births, of which 601 were vaginal birth. We found poor reporting on demographic variables in terms of completeness. Medicalization and mobilization variables are better documented, although limited in scope. Conclusions: Putting more emphasis on the completeness of standardized data could increase their potential for vBI-related research. Perinatal data alone are insufficient to assess vBI, but a broader, theory-informed discussion of indicators to be included in standardized datasets would contribute to capturing the different aspects of integrity violation in a more systematic way and expand the evidence-base on different types of vBI.
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Affiliation(s)
- Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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Asefa A, McPake B, Langer A, Bohren MA, Morgan A. Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care. Sex Reprod Health Matters 2021; 28:e1854153. [PMID: 33308051 PMCID: PMC7888043 DOI: 10.1080/26410397.2020.1854153] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Evidence of the health system challenges to promoting respectful maternity care (RMC) is limited in Ethiopia and globally. This study investigated the health system constraints to RMC in three Southern Ethiopian hospitals. We conducted a qualitative study (7 focus group discussions (FGDs) with providers of RMC and 12 in-depth interviews with focal persons and managers) before and after the implementation of an RMC intervention. We positioned childbirth services within the health system and applied complex adaptive system theory to analyse the opportunities and constraints to the promotion of RMC. Both system “hardware” and “software” factors influencing the promotion of RMC were identified, and their interaction was complex. The “hardware” factors included bed availability, infrastructure and supplies, financing, and health workforce. “Software” factors encompassed service providers’ mindset, staff motivation, and awareness of RMC. Interactions between these factors included privacy breaches for women when birth companions were admitted in labour rooms. Delayed reimbursement following the introduction of fee-exemption for maternity services resulted in depleted revenues, supply shortages, and ultimately disrespectful behaviour among providers. Other financial constraints, including the insufficient and delayed release of funds, also led to complex interactions with the motivation of staff and the availability of workforce and supplies, resulting in poor adherence to RMC guidance. Interventions aimed at improving only behavioural components fall short of mitigating the mistreatment of women. System-wide interventions are required to address the complex interactions that constraint RMC.
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Affiliation(s)
- Anteneh Asefa
- PhD Candidate, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Assistant Professor, School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Barbara McPake
- Professor, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ana Langer
- Professor, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Meghan A Bohren
- Senior Lecturer, Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Alison Morgan
- Associate Professor, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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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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Tiruneh GT, Demissie M, Worku A, Berhane Y. Community's experience and perceptions of maternal health services across the continuum of care in Ethiopia: A qualitative study. PLoS One 2021; 16:e0255404. [PMID: 34347800 PMCID: PMC8336848 DOI: 10.1371/journal.pone.0255404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Continuum of care is an effective strategy to ensure that every woman receives a series of maternal health services continuously from early pregnancy to postpartum stages. The community perceptions regarding the use of maternal services across the continuum of care are essential for utilization of care in low-income settings but information in that regard is scanty. This study explored the community perceptions on the continuum of care for maternal health services in Ethiopia. METHODS This study employed a phenomenological qualitative research approach. Four focus group discussions involving 26 participants and eight in-depth interviews were conducted with women who recently delivered, community health workers, and community leaders that were purposively selected for the study in West Gojjam zone, Amhara region. All the interviews and discussions were audio-taped; the records were transcribed verbatim. Data were coded and analyzed thematically using ATLAS.ti software. RESULTS We identified three primary themes: practice of maternal health services; factors influencing the decision to use maternal health services; and reasons for discontinuation across the continuum of maternal health services. The study showed that women faced multiple challenges to continuously uptake maternal health services. Late antenatal care booking was the main reasons for discontinuation of maternal health services across the continuum at the antepartum stage. Women's negative experiences during care including poor quality of care, incompetent and unfriendly health providers, disrespectful care, high opportunity costs, difficulties in getting transportation, and timely referrals at healthcare facilities, particularly at health centers affect utilization of maternal health services across the continuum of care. In addition to the reverberation effect of the intrapartum care factors, the major reasons mentioned for discontinuation at the postpartum stage were lack of awareness about postnatal care and service delivery modality where women are not scheduled for postpartum consultations. CONCLUSION This study showed that rural mothers still face multiple challenges to utilize maternal health services as recommended by the national guidelines. Negative experiences women encountered in health facilities, community perceptions about postnatal care services as well as challenges related to service access and opportunity costs remained fundamental to be reasons for discontinuation across the continuum pathways.
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Affiliation(s)
- Gizachew Tadele Tiruneh
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | - Meaza Demissie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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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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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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Farrington E, Connolly M, Phung L, Wilson AN, Comrie-Thomson L, Bohren MA, Homer CSE, Vogel JP. The prevalence of uterine fundal pressure during the second stage of labour for women giving birth in health facilities: a systematic review and meta-analysis. Reprod Health 2021; 18:98. [PMID: 34006288 PMCID: PMC8132352 DOI: 10.1186/s12978-021-01148-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine fundal pressure involves a birth attendant pushing on the woman's uterine fundus to assist vaginal birth. It is used in some clinical settings, though guidelines recommend against it. This systematic review aimed to determine the prevalence of uterine fundal pressure during the second stage of labour for women giving birth vaginally at health facilities. METHODS The population of interest were women who experienced labour in a health facility and in whom vaginal birth was anticipated. The primary outcome was the use of fundal pressure during second stage of labour. MEDLINE, EMBASE, CINAHL and Global Index Medicus databases were searched for eligible studies published from 1 January 2000 onwards. Meta-analysis was conducted to determine a pooled prevalence, with subgroup analyses to explore heterogeneity. RESULTS Eighty data sets from 76 studies (n = 898,544 women) were included, reporting data from 22 countries. The prevalence of fundal pressure ranged from 0.6% to 69.2% between studies, with a pooled prevalence of 23.2% (95% CI 19.4-27.0, I2 = 99.97%). There were significant differences in prevalence between country income level (p < 0.001, prevalence highest in lower-middle income countries) and method of measuring use of fundal pressure (p = 0.001, prevalence highest in studies that measured fundal pressure based on women's self-report). CONCLUSIONS The use of uterine fundal pressure on women during vaginal birth in health facilities is widespread. Efforts to prevent this potentially unnecessary and harmful practice are needed.
