1
|
AlKhunaizi AN, Al-Otaibi AG, Alharbi MF, Bahari G. Exploring Healthcare Providers' and Women's Perspectives of Labor Companionship during Childbirth: An Interpretative Phenomenological Analysis Study. Healthcare (Basel) 2024; 12:869. [PMID: 38727426 PMCID: PMC11083292 DOI: 10.3390/healthcare12090869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
A labor companion of choice during childbirth is crucial for improving women's birth experience and confidence to give birth. Labor companions provide various benefits, including enhanced communication, emotional support, non-pharmacological pain relief, and better healthcare. However, little is known about the supportive actions of labor companions with respect to women's needs during labor and birth, as well as healthcare providers' perceptions of labor companions. Therefore, this study was conducted to explore the perceptions of healthcare providers and women regarding labor companions. The study utilized an interpretative phenomenology research design. Data collection involved conducting semi-structured interviews with 14 participants. The sample consisted of mothers, physicians, and nurses, ensuring a diverse range of perspectives. An interpretative phenomenological analysis was conducted for data analysis. Five themes were identified: (a) impact of companionship, (b) benefits for healthcare providers, (c) companion roles, (d) loneliness and alienation of mothers, and (e) challenges of implementation. The findings indicated that the presence of a companion reduces the need for unnecessary medical interventions and eases the workload of healthcare providers. Without a companion, mothers often feel lonely and disconnected during the birthing process. The presence of companions is often hindered by space limitations in delivery rooms, the absence of clear policies, and lack of childbirth education programs for companions. Clear policies, education programs, and adequate space are essential for implementing and promoting labor companionship during childbirth.
Collapse
Affiliation(s)
- Anwar Nader AlKhunaizi
- Maternal and Child Health Nursing Department, College of Nursing, King Saud University, Riyadh 11421, Saudi Arabia; (A.N.A.); (M.F.A.)
| | - Areej Ghalib Al-Otaibi
- Fundamental of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Manal F. Alharbi
- Maternal and Child Health Nursing Department, College of Nursing, King Saud University, Riyadh 11421, Saudi Arabia; (A.N.A.); (M.F.A.)
| | - Ghareeb Bahari
- Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh 11421, Saudi Arabia
| |
Collapse
|
2
|
Mwakawanga DL, Chen S, Mwilike B, Lyimo AA, Hirose N, Shimpuku Y. Association between decision-making during pregnancy and woman-centred care among Tanzanian pregnant women: A cross-sectional survey. Women Birth 2024; 37:101615. [PMID: 38615514 DOI: 10.1016/j.wombi.2024.101615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Many women in Tanzania lack autonomy in decision-making for their pregnancy and childbirth. Woman-centred care (WCC) seeks to provide each woman with the appropriate information that promotes participation and highlights their informed decision-making. Thus, decision-making has been proposed as an essential determinant of WCC. This study aimed to assess the association between decision-making and WCC among Tanzanian pregnant women. METHODS We conducted a cross-sectional study among 710 pregnant women in Tanzania. The 23-item Woman-Centred Care English version questionnaire was used to assess how women perceived the care provided by midwives. Participants were categorized into two decision-making groups: decision-making for the birthing place by pregnant women themselves and by others. The pre-defined cut-off point of the top 20 percentile was used to indicate a high level of WCC. Binary logistic regression models were used to determine the association between decision-making and WCC. RESULTS The median score (interquartile range) of WCC was 97 (92-103) points when decisions were made by pregnant women, compared to 92 (88-96) points when decisions were made by others (p<0.001). There was a significant association between decision-maker and WCC in both unadjusted (p<0.001) and multivariable-adjusted (p=0.006) analyses. The unadjusted odds were approximately 5 times higher in the pregnant women decision-making group (OR: 4.80, 95% CI: 2.74-8.43) and 3 times higher (OR:2.90, 95% CI: 1.36-6.07) after the adjustment for covariates. We observed no significant interaction between decision-making and parity on the level of WCC (p for interaction=0.52). CONCLUSION Pregnant women who made decisions for the birthing place had a higher likelihood of having a high level of WCC compared with their counterparts. Our findings suggest that women should be empowered to be involved in decision-making to increase their satisfaction with the care provided by healthcare providers and foster a positive childbirth experience.
Collapse
Affiliation(s)
- Dorkasi L Mwakawanga
- Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami Ward, Hiroshima 734-8553, Japan; Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, P. O Box 65001, Dar es Salaam, Tanzania
| | - Sanmei Chen
- Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami Ward, Hiroshima 734-8553, Japan
| | - Beatrice Mwilike
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, P. O Box 65001, Dar es Salaam, Tanzania
| | - Ally Abdul Lyimo
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, P. O Box 65001, Dar es Salaam, Tanzania
| | - Naoki Hirose
- Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami Ward, Hiroshima 734-8553, Japan
| | - Yoko Shimpuku
- Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami Ward, Hiroshima 734-8553, Japan.
| |
Collapse
|
3
|
Lanyo TN, Zielinski R, Kukula VA, Apetorgbor VEA, Ghosh B, Lockhart NA, Lori JR. Improving respectful maternity care through group antenatal care: findings from a cluster randomized controlled trial. RESEARCH SQUARE 2023:rs.3.rs-3682833. [PMID: 38196651 PMCID: PMC10775374 DOI: 10.21203/rs.3.rs-3682833/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background Disrespect and patient mistreatment are identified as barriers to care-seeking and low uptake of facility-based deliveries. These mitigating factors have led to slow progress in the achievement of maternal and child health targets, especially in Ghana. Group antenatal care, as an alternative to individual antenatal was implemented to explore the impact on outcomes, including mothers' perception of respectful care. Methods A cluster randomized controlled trial was conducted in 14 health facilities across four districts in the Easter Region of Ghana. These facilities were randomized to intervention or control using a matched pair. Data was collected at several timepoints: enrollment (Time 0), 34 weeks gestation to 3 weeks post-delivery (Time 1), 6 to 12 weeks post-delivery (Time 2), 5 to 8 months post-delivery (Time 3), and 11 to 14 months post-delivery (Time 4). Questions related to respectful care were asked at Time 2, while a focus group discussion (FGDs) was conducted as part of a process evaluation to examine participants' experiences about respectful maternity care. Results The findings from the intervention group indicate that participants perceived higher levels of respect in comparison to the control group. Privacy and con dentiality were maintained. They believed they had been provided with adequate information, education, and counseling, empowering them to make informed decisions. Participants perceived a shortened waiting time and reduced discrimination in care provision. Generally, there were higher levels of satisfaction with antenatal care. Conclusion The provision of respectful maternity care, which is essential to increasing healthcare utilization, has been demonstrated to correlate positively with group antenatal care.
Collapse
|
4
|
Manu A, Pingray V, Billah SM, Williams J, Kilima S, Yeji F, Gohar F, Wobil P, Karim F, Muganyizi P, Mogela D, El Arifeen S, Vandenent M, Matin Z, Janda I, Zaka N, Hailegebriel TD. Implementing maternal and newborn health quality of care standards in healthcare facilities to improve the adoption of respectful maternity care in Bangladesh, Ghana and Tanzania: a controlled before and after study. BMJ Glob Health 2023; 8:e012673. [PMID: 37963610 PMCID: PMC10649771 DOI: 10.1136/bmjgh-2023-012673] [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: 04/25/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Many women worldwide cannot access respectful maternity care (RMC). We assessed the effect of implementing maternal and newborn health (MNH) quality of care standards on RMC measures. METHODS We used a facility-based controlled before and after design in 43 healthcare facilities in Bangladesh, Ghana and Tanzania. Interviews with women and health workers and observations of labour and childbirth were used for data collection. We estimated difference-in-differences to compare changes in RMC measures over time between groups. RESULTS 1827 women and 818 health workers were interviewed, and 1512 observations were performed. In Bangladesh, MNH quality of care standards reduced physical abuse (DiD -5.2;-9.0 to -1.4). The standards increased RMC training (DiD 59.0; 33.4 to 84.6) and the availability of policies and procedures for both addressing patient concerns (DiD 46.0; 4.7 to 87.4) and identifying/reporting abuse (DiD 45.9; 19.9 to 71.8). The control facilities showed greater improvements in communicating the delivery plan (DiD -33.8; -62.9 to -4.6). Other measures improved in both groups, except for satisfaction with hygiene. In Ghana, the intervention improved women's experiences. Providers allowed women to ask questions and express concerns (DiD 37.5; 5.9 to 69.0), considered concerns (DiD 14.9; 4.9 to 24.9), reduced verbal abuse (DiD -8.0; -12.1 to -3.8) and physical abuse (DiD -5.2; -11.4 to -0.9). More women reported they would choose the facility for another delivery (DiD 17.5; 5.5 to 29.4). In Tanzania, women in the intervention facilities reported improvements in privacy (DiD 24.2; 0.2 to 48.3). No other significant differences were observed due to improvements in both groups. CONCLUSION Institutionalising care standards and creating an enabling environment for quality MNH care is feasible in low and middle-income countries and may facilitate the adoption of RMC.