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Affiliation(s)
- Elise Farrington
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Mairead Connolly
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Laura Phung
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Liz Comrie-Thomson
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, School of Population and Global Health, Centre for Health Equity, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Population and Global Health, The University of Melbourne, Parkville, VIC, 2010, Australia
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Obstetric violence: Comparing medical student perceptions in India and the UK. Eur J Obstet Gynecol Reprod Biol 2021; 261:98-102. [PMID: 33932685 DOI: 10.1016/j.ejogrb.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/11/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE(S) Obstetric Violence refers to professional deficiencies in maternity care, which can occur in both low and high resource settings. Examples include non-dignified care, lack of respect when giving care, discrimination and abandonment of care. The objective of this study was to assess knowledge and attitudes towards obstetric violence in a cohort of medical students in India and the UK. STUDY DESIGN An online survey was sent to 240 UK and 280 Indian medical students. This incorporated a video showing a dramatized scenario of obstetric violence. The survey assessed participant's demographics and prior knowledge of obstetric violence. Participants scored their perceptions of eight behaviours in the video on visual analogue scales. Participants were asked to reflect on their own practice and score this. Comparisons of survey responses between UK and Indian participants were made using chi squared/Student's t-test. RESULTS 62 Indian medical students and 58 UK medical students completed the survey. Indian medical students were significantly more likely to be male (p < 0.001). 26 % of UK participants had previously heard the term obstetric violence, compared to 34 % of Indian participants (p = 0.15). Both were able to correctly define obstetric violence at similar rates (32 % versus 34 %). Indian medical students were significantly less critical (p < 0.001) of all eight scored behaviours in the video of obstetric violence compared to their UK counterparts. UK medical students were significantly less likely to agree that the video had changed their perception on how teams should behave and act in this context (p < 0.001). 90 % of UK participants and 38 % of Indian participants had received training in professional behaviours. 14 % of UK participants had seen examples of obstetric violence in clinical practice compared to 49 % of Indian participants. CONCLUSIONS UK and Indian medical students were able to identify behaviours associated with obstetric violence, although the majority were previously unaware of the term. Indian medical students in this study were less critical of obstetric violence in the video, which may be because of cultural reasons, greater numbers of male students, greater exposure to obstetric violence or less training on professional behaviours. Standardised training to prevent obstetric violence should be part of undergraduate medical training internationally.
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Gurung R, Ruysen H, Sunny AK, Day LT, Penn-Kekana L, Målqvist M, Ghimire B, Singh D, Basnet O, Sharma S, Shaver T, Moran AC, Lawn JE, Kc A. Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal. BMC Pregnancy Childbirth 2021; 21:228. [PMID: 33765971 PMCID: PMC7995692 DOI: 10.1186/s12884-020-03516-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns. METHODS At one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017-July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health - ethnicity, age, sex, mode of birth - as possible predictors for reporting poor care. RESULTS Among 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (β = 0.23, p-value < 0.0001). Women from Madeshi (a disadvantaged ethnic group) were more likely to report poor care (β = - 0.34; p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (β = - 0.42; p-value < 0.0001) than women with a vaginal birth. However, babies born by caesarean had a 98% decrease in the odds (aOR = 0.02, 95% CI, 0.01-0.05) of receiving skin-to-skin contact than those with vaginal births. CONCLUSIONS Measurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women's age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.
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Affiliation(s)
- Rejina Gurung
- Research Division, Golden Community, Lalitpur, Nepal
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | | | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Loveday Penn-Kekana
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Mats Målqvist
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden
| | | | - Dela Singh
- Ministry of Health and Population, Kathmandu, Nepal
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | | | | | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden.
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Disrespect and Abuse during Childbirth in Ethiopia: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8186070. [PMID: 33150181 PMCID: PMC7603554 DOI: 10.1155/2020/8186070] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 10/03/2020] [Indexed: 11/22/2022]
Abstract
Background Disrespect and abuse are recognized for the restricting impact of women from seeking maternal care, psychological humiliations, grievances, and unspoken sufferings on women during childbirth. Individual primary studies are limited in explaining of extent of disrespect and abusive care. Hence, this review considers the synthesis of comprehensive evidence on the extent, contributing factors, and consequences of disrespectful and abusive intrapartum care from the women's and providers' perspectives in Ethiopia. Methods Articles had been systematically searched from the databases of PubMed, Cochrane Library, POPLINE, Google Scholar, HINARI, African Journals Online, and WHO Global Health Library. A qualitative and quantitative synthesis was performed using the Bowser and Hill landscape analytical framework. Result Twenty-two studies comprised of the 16 quantitative; 5 qualitative and one mixed studies were included. The most repeatedly dishonored right during facility-based childbirth in Ethiopia was nondignified care, and the least commonly reported abuse was detention in health facilities. These behaviors were contributed by normalization of care, lack of empowerment and education of women, weak health system, and lack of training of providers. Women subjected to disrespectful and abusive behavior distanced themselves from the use of facility-based childbirth-related services and have endured psychological humiliations. Conclusion Disrespectful and abusive care of women during childbirth is repeatedly practiced care in Ethiopia. This result specifically described the contributing factors and their effects as a barrier to the utilization of facility-based childbirth. Therefore, to overcome this alarming problem, health systems and care providers must be responsive to the specific needs of women during childbirth, and implementing policies for standard care of respectful maternity care must be compulsory. In addition, observational, qualitative, and mixed types of studies are required to provide comprehensive evidences on disrespect and abusive behavior during childbirth in Ethiopia.