Collapse
Affiliation(s)
- Alexander Manu
- Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Veronica Pingray
- Maternal, Newborn and Adolescents Health, UNICEF HQ consultant, New York, New York, USA
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Sk Masum Billah
- Maternal and Child Health Division, ICDDRB, Dhaka, Bangladesh
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John Williams
- Department of Clinical Sciences, Dodowa Health Research Centre, Ghana Health Service, Accra, Ghana
| | - Stella Kilima
- Research Publication and Documentation Section, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Francis Yeji
- Planning, Policy, Monitoring, and Evaluation Division (PPMED), Ghana Health Service, HQ, Accra, Ghana
| | - Fatima Gohar
- Health Section, UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | | | - Farhana Karim
- Maternal and Child Health Division, ICDDRB, Dhaka, Bangladesh
| | - Projestine Muganyizi
- Department of Obstetrics & Gynaecology, University of Dar es Salaam Mbeya College of Health and Allied Sciences (UDSM MCHAS), Mbeya, United Republic of Tanzania
| | - Deus Mogela
- National Blood Transfusion Unit, Ministry of Health, Social Development, Gender, Elderly and Children, Dar es Salaam, United Republic of Tanzania
| | | | | | - Ziaul Matin
- Health, UNICEF Bangladesh, Dhaka, Bangladesh
| | - Indeep Janda
- Maternal, Newborn and Adolescents Health, UNICEF, New York, New York, USA
| | - Nabila Zaka
- Health, UNICEF Pakistan, Islamabad, Pakistan
| | | |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Amathullah AS, Rishard M, Walpita Y. Impacts of disrespectful care and abusive care practices in maternity units and potential interventions to improve the quality of care in low- and middle-income countries: A narrative review. Int J Gynaecol Obstet 2023; 162:847-859. [PMID: 37118934 DOI: 10.1002/ijgo.14811] [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: 01/17/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
This review article explored the impacts of disrespectful care and abusive care practices and the potential interventions to eliminate those practices. Respectful maternity care is a fundamental right for all women. It ensures that women are able to exercise their rights in maternity care. However, research studies have shown the recent prevalence of poor-quality care for women in maternity units in low- and middle-income countries. The literature on this topic was searched on PubMed, Medline, Google Scholar, Cochrane, Science Direct/ Elsevier, and SCOPUS. A total of 24 qualitative and quantitative research articles were included. Thematic analysis was conducted by using the six steps. Impacts are coded on topics including psychological impacts due to disrespectful and abusive care practices, impact on the care process, normalization of the absence of care, suppression of knowledge regarding the labor process, and poor obstetric outcomes. Interventions are coded on topics including programs for health professionals to improve care, education and empowerment programs targeting the women and community, enacting policies and guidelines regarding disrespectful and abusive care practices and improving the facilities in the healthcare system. The majority of the evidenced-based interventions were multi-component and tailored to the needs of a particular setting. More research evidence is needed to inform the healthcare authorities and policymakers to transform these potential interventions into practice. Future research should clearly document the effectiveness of various combinations of interventions, feasibility, cost-effectiveness, and outcomes.
Collapse
Affiliation(s)
| | - Mohamed Rishard
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Yasaswi Walpita
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| |
Collapse
|
7
|
Pokharel A, Kiriya J, Shibanuma A, Silwal RC, Jimba M. Association of workload and practice of respectful maternity care among the healthcare providers, before and during the early phase of COVID-19 pandemic in South Western Nepal: a cross-sectional study. BMC Health Serv Res 2023; 23:538. [PMID: 37226236 DOI: 10.1186/s12913-023-09561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Respectful maternity care is an approach that involves respecting women's belief, choices, emotions, and dignity during the childbirth process. As the workload among maternity care workforce affects intrapartum quality care, respectful maternity care might have also been affected, particularly during the pandemic. Thus, this study was conducted to examine the association between workload among healthcare providers and their practice of respectful maternity care, before and during the early phase of pandemic. METHODS A cross-sectional study was conducted in South Western Nepal. A total of 267 healthcare providers from 78 birthing centers were included. Data collection was done through telephone interviews. The exposure variable was workload among the healthcare providers, and the outcome variable was respectful maternity care practice before and during the COVID-19 pandemic. Multilevel mixed-effect linear regression was used to examine the association. RESULTS The median client-provider ratio before and during the pandemic was 21.7 and 13.0, respectively. The mean score of respectful maternity care practice was 44.5 (SD 3.8) before the pandemic, which was decreased to 43.6 (SD 4.5) during the pandemic. Client-provider ratio was negatively associated with respectful maternity care practice for both times; before (Coef. -5.16; 95% CI -8.41 to -1.91) and during (Coef. -7.47; 95% CI -12.72 to -2.23) the pandemic. CONCLUSIONS While a higher client-provider was associated with a lower respectful maternity care practice score both before and during the COVID-19 pandemic, the coefficient was larger during the pandemic. Therefore, workload among the healthcare providers should be considered before the implementation of respectful maternity care, and more attention should be given during the pandemic.