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Dagnaw FT, Tiruneh SA, Azanaw MM, Desale AT, Engdaw MT. Determinants of person-centered maternity care at the selected health facilities of Dessie town, Northeastern, Ethiopia: community-based cross-sectional study. BMC Pregnancy Childbirth 2020; 20:524. [PMID: 32912244 PMCID: PMC7488053 DOI: 10.1186/s12884-020-03221-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/28/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Person-centered maternity care is providing care that is respectful and responsive to individual women's preferences, needs, and values and ensuring that their values guide all clinical decisions during childbirth. Although person-centered health care is one of the factors that increase client satisfaction and increased health service utilization in Ethiopia, little is known about predictors of person-centered maternity care. Therefore, the aim of this study was to identify the determinant factors of person-centered maternity care among mothers who gave birth in selected health facilities in Dessie town, Northeastern, Ethiopia. METHODS A community-based cross-sectional study was conducted with a total of 317 study participants at Dessie town selected by a simple random sampling technique. The data was coded and entered Epi-data version 4.4 and analyzed using SPSS version 23. Descriptive statistics was presented using tables and figures. Multivariable linear regression analysis was used to identify factors associated with Person-Centered Maternity Care. Two sides P-value < 0.05 was taken to declare statistically significant. RESULTS Overall, 310 study participants participated with a response rate of 97.8%. In multivariable linear regression, rural residence (β = -4.12; 95% CI: -7.60, -0.67), family average monthly income ≤ 3000 birr (β = -6.20, 95% CI: -9.40, -3.04), night time delivery(β = -2.98, 95%CI: -5.90, -0.06), dead fetus outcome during delivery (β = -12.7; 95% CI: -21.80, -3.50), and 2-7 days health facility length of stay (β = -5.07, 95% CI: -9.20, -0.92) were significantly decreased Person Center Maternity Care score, whereas private health institution delivery (β = 14.13, 95% CI: 7.70, 20.60) is significantly increased Person centered maternity care score. CONCLUSIONS This study revealed that most of the factors that affect person-centered maternity care are modifiable factors. Therefore, Primary attention should be given to improve the quality of care through effective communication between clients and providers at each level of the health care delivery system to increase the uptake of high-quality facility-based births.
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Affiliation(s)
- Fentaw Teshome Dagnaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkalem Mamuye Azanaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aragaw Tesfaw Desale
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melaku Tadege Engdaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Kassa ZY, Tsegaye B, Abeje A. Disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa: a systematic review and meta-analysis. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:23. [PMID: 32894127 PMCID: PMC7487593 DOI: 10.1186/s12914-020-00242-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 08/31/2020] [Indexed: 12/30/2022]
Abstract
Background Disrespectful and abusive treatment of women by health care providers during the process of childbirth at health facility is an international problem. There is a lack of data on disrespect and abuse of women during the process of childbirth at health facilities in Sub-Saharan Africa. The purpose of this study was to determine the prevalence of disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa. Methods The PRISMA guideline protocol was followed to write the systematic review and meta-analysis. Published studies were searched from Medline, PubMed, CINAHL, EMBASE, Maternal and infant care, science direct, and PsycINFO. Articles were accessed by three reviewers (ZY, BT and AA) using the following key terms, “attitude of health personnel” AND “delivery obstetrics*/nursing” OR “maternity care” AND “disrespect” OR “abuse” OR “professional misconduct” AND “parturition” AND “prevalence” AND “professional-patient relations” AND “Sub-Saharan Africa”. Additional articles were retrieved by cross referencing of reference. The heterogeneity of studies were weighed using Cochran’s Q test and I2 test statistics. Publication bias was assessed by Egger’s test. Results Thirty three studies met the inclusion and included in this systematic review and meta–analysis of disrespect and abuse of women during the process of childbirth at health facilities. The pooled prevalence of disrespect and abuse women during the process of childbirth at health facilities in Sub-Saharan Africa was 44.09% (95% CI: 29.94–58.24).Particularly physical abuse was 15.77% (95% CI: 13.38–18.15), non-confidential care was 16.87% (95% CI: 14.49–19.24), abandonment was 16.86% (95% CI: 13.88–19.84) and detention was 4.81% (95% CI: 3.96–5.67). Conclusion In this study disrespect and abuse of women during the process of childbirth at health facilities are high compared with other studies, particularly non-confidential care and abandonment his high compared with other studies. This study points out that the ministry of health, health care providers, maternal health experts shall due attention to women’s right during the process of childbirth at health facilities.
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Affiliation(s)
- Zemenu Yohannes Kassa
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Berhan Tsegaye
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Abebaw Abeje
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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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: 20] [Impact Index Per Article: 5.0] [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: 27] [Impact Index Per Article: 6.8] [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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Bohren MA, Tunçalp Ö, Miller S. Transforming intrapartum care: Respectful maternity care. Best Pract Res Clin Obstet Gynaecol 2020; 67:113-126. [DOI: 10.1016/j.bpobgyn.2020.02.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
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Exploring midwives' understanding of respectful maternal care in Kumasi, Ghana: Qualitative inquiry. PLoS One 2020; 15:e0220538. [PMID: 32644991 PMCID: PMC7347175 DOI: 10.1371/journal.pone.0220538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 06/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background Various aspects of disrespect and abusive maternity care have received scholarly attention because of frequent reports of the phenomenon in most healthcare facilities globally, especially in low- and middle-income countries. Experiences of disrespect and abuse during childbirth may dissuade women from returning for facility-based postpartum services, for antenatal care, and delivery for future pregnancies and births. Midwives’ knowledge of respectful maternity care is critical in designing any interventive measures to address the menace of disrespect and abuse in maternity care. However, the perspectives of skilled providers on respectful maternal care have not been extensively studied. Therefore, the present study sought to explore the views of midwives on respectful maternity care at a teaching hospital in Kumasi, Ghana. Methods We employed an exploratory descriptive qualitative research design using an interpretative approach. Data were generated through individual in-depth interviews of fifteen midwives, which were audio-recorded and transcribed verbatim. Open Code 4.03 was used to manage and analyse the data. Findings The midwives demonstrated some degree of awareness of respectful maternity care that comprised of the following components: non-abusive care, consented care, confidential care, non-violation of childbearing women’s basic human rights, and non-discriminatory care. However, midwives’ support for disrespectful and abusive practices such as hitting, pinching, and implicitly blaming childbearing women for mistreatment suggests that midwives awareness of respectful maternity care is disconnected from its practice. Conclusion In view of these findings, we recommend frequent in-service training for midwives and the institutionalization of regular supervision of intrapartum care services in the healthcare facility.
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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: 30] [Impact Index Per Article: 7.5] [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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Dzomeku VM, Boamah Mensah AB, Nakua EK, Agbadi P, Lori JR, Donkor P. "I wouldn't have hit you, but you would have killed your baby:" exploring midwives' perspectives on disrespect and abusive Care in Ghana. BMC Pregnancy Childbirth 2020; 20:15. [PMID: 31906875 PMCID: PMC6945392 DOI: 10.1186/s12884-019-2691-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Quality maternal health reduces maternal and neonatal mortality and morbidity. Healthcare professionals, including midwives, are significant agents for the promotion of quality maternal health. Frequents reports of disrespect and abuse of childbearing women by midwives during intrapartum care are becoming common, suggesting that many of these agents are engaging in care practices that compromise quality maternal health. Thus, understanding midwives' descriptions and experiences of the phenomenon is critical to addressing the threat. This paper, therefore, explored the understanding of midwives on D&AC and their occurrence in professional practice in a tertiary health facility in Kumasi, Ghana. METHODS An exploratory descriptive qualitative research design using an interpretative approach was employed in the study. Data were generated through individual in-depth interviews. Data saturation was reached with fifteen interviews. The interviews were audio-recorded and transcribed verbatim. Open Code 4.03 was used to manage and analyse the data. RESULTS The midwives understood D&AC. They also confirmed meting out or witnessing colleagues engage in D&AC in their professional practice. The midwives described D&AC as the provision of inadequate care and the overlooking of patient-centred care, and verbal, physical, and psychological abuse. The themes revealed that socio-economic inequalities, provider perception and victim-blaming, and health system-related factors facilitate D&AC. It emerged that the following marginalized groups were at high risk for D&AC: the non-compliant, mentally ill, HIV/AIDs+, teenagers, poor, and childbearing women on admission at the general labour ward. CONCLUSION The midwives understood D&AC and revealed that it frequently occurred in their professional practice. Frequent in-service training on respectful maternity care and monitoring of care provision in healthcare facilities are needed to eliminate the incidence of D&AC.
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Affiliation(s)
- Veronica Millicent Dzomeku
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Adwoa Bemah Boamah Mensah
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Kweku Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pascal Agbadi
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jody R Lori
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter Donkor
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Umar N, Wickremasinghe D, Hill Z, Usman UA, Marchant T. Understanding mistreatment during institutional delivery in Northeast Nigeria: a mixed-method study. Reprod Health 2019; 16:174. [PMID: 31791374 PMCID: PMC6889445 DOI: 10.1186/s12978-019-0837-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 11/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving quality of care including the clinical aspects and the experience of care has been advocated for improved coverage and better childbirth outcomes. OBJECTIVE This study aimed to explore the quality of care relating to the prevalence and manifestations of mistreatment during institutional birth in Gombe State, northeast Nigeria, an area of low institutional delivery coverage. METHODS The frequency of dimensions of mistreatment experienced by women delivering in 10 health facilities of Gombe State were quantitatively captured during exit interviews with 342 women in July-August 2017. Manifestations of mistreatment were qualitatively explored through in-depth interviews and focus groups with 63 women living in communities with high and low coverage of institutional deliveries. RESULTS The quantitative data showed that at least one dimension of mistreatment was reported by 66% (95% confidence interval (CI) 45-82%) of women exiting a health facility after delivery. Mistreatment related to health system conditions and constraints were reported in 50% (95% CI 31-70%) of deliveries. In the qualitative data women expressed frustration at being urged to deliver at the health facility only to be physically or verbally mistreated, blamed for poor birth outcomes, discriminated against because of their background, left to deliver without assistance or with inadequate support, travelling long distances to the facility only to find staff unavailable, or being charged unjustified amount of money for delivery. CONCLUSIONS Mistreatment during institutional delivery in Gombe State is highly prevalent and predominantly relates to mistreatment arising from both health system constraints as well as health worker behaviours, limiting efforts to increase coverage of institutional delivery. To address mistreatment during institutional births, strategies that emphasise a broader health systems approach, tackle multiple causes, integrate a detailed understanding of the local context and have buy-in from grassroots-level stakeholders are recommended.