Collapse
Affiliation(s)
| | - Junko Kiriya
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ram Chandra Silwal
- Green Tara Nepal, Kathmandu, Nepal
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
8
|
Hetherington E, Harper S, Davidson R, Festo C, Lampkin N, Mtenga S, Teixeira C, Vincent I, Nandi A. Impact evaluation of the TAMANI project to improve maternal and child health in Tanzania. J Epidemiol Community Health 2023; 77:410-416. [PMID: 37116960 DOI: 10.1136/jech-2022-219995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND The Tabora Maternal and Newborn Health Initiative project was a multicomponent intervention to improve maternal and newborn health in the Tabora region of Tanzania. Components included training healthcare providers and community health workers, infrastructure upgrades, and improvements to health management. This study aimed to examine the impact of trainings on four key outcomes: skilled birth attendance, antenatal care, respectful maternity care and patient-provider communication. METHODS Trainings were delivered sequentially at four time points between 2018 and 2019 in eight districts (two districts at a time). Cross-sectional surveys were administered to a random sample of households in all districts at baseline and after each training wave. Due to practical necessities, the original stepped wedge cluster randomised design of the evaluation was altered mid-programme. Therefore, a difference-in-differences for multiple groups in multiple periods was adopted to compare outcomes in treated districts to not yet treated districts. Risk differences were estimated for the overall average treatment effect on the treated and group/time dynamic effects. RESULTS Respondents reported 3895 deliveries over the course of the study. The intervention was associated with a 12.9 percentage point increase in skilled birth attendance (95% CI 0.4 to 25.4), which began to increase 4 months after the end of training in each district. There was little evidence of impact on antenatal care visits, respectful treatment during delivery and patient-provider communication. CONCLUSION Interventions to train local healthcare workers in basic and comprehensive emergency obstetric and newborn care increased skilled birth attendance but had limited impact on other pregnancy-related outcomes.
Collapse
Affiliation(s)
- Erin Hetherington
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | | | - Charles Festo
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania, United Republic of
| | | | - Sally Mtenga
- Ifakara Health Institute, Ifakara, Tanzania, United Republic of
| | | | - Ilona Vincent
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Arijit Nandi
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| |
Collapse
|
9
|
Habib HH, Mwaisaka J, Torpey K, Maya ET, Ankomah A. Are respectful maternity care (RMC) interventions effective in reducing intrapartum mistreatment against adolescents? A systematic review. Front Glob Womens Health 2023; 4:1048441. [PMID: 36937041 PMCID: PMC10014999 DOI: 10.3389/fgwh.2023.1048441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/31/2023] [Indexed: 03/05/2023] Open
Abstract
Intrapartum mistreatment of women by health professionals is a widespread global public health challenge. It leads to a decreased quality of maternity care and is evinced to precipitate detrimental maternal and neonatal outcomes, especially among adolescents. Relatedly, research indicates that Respectful Maternity Care (RMC) interventions are especially effective in mitigating intrapartum mistreatment and improving birth outcomes. However, evidence on the success of RMC, specifically for adolescents, is insufficient and unaggregated. Accordingly, this review specifically aims to synthesize existing evidence on RMC care provision to adolescent parturients. This review searched for relevant literature from published and gray sources including PubMed, ScienceDirect, Cochrane, CINAHL, PsycINFO, Scopus, as well as Population Council, WHO and White Ribbon Alliance data sources published between January 1990 and December 2021. Based on eligibility, studies were selected and quality appraised after which thematic analysis and narrative synthesis was conducted. Twenty-nine studies were included in the systematic review. Due to paucity and heterogeneity of quantitative studies, the review was limited to a thematic analysis. Adolescent and health provider perspectives alike underscored the burden and outcomes of mistreatment. Need for RMC interventions to improve quality of maternity care was recommended by majority of studies. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42020183440.