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Affiliation(s)
- Nasir Umar
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Deepthi Wickremasinghe
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Zelee Hill
- Institute for Global Health, University College London, London, UK
| | | | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
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Bohren MA, Mehrtash H, Fawole B, Maung TM, Balde MD, Maya E, Thwin SS, Aderoba AK, Vogel JP, Irinyenikan TA, Adeyanju AO, Mon NO, Adu-Bonsaffoh K, Landoulsi S, Guure C, Adanu R, Diallo BA, Gülmezoglu AM, Soumah AM, Sall AO, Tunçalp Ö. How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys. Lancet 2019; 394:1750-1763. [PMID: 31604660 PMCID: PMC6853169 DOI: 10.1016/s0140-6736(19)31992-0] [Citation(s) in RCA: 243] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/08/2019] [Accepted: 08/15/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Women across the world are mistreated during childbirth. We aimed to develop and implement evidence-informed, validated tools to measure mistreatment during childbirth, and report results from a cross-sectional study in four low-income and middle-income countries. METHODS We prospectively recruited women aged at least 15 years in twelve health facilities (three per country) in Ghana, Guinea, Myanmar, and Nigeria between Sept 19, 2016, and Jan 18, 2018. Continuous observations of labour and childbirth were done from admission up to 2 h post partum. Surveys were administered by interviewers in the community to women up to 8 weeks post partum. Labour observations were not done in Myanmar. Data were collected on sociodemographics, obstetric history, and experiences of mistreatment. FINDINGS 2016 labour observations and 2672 surveys were done. 838 (41·6%) of 2016 observed women and 945 (35·4%) of 2672 surveyed women experienced physical or verbal abuse, or stigma or discrimination. Physical and verbal abuse peaked 30 min before birth until 15 min after birth (observation). Many women did not consent for episiotomy (observation: 190 [75·1%] of 253; survey: 295 [56·1%] of 526) or caesarean section (observation: 35 [13·4%] of 261; survey: 52 [10·8%] of 483), despite receiving these procedures. 133 (5·0%) of 2672 women or their babies were detained in the facility because they were unable to pay the bill (survey). Younger age (15-19 years) and lack of education were the primary determinants of mistreatment (survey). For example, younger women with no education (odds ratio [OR] 3·6, 95% CI 1·6-8·0) and younger women with some education (OR 1·6, 1·1-2·3) were more likely to experience verbal abuse, compared with older women (≥30 years), adjusting for marital status and parity. INTERPRETATION More than a third of women experienced mistreatment and were particularly vulnerable around the time of birth. Women who were younger and less educated were most at risk, suggesting inequalities in how women are treated during childbirth. Understanding drivers and structural dimensions of mistreatment, including gender and social inequalities, is essential to ensure that interventions adequately account for the broader context. FUNDING United States Agency for International Development and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO.
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Affiliation(s)
- Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Bukola Fawole
- Department of Obstetrics and Gynaecology, National Institute of Maternal and Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Mamadou Dioulde Balde
- Cellule de Recherche en Sante de la Reproduction en Guinee (CERREGUI), Conakry, Guinea
| | - Ernest Maya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Ghana
| | - Soe Soe Thwin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Adeniyi K Aderoba
- Department of Obstetrics and Gynaecology, Mother and Child Hospital, Oke-Aro, Akure, Ondo State, Nigeria
| | - Joshua P Vogel
- Maternal and Child Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Theresa Azonima Irinyenikan
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, University of Medical Sciences, Ondo, Ondo State, Nigeria; University of Medical Sciences Teaching Hospital, Akure, Ondo State, Nigeria
| | | | - Nwe Oo Mon
- Department of Medical Research, Yangon, Myanmar
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, Unive rsity of Ghana, Accra, Ghana
| | - Sihem Landoulsi
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - Richard Adanu
- School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - Boubacar Alpha Diallo
- Cellule de Recherche en Sante de la Reproduction en Guinee (CERREGUI), Conakry, Guinea
| | - A Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anne-Marie Soumah
- Cellule de Recherche en Sante de la Reproduction en Guinee (CERREGUI), Conakry, Guinea
| | - Alpha Oumar Sall
- Cellule de Recherche en Sante de la Reproduction en Guinee (CERREGUI), Conakry, Guinea
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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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: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/06/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Obstetric violence is an often overlooked obstacle to quality maternal health care service utilization. In the study setting, there was limited evidence on obstetric violence. Hence, this study aimed at assessing the prevalence and associated factors of obstetric violence among women who gave birth in Gondar University Specialized Comprehensive Hospital, Northwest Ethiopia. Results A total of 409 women had been participated in the study with a response rate of 100%. Three in four (75.1%) women reported that they had been subjected to at least one form of obstetric violence during labor and delivery with 95% CI (70.9–79.0). The reported forms of obstetric violence include non-consented care—260 (63.6%), non-dignified care—226 (55.3%), physical abuse—192 (46.9%), non-confidential care—132 (32.3%, neglected care—52 (12.7%) and discriminated care—38 (9.3%). On the contrary, none of the respondent had reported detention for failure to pay in the hospital. The multivariable logistic regression analysis demonstrated that urban residents (AOR = 1.89; 95% CI 1.11, 3.22) and primary school attendants (AOR = 0.49; 95% CI 0.27, 0.91) were significantly associated with experiencing obstetric violence. This study indicated the high prevalence of obstetric violence. Thus, interventions need to be undertaken by taking the reported forms of obstetric violence and participants’ sociodemographic status in to account.
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Affiliation(s)
- Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Po. Box 196, Gondar, Ethiopia.
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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: 15] [Impact Index Per Article: 3.0] [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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Macarayan EK, Ratcliffe HL, Otupiri E, Hirschhorn LR, Miller K, Lipsitz SR, Gawande AA, Bitton A. Facility management associated with improved primary health care outcomes in Ghana. PLoS One 2019; 14:e0218662. [PMID: 31265454 PMCID: PMC6605853 DOI: 10.1371/journal.pone.0218662] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background Strong primary health care (PHC) is essential for achieving universal health coverage, but in many low- and middle-income countries (LMICs) PHC services are of poor quality. Facility management is hypothesized to be critical for improving PHC performance, but evidence about management performance and its associations with PHC in LMICs remains limited. Methods We quantified management performance of PHC facilities in Ghana and assessed the experiences of women who sought care at sampled facilities. Using multi-level models, we examined associations of facility management with five process outcomes and eight experiential outcomes. Findings On a scale of 0 to 1, the average overall management score in Ghana was 0·76 (IQR = 0·68–0·85). Facility management was significantly associated with one process outcome and three experiential outcomes. Controlling for facility characteristics, facilities with management scores at the 90th percentile (management score = 0·90) had 22% more essential drugs compared to facilities with management scores at the 10th percentile (0·60) (p = 0·002). Positive statistically non-significant associations were also seen with three additional process outcomes—integration of family planning services (p = 0·054), family planning types provided (p = 0·067), and essential equipment availability (p = 0·104). Compared to women who sought care at facilities with management scores at the 10th percentile, women who sought care at facilities at the 90th percentile reported 8% higher ratings of trust in providers (p = 0·028), 15% higher ratings of ease of following provider’s advice (p = 0·030), and 16% higher quality rating (p = 0·020). However, women who sought care in the 90th percentile facilities rated their waiting times as worse (22% lower, p = 0·039). Interpretation Higher management scores were associated with higher scores for some process and experiential outcomes. Large variations in management performance indicate the need to strengthen management practices to help realize the full potential of PHC in improving health outcomes.
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Affiliation(s)
- Erlyn K. Macarayan
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Hannah L. Ratcliffe
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Easmon Otupiri
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lisa R. Hirschhorn
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Kate Miller
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Stuart R. Lipsitz
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Atul A. Gawande
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Center for Primary Care, Harvard Medical School, Boston, MA, United States of America
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America
- Division of General Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- * E-mail:
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Tekle Bobo F, Kebebe Kasaye H, Etana B, Woldie M, Feyissa TR. Disrespect and abuse during childbirth in Western Ethiopia: Should women continue to tolerate? PLoS One 2019; 14:e0217126. [PMID: 31173588 PMCID: PMC6555589 DOI: 10.1371/journal.pone.0217126] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/07/2019] [Indexed: 11/24/2022] Open
Abstract
Background Healthcare coverage in Ethiopia has improved dramatically in recent decades. However, facility-based delivery remains persistently low, while maternal mortality remains high. This paper presents the prevalence and associated factors of disrespect and abuse (D&A) during childbirth in public health facilities of western Oromia, Ethiopia. Method A facility-based cross-sectional study was conducted among 612 women from February 2017 to May 2017. Exit interview with the mothers were conducted upon discharge from the maternity ward. We measured D&A during childbirth using seven dimensions. Multivariable logistic regression model was used to assess the association between experience of D&A and client characteristics and institutional factors. Result Three quarters (74.8%) of women reported experiencing at least one form of D&A during their facility childbirth. The types of D&A experienced by the women were; physical abuse (37.1%), non-dignified care (34.6%), non-consented care (54.1%), non-confidential care (40.4%), neglect (25.2%), detention (2.9%), and discrimination (13.2%). Experiences of D&A were 1.6 times more likely to be reported by women delivering at hospitals than health centers (OR: 1.64, 95% CI: 1.01, 2.66). Women without a companion throughout their delivery were almost 10 times more likely than women who had a companion to encounter D&A (OR: 9.94, 95% CI: 5.72, 17.28). On the other hand, women with more than 1,368-birr (USD 57) monthly income were less likely to experience any type of D&A (OR: 0.36, 95% CI: .21, .65). Conclusion Three in four women reported experiencing at least one form of D&A during labor and delivery. This demonstrates a real disconnect between what the health system intends to achieve and what is practiced and calls for fundamental solutions in terms of both improving quality of facility-based delivery and ensuring women’s right to receive health care with dignity.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Wollega University; Nekemte, Oromia, Ethiopia
- * E-mail:
| | | | - Belachew Etana
- Department of Public Health, Wollega University; Nekemte, Oromia, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University; Jimma, Oromia, Ethiopia
- Fenot Project, Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Addis Ababa, Ethiopia
| | - Tesfaye Regassa Feyissa
- Department of Public Health, Wollega University; Nekemte, Oromia, Ethiopia
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
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Siraj A, Teka W, Hebo H. Prevalence of disrespect and abuse during facility based child birth and associated factors, Jimma University Medical Center, Southwest Ethiopia. BMC Pregnancy Childbirth 2019; 19:185. [PMID: 31132988 PMCID: PMC6537397 DOI: 10.1186/s12884-019-2332-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In countries where the proportion of births attended by skilled providers is low, maternal mortality is high. According to the 2016 EDHS report, the proportion of births attended by skilled providers was only 26% and the maternal mortality ratio was 412 per 100,000 live-births. Disrespectful and abusive behavior of health workers and other facility staff experienced by women during facility-based childbirth is important, but the little-understood barrier of institutional delivery. OBJECTIVE This study assessed the prevalence of disrespect and abuse experienced by mothers during facility-based childbirth and associated factors. METHODS A facility based cross-sectional study was undertaken from October to December 2016. Data were collected by face-to-face interview using a structured questionnaire from 290 mothers consecutively included in the study immediately prior to discharge from the hospital. Reports of disrespect and abuse during childbirth were measured using 23 performance indicators. Data were entered into EpiData and analyzed by SPSS; bivariate and multivariable binary logistic regression analyses were performed to identify factors associated with disrespect and abuse. RESULT Three-fourths (217,[74.8%]) of participants were Muslim. Nearly half (142,[49%]) had a primary level of education. Most (232,[80%]) were housewives and 175(60.3%) were from outside Jimma town. The prevalence of disrespect and abuse during childbirth was 91.7% (266/290; 95%CI:0.879,0.946). The most common types of disrespect and abuse reported were culturally inappropriate care (218,[75.2%]), failure to encourage the client to ask questions (220,[75.9%]), the provider not introducing him/herself (232,[80.0%]), failure to obtain consent/permission prior to any procedure (185,[63.8%]) and not using curtains/visual barriers to protect client (237,[81.7%]). Being non-married [95%CI:(0.009,0.222), ≥para-II [95%CI:(0.093,0.862)] and being attended by female care provider [95%CI:(0.026,0.224)] were associated with the reduced chance of reporting disrespect and abuse. However, achieving ≥secondary education [95%CI:(1.028,10.272)] was associated with a higher chance of reporting disrespect and abuse. CONCLUSION The very high prevalence of abuse or disrespect during facility-based delivery shows a health system in crisis. A key implication of this finding is that efforts to increase facility-based delivery must address disrespect and abuse to ensure higher utilization by women. Making facility-based deliveries attended by female providers may reduce the problem.