Collapse
|
10
|
Bohren MA, Hazfiarini A, Vazquez Corona M, Colomar M, De Mucio B, Tunçalp Ö, Portela A. From global recommendations to (in)action: A scoping review of the coverage of companion of choice for women during labour and birth. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001476. [PMID: 36963069 PMCID: PMC10021298 DOI: 10.1371/journal.pgph.0001476] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/22/2022] [Indexed: 02/04/2023]
Abstract
Women greatly value and benefit from the presence of someone they trust to support them throughout labour and childbirth ('labour companion of choice'). Labour companionship improves maternal and perinatal outcomes, including enhancing physiological labour and birth experiences. Despite clear benefits, implementation is slow. We conducted a scoping review to assess coverage and models of labour companionship, including quantitative studies reporting coverage of labour companionship in any level health facility globally. We searched MEDLINE, CINAHL, and Global Health from 1 January 2010-14 December 2021. We extracted data on study design, labour companionship coverage, timing and type of companions allowed, and recoded data into categories for comparison across studies. We included data from a maternal health sentinel network of hospitals in Latin America, using descriptive statistics to assess coverage among 120,581 women giving birth in these sites from April 2018-April 2022. In the scoping review, we included 77 studies from 27 countries. There was wide variation in the coverage of labour companionship: almost one-third of studies reported coverage less than 40%, and one-third of studies reported coverage between 40-80%. Husbands or partners were the most frequent companion (37.7%, 29/77), followed by family member or friend (gender not specified) (32.5%, 25/77), family member or friend (female-only) (13.0%, 10/77). Across nine sentinel hospitals in five Latin American countries, there was variation in coverage, with no companion at any time ranging from 14.9%-93.8%. Despite the well-known benefits and factors affecting implementation of labour companionship, more work is needed to improve equitable coverage. Concerted efforts are needed to engage with communities, health workers, health managers, and policy-makers to establish policies, address implementation barriers, and integrate data on coverage into perinatal records and quality processes to ensure that all women have access. Harmonized reporting of labour companionship would greatly enhance understanding at global level.
Collapse
Affiliation(s)
- Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Alya Hazfiarini
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Martha Vazquez Corona
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Mercedes Colomar
- The Latin American Center for Perinatology/Women´s and Reproductive Health Unit, Pan American Health Organization, Montevideo, Uruguay
| | - Bremen De Mucio
- The Latin American Center for Perinatology/Women´s and Reproductive Health Unit, Pan American Health Organization, Montevideo, Uruguay
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| |
Collapse
|
11
|
Moridi M, Pazandeh F, Potrata B. Midwives' knowledge and practice of Respectful Maternity Care: a survey from Iran. BMC Pregnancy Childbirth 2022; 22:752. [PMID: 36199103 PMCID: PMC9535863 DOI: 10.1186/s12884-022-05065-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the past decade, countries worldwide aimed to evaluate the quality of childbirth care and reduce the high rates of disrespect and abuse during childbirth. Few studies have attempted to identify providers' characteristics associated with respectful maternity care quantitatively. This study aims to evaluate midwives' knowledge and practice of respectful maternity care (RMC). METHODS A cross-sectional study was carried out in 15 teaching and non-teaching hospitals in Tehran, Iran. The hospitals were selected by using a cluster sampling design. Midwives' Knowledge and Practice of Respectful Maternity Care scale (MKP-RMC) was administered to 250 midwives working in maternity units at study hospitals. The data were analysed by statistics package for social science (SPSS, version 21.0, Chicago, IL). RESULTS Findings demonstrated that the mean score for knowledge and practice of midwives were 20.96 ± 3.54 and 101.64 ± 11.49, respectively. Also, in both knowledge and practice scales, midwives had the highest score in "providing safe care' domain and the lowest score in "preventing mistreatment" domain. CONCLUSION Our findings showed that for Iranian midwives, providing care to preserve mothers' and their babies' wellbeing is more critical than preventing maternal mistreatment, resulting from the importance of the care provision in the Iranian healthcare system. Promoting midwives' knowledge and practice through developing a tailored educational program to prevent mistreatment and providing emotional support alongside physical care is recommended.
Collapse
Affiliation(s)
- Maryam Moridi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Pazandeh
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | | |
Collapse
|
12
|
Diamond-Smith N, Lin S, Peca E, Walker D. A landscaping review of interventions to promote respectful maternal care in Africa: Opportunities to advance innovation and accountability. Midwifery 2022; 115:103488. [PMID: 36191382 DOI: 10.1016/j.midw.2022.103488] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In the past decade, global recognition of the need to address disrespect and abuse (also described as mistreatment of women) and promote respectful maternal care in facility-based childbirth has increased. While many studies have documented gaps in respectful maternal care, little is known about the design and implementation of these interventions. Our aim was to summarize and describe respectful maternal care -promoting interventions during childbirth implemented in Africa. DESIGN We identified respectful maternal care -promoting interventions in Africa through a rapid scoping of peer-reviewed articles and gray literature, and a crowdsourcing survey distributed through stakeholder networks. SETTING Africa PARTICIPANTS: NA MEASUREMENTS AND FINDINGS: We identified 43 unique interventions implemented in 16 African countries, gathered from a crowdsourcing survey, gray and published literature between 2010 and 2020. Most interventions were implemented in East Africa (N = 13). The interventions had various targets and were categorized into nine approaches, 60% of interventions focused on training providers about respectful maternal care and practice. About two thirds included multiple intervention approaches, and about two thirds addressed respectful maternal care beyond the period of childbirth. Few publications presented data on the effectiveness of the intervention, and those that did used a wide variety of indicators. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE There is a reliance on provider training approaches to promote respectful maternal care and there are few examples of either engaging women in the community or adopting social accountability approaches. We encourage implementors to develop interventions targeting multiple approaches beyond provider training and consider delivery across pre-pregnancy, pregnancy, birth, and the postnatal periods. Finally, in order to effectively move from documenting respectful maternal care gaps to action and scale, we need global consensus on common indicators and measures of effectiveness for interventions promoting respectful care across the life course.
Collapse
Affiliation(s)
- Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Sunny Lin
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America.
| | - Emily Peca
- University Research Co., LLC., Chevy Chase, Maryland, United States of America
| | - Dilys Walker
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States of America
| |
Collapse
|
13
|
Hughes CS, Kamanga M, Jenny A, Zieman B, Warren C, Walker D, Kazembe A. Perceptions and predictors of respectful maternity care in Malawi: A quantitative cross-sectional analysis. Midwifery 2022; 112:103403. [PMID: 35728299 DOI: 10.1016/j.midw.2022.103403] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Access to high-quality, respectful care is a basic human right. A lack of respectful care during childbirth is associated with poor outcomes and can negatively influence care-seeking and maternal mental health. We aimed to describe how women perceive their experience of maternity care in Malawi. METHODS We implemented a cross-sectional survey of women (n = 660) who delivered in 25 birth facilities in four districts in Malawi in March 2020 using a validated 30-item, 90-point person-centered maternity care (PCMC) scale. We used descriptive statistics to examine women's experience of care and analyzed bivariable and multivariable mixed-effects models to evaluate predictors of PCMC. Statistical models accounted for clustering of women at the facility level and included maternal age, marital status, education, parity, mother or infant complications, timing of antenatal care (ANC), provider cadre and gender, facility type and sector, and district. RESULTS Mean PCMC score was 57.5 (range 21-84), with the lowest score (12.4 of 27 points) in communication and autonomy. Women reported: being prohibited from having a birth companion during labor (49.4%) or delivery (60.3%); providers did not introduce themselves (81.1%); providers did not ask consent before procedures/examinations (42.4%); women felt they could not ask questions (40.9%); and were not involved in care decisions (61.5%). Few women reported being frequently abused physically (2%) or verbally (3.5%); almost all had water/electricity available (>95%). In bivariate analyses, statistically significant positive associations were found between PCMC score and early ANC, male accompaniment to the facility, male provider, and a lack of complications; all associations remained at least potentially statistically significant in multivariable modeling. CONCLUSIONS Physical and verbal abuse and a lack of basic amenities were rare, while a lack of communication with patients and social support were common. Maternal characteristics (like timing of ANC and maternal or newborn complications) were predictors of RMC, while facility/system factors, like facility type and sector, were not. Continued efforts to improve respectful care will require strengthening provider communication skills and encouraging patient and companion involvement in care.
Collapse
Affiliation(s)
- Carolyn Smith Hughes
- University of California San Francisco, 550 16th St, 3rd Floor, San Francisco, CA 94158, USA.