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Affiliation(s)
| | - Woubishet Teka
- Department of Gynecology & Obstetrics, Medical Science Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Habtemu Hebo
- Department of Epidemiology, Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia.
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Abstract
The world is becoming increasingly urban. For the first time in history, more than 50% of human beings live in cities (United Nations, Department of Economic and Social Affairs, Population Division, ed. (2015)). Rapid urbanization is often chaotic and unstructured, leading to the formation of informal settlements or slums. Informal settlements are frequently located in environmentally hazardous areas and typically lack adequate sanitation and clean water, leading to poor health outcomes for residents. In these difficult circumstances women and children fair the worst, and reproductive outcomes for women living in informal settlements are grim. Insufficient uptake of antenatal care, lack of skilled birth attendants and poor-quality care contribute to maternal mortality rates in informal settlements that far outpace wealthier urban neighborhoods (Chant and McIlwaine (2016)). In response, a birth center model of maternity care is proposed for informal settlements. Birth centers have been shown to provide high quality, respectful, culturally appropriate care in high resource settings (Stapleton et al. J Midwifery Women's Health 58(1):3-14, 2013; Hodnett et al. Cochrane Database Syst Rev CD000012, 2012; Brocklehurst et al. BMJ 343:d7400, 2011). In this paper, three case studies are described that support the use of this model in low resource, urban settings.
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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: 29] [Impact Index Per Article: 5.8] [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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Gray T, Mohan S, Lindow S, Farrell T. Obstetric violence: Clinical staff perceptions from a video of simulated practice. Eur J Obstet Gynecol Reprod Biol X 2019; 1:100007. [PMID: 31396594 PMCID: PMC6683974 DOI: 10.1016/j.eurox.2019.100007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives Obstetric Violence refers to professional deficiencies in maternity care. Examples include non-dignified care, discrimination and abandonment of care. Obstetric violence has been described in both low and high resource settings. The objective of this study was to assess knowledge and attitudes towards obstetric violence in a cohort of multinational obstetric nursing/midwifery staff and obstetricians at a private maternity hospital in Qatar. Study design An online survey for anonymous completion was sent to the hospital email accounts of obstetric nursing/midwifery staff and obstetricians at Sidra Medicine (n = 640). The survey incorporated a video showing a dramatized scenario of obstetric violence. The survey assessed the participant's demographics and knowledge of the term obstetric violence. The participants scored their perceptions on the behaviors in the video using a visual analogue scale. The participants were then asked to reflect on their own practice. Comparisons of the survey responses were made between both doctors and nursing/midiwfery staff members using student's t-test. Results 50 obstetricians and 167 obstetric nursing/midwifery staff fully completed the survey. Fifty two percent had previously heard of the term obstetric violence, and 48% could define it correctly. 136 (63%) had witnessed obstetric violence at some point in their career. Significant differences were seen when each professional group was asked to report on the behavior of the opposite professional team as depicted in the video (p = 0.01 and p < 0.001). Doctors completing the survey were also more critical of the doctors-in-training than were the midwifery/nursing staff (p = 0.06). Obstetricians and nursing/midiwfery responders identified patient dignity, privacy and patient-centred care as the leading professional deficiencies seen in the video. Obstetricians were significantly less likely to change their perceptions of how a care team should interact with a patient compared to the obstetric nursing/midwifery group (p < 0.001). Conclusions This questionnaire study demonstrates that the majority of staff in this cohort were aware of obstetric violence and able to identify negative behaviours in the video and then reflect on how this impacts care they provide. Further studies are needed to identify ways in which obstetric violence can be prevented in both low resource and high resource settings.