| | - Martha Kamanga
- University of Malawi Kamuzu College of Nursing, P/Bag 1, Lilongwe, Malawi
| | - Alisa Jenny
- University of California San Francisco, 550 16th St, 3rd Floor, San Francisco, CA 94158, USA
| | - Brady Zieman
- Population Council, One Dag Hammarskjold Plaza, 3rd Floor, New York, NY 10017, USA
| | - Charlotte Warren
- Population Council, One Dag Hammarskjold Plaza, 3rd Floor, New York, NY 10017, USA
| | - Dilys Walker
- University of California San Francisco, 550 16th St, 3rd Floor, San Francisco, CA 94158, USA
| | - Abigail Kazembe
- University of Malawi Kamuzu College of Nursing, P/Bag 1, Lilongwe, Malawi
| |
Collapse
|
14
|
Eduardo Pereira Dutra P, Quagliato LA, Nardi AE. Improving the perception of respect for and the dignity of inpatients: a systematic review. BMJ Open 2022; 12:e059129. [PMID: 35568491 PMCID: PMC9109089 DOI: 10.1136/bmjopen-2021-059129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this systematic review is to find evidence to determine which strategies are effective for improving hospitalised patients' perception of respect and dignity. METHODS A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The MEDLINE/PubMed, PsycINFO and Cochrane Library databases were searched on 9 March 2021. Observational studies, prospective studies, retrospective studies, controlled trials and randomised controlled trials with interventions focused on improving respect for patients and maintaining their dignity were included. Case reports, editorials, opinion articles, studies <10 subjects, responses/replies to authors, responses/replies to editors and review articles were excluded. The study population included inpatients at any health facility. Two evaluators assessed risk of bias according to the Cochrane Handbook of Systematic Reviews of Interventions criteria: allocation, randomisation, blinding and internal validity. The reviewers were blinded during the selection of studies as well as during the quality appraisal. Disagreements were resolved by consensus. RESULTS 2515 articles were retrieved from databases and 44 articles were included in this review. We conducted a quality appraisal of the studies (27 qualitative studies, 14 cross-sectional studies, 1 cohort study, 1 quali-quantitative study and 1 convergent parallel mixed-method study). DISCUSSION A limitation of this study is that it may not be generalisable to all cultures. Most of the included studies are of good quality according to the quality appraisal. To improve medical and hospital care in most countries, it is necessary to improve the training of doctors and other health professionals. CONCLUSION Many strategies could improve the perception of respect for and the dignity of the inpatient. The lack of interventional studies in this field has led to a gap in knowledge to be filled with better designed studies and effect measurements. PROSPERO REGISTRATION NUMBER CRD42021241805.
Collapse
|
15
|
Maldie M, Egata G, Chanie MG, Muche A, Dewau R, Worku N, Alemu MD, Ewunetie GE, Birhane T, Addisu E, Ayele WM, Adane M. Magnitude and associated factors of disrespect and abusive care among laboring mothers at public health facilities in Borena District, South Wollo, Ethiopia. PLoS One 2021; 16:e0256951. [PMID: 34793460 PMCID: PMC8601571 DOI: 10.1371/journal.pone.0256951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recent studies have indicated that disrespectful/abusive/coercive service by skilled care providers in health facilities that results in actual or perceived poor quality of care is directly and indirectly associated with adverse maternal and newborn outcomes. According to the 2016 Ethiopian Demography and Health Survey, only 26% of births were attended by qualified clinicians, with a maternal mortality rate of 412 per 100,000 live-births. Using seven categories developed by Bowser and Hill (2010), this study looked at disrespect and abuse experienced by women in labor and delivery rooms in health facilities of Borena Ddistrict, South Wollo, Ethiopia. METHODS A facility-based cross-sectional study was conducted among 374 immediate postpartum women in Borena District from January 12 to March 12, 2020. Systematic sampling was used to access respondents to participate in a structured, pre-tested face-to-face exit interview. Data were entered into EpiData version 4.6 and exported to SPSS version 25 for analysis. Finally, bivariable and multivariable logistic regression analysis were performed to declare statistically significant factors related to maternal disrespect and abusive care in Borena District at a p-value of < 0.05 and at 95% CI. RESULT Almost four out of five (79.4%) women experienced at least one type of disrespect and abuse during facility-based childbirth. The most frequently reported type of disrespect and abuse was non-consented care 63.7%. Wealth index [AOR = 3.27; 95% CI: (1.47, 7.25)], type of health facility [AOR = 1.96; 95% CI: (1.01, 3.78)], presence of companion(s) [AOR = 0.05; 95% CI: (0.02, 0.12)], and presence of complications [AOR = 2.65; 95% CI: (1.17, 5.99)] were factors found to be significantly related to women experiencing disrespect and abuse. CONCLUSION The results showed that wealth index, type of health facility, presence of companion(s), and birth complications were found to be significant factors. Therefore, health personnel need to develop interventions that integrate provider's behavior on companionship and prevention of complications across facilities to reduce the impact of disrespectful and abusive care for laboring women.