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Affiliation(s)
- Thomas Gray
- Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK
| | - Suruchi Mohan
- Sidra Medicine, Sidra Outpatient Building, Al Luqta Street, Education City North Campus, Qatar Foundation, PO BOX 26999, Doha, Qatar
| | - Stephen Lindow
- Sidra Medicine, Sidra Outpatient Building, Al Luqta Street, Education City North Campus, Qatar Foundation, PO BOX 26999, Doha, Qatar
| | - Tom Farrell
- Sidra Medicine, Sidra Outpatient Building, Al Luqta Street, Education City North Campus, Qatar Foundation, PO BOX 26999, Doha, Qatar
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Nawab T, Erum U, Amir A, Khalique N, Ansari MA, Chauhan A. Disrespect and abuse during facility-based childbirth and its sociodemographic determinants - A barrier to healthcare utilization in rural population. J Family Med Prim Care 2019; 8:239-245. [PMID: 30911513 PMCID: PMC6396581 DOI: 10.4103/jfmpc.jfmpc_247_18] [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] [Indexed: 11/04/2022] Open
Abstract
CONTEXT The provider-driven disrespect and abuse (DA) of women during childbirth is a marker for quality of maternal care and violation of basic human rights. AIMS This study was done to assess prevalence and sociodemographic determinants of DA experienced during facility-based childbirth. SETTINGS AND DESIGN This is a cross-sectional, community-based study done in six villages in the district of Aligarh, north India. SUBJECTS AND METHODS In all, 305 women who underwent facility-based childbirth were interviewed by pretested and structured questionnaire at home between 4 and 6 weeks postpartum period. STATISTICAL ANALYSIS USED Descriptive statistics, Chi-square test, and bivariate regression analysis using SPSS 20.0 were used. RESULTS A total of 257 (84.3%) of 305 women reported any form of DA. Nonconsented services (71.1%) and nonconfidential care (62.3%) were the most common types. Abandonment/neglect during childbirth was reported by 10.2% women, nondignified care by 9.2%, physical abuse by 5.9%, detention in the health facility by 3.3%, and discrimination by 3.9%. Women who had undergone vaginal birth [odds ratio (OR) 3.36; confidence interval (CI) 1.7-6.5], at public health facility (OR 2.65; CI 1.4-5.0), given care by providers other than doctors (OR 2.89; CI 1.5-5.5), who belonged to low socioeconomic status (OR 3.68; CI 1.4-9.7), and who did not decide place of delivery themselves (OR 4.49; CI 2.0-12.1) were more at risk of DA. Out of all females unwilling to attend facility in future, 93.8% reported experiencing DA. The association between any DA and decision to attend the facility in future was statistically significant. CONCLUSION More than 8 of 10 women experienced any DA during facility-based childbirth. It can be a barrier to utilization of facility for childbirth. Preventing DA is important to improve quality of maternal care and institutional deliveries.
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Affiliation(s)
- Tabassum Nawab
- Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Uzma Erum
- Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Ali Amir
- Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Najam Khalique
- Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammed A. Ansari
- Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Ambreen Chauhan
- Department of Community Medicine, Rama Medical College Hospital and Research Centre, Hapur, Uttar Pradesh, India
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Bohren MA, Vogel JP, Fawole B, Maya ET, Maung TM, Baldé MD, Oyeniran AA, Ogunlade M, Adu-Bonsaffoh K, Mon NO, Diallo BA, Bangoura A, Adanu R, Landoulsi S, Gülmezoglu AM, Tunçalp Ö. Methodological development of tools to measure how women are treated during facility-based childbirth in four countries: labor observation and community survey. BMC Med Res Methodol 2018; 18:132. [PMID: 30442102 PMCID: PMC6238369 DOI: 10.1186/s12874-018-0603-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/01/2018] [Indexed: 01/10/2023] Open
Abstract
Background Efforts to improve maternal health are increasingly focused on improving the quality of care provided to women at health facilities, including the promotion of respectful care and eliminating mistreatment of women during childbirth. A WHO-led multi-country research project aims to develop and validate two tools (labor observation and community survey) to measure how women are treated during facility-based childbirth. This paper describes the development process for these measurement tools, and how they were implemented in a multi-country study (Ghana, Guinea, Myanmar and Nigeria). Methods An iterative mixed-methods approach was used to develop two measurement tools. Methodological development was conducted in four steps: (1) initial tool development; (2) validity testing, item adjustment and piloting of paper-based tools; (3) conversion to digital, tablet-based tools; and (4) data collection and analysis. These steps included systematic reviews, primary qualitative research, mapping of existing tools, item consolidation, peer review by key stakeholders and piloting. Results The development, structure, administration format, and implementation of the labor observation and community survey tools are described. For the labor observations, a total of 2016 women participated: 408 in Nigeria, 682 in Guinea, and 926 in Ghana. For the community survey, a total of 2672 women participated: 561 in Nigeria, 644 in Guinea, 836 in Ghana, and 631 in Myanmar. Of the 2016 women who participated in the labor observations, 1536 women (76.2%) also participated in the community survey and have linked data: 779 in Ghana, 425 in Guinea, and 332 in Nigeria. Conclusions An important step to improve the quality of maternity care is to understand the magnitude and burden of mistreatment across contexts. Researchers and healthcare providers in maternal health are encouraged to use and implement these tools, to inform the development of more women-centered, respectful maternity healthcare services. By measuring the prevalence of mistreatment of women during childbirth, we will be able to design and implement programs and policies to transform maternity services. Electronic supplementary material The online version of this article (10.1186/s12874-018-0603-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Meghan A Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, 1211, Geneva, Switzerland. .,Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, 3053, Australia.
| | - Joshua P Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, 1211, Geneva, Switzerland
| | - Bukola Fawole
- Department of Obstetrics and Gynecology, National Institute of Maternal and Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ernest T Maya
- School of Public Health, University of Ghana, Accra, Ghana
| | | | - Mamadou Diouldé Baldé
- Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea.,Faculté de Médecine, Pharmacie et Odontostomatologie, Université G.A. Nasser de Conakry, Conakry, Guinea
| | - Agnes A Oyeniran
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Modupe Ogunlade
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Nwe Oo Mon
- Department of Medical Research, Yangon, Myanmar
| | - Boubacar Alpha Diallo
- Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea.,Faculté de Médecine, Pharmacie et Odontostomatologie, Université G.A. Nasser de Conakry, Conakry, Guinea
| | - Abou Bangoura
- Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea.,Département de sociologie, Université Sonfonia, Conakry, Guinea
| | - Richard Adanu
- School of Public Health, University of Ghana, Accra, Ghana
| | - Sihem Landoulsi
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, 1211, Geneva, Switzerland
| | - A Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, 1211, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, 1211, Geneva, Switzerland
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