Collapse
Affiliation(s)
- Mulusew Maldie
- Borena Woreda Health Office, South Wollo Ethiopia, Borena, Ethiopia
| | - Gudina Egata
- Schools of Public Health, Haramaya University, Harar, Ethiopia
| | - Muluken Genetu Chanie
- Department of Health Systems and Policy, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amare Muche
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Nigusu Worku
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mamo Dereje Alemu
- Health Systems Strengthening Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Tesfaye Birhane
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Elsabeth Addisu
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Wolde Melese Ayele
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Metadel Adane
- Department of Environmental Health Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
16
|
Jolivet RR, Gausman J, Kapoor N, Langer A, Sharma J, Semrau KEA. Operationalizing respectful maternity care at the healthcare provider level: a systematic scoping review. Reprod Health 2021; 18:194. [PMID: 34598705 PMCID: PMC8485458 DOI: 10.1186/s12978-021-01241-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ensuring the right to respectful care for maternal and newborn health, a critical dimension of quality and acceptability, requires meeting standards for Respectful Maternity Care (RMC). Absence of mistreatment does not constitute RMC. Evidence generation to inform definitional standards for RMC is in an early stage. The aim of this systematic review is clear provider-level operationalization of key RMC principles, to facilitate their consistent implementation. METHODS Two rights-based frameworks define the underlying principles of RMC. A qualitative synthesis of both frameworks resulted in seven fundamental rights during childbirth that form the foundation of RMC. To codify operational definitions for these key elements of RMC at the healthcare provider level, we systematically reviewed peer-reviewed literature, grey literature, white papers, and seminal documents on RMC. We focused on literature describing RMC in the affirmative rather than mistreatment experienced by women during childbirth, and operationalized RMC by describing objective provider-level behaviors. RESULTS Through a systematic review, 514 records (peer-reviewed articles, reports, and guidelines) were assessed to identify operational definitions of RMC grounded in those rights. After screening and review, 54 records were included in the qualitative synthesis and mapped to the seven RMC rights. The majority of articles provided guidance on operationalization of rights to freedom from harm and ill treatment; dignity and respect; information and informed consent; privacy and confidentiality; and timely healthcare. Only a quarter of articles mentioned concrete or affirmative actions to operationalize the right to non-discrimination, equality and equitable care; less than 15%, the right to liberty and freedom from coercion. Provider behaviors mentioned in the literature aligned overall with seven RMC principles; yet the smaller number of available research studies that included operationalized definitions for some key elements of RMC illustrates the nascent stage of evidence-generation in this area. CONCLUSIONS Lack of systematic codification, grounded in empirical evidence, of operational definitions for RMC at the provider level has limited the study, design, implementation, and comparative assessment of respectful care. This qualitative systematic review provides a foundation for maternity healthcare professional policy, training, programming, research, and program evaluation aimed at studying and improving RMC at the provider level.
Collapse
Affiliation(s)
- R Rima Jolivet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jewel Gausman
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Neena Kapoor
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Ana Langer
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Jigyasa Sharma
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Katherine E A Semrau
- BetterBirth Program, Ariadne Labs
- Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
| |
Collapse
|
17
|
Strong AE, White TL. Re-examining Norms of Disrespect and Abuse in the Second Stage of Labor in Tanzanian Maternity Care. Med Anthropol 2021; 40:307-321. [PMID: 33703977 DOI: 10.1080/01459740.2021.1884075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Globally, the widespread occurrence of disrespect and abuse (D&A) on maternity wards is well-documented. Using ethnography and cultural consensus analysis we explore how the practice of midwives hitting women who are in the second stage of labor (pushing) has become a locally accepted form of care in Tanzania if a baby's life appears to be at risk. This analysis interrogates the deep uncertainty of birth outcomes in this setting that may motivate abuse during this time. Seriously engaging with local discourses on abuse and care sheds light on hegemonic norms and power dynamics and is critical for improving maternity services.
Collapse
Affiliation(s)
- Adrienne E Strong
- Department of Anthropology, University of Florida, Gainesville, Florida, USA
| | - Tara L White
- Faculty of Earth and Life Sciences, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
18
|
Asefa A, Morgan A, Gebremedhin S, Tekle E, Abebe S, Magge H, Kermode M. Mitigating the mistreatment of childbearing women: evaluation of respectful maternity care intervention in Ethiopian hospitals. BMJ Open 2020; 10:e038871. [PMID: 32883738 PMCID: PMC7473661 DOI: 10.1136/bmjopen-2020-038871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES There is a lack of evidence on approaches to mitigating mistreatment during facility-based childbirth. This study compares the experiences of mistreatment reported by childbearing women before and after implementation of a respectful maternity care intervention. DESIGN A pre-post study design was undertaken to quantify changes in women's experiences of mistreatment during facility-based childbirth before and after the respectful maternity care intervention. INTERVENTION A respectful maternity care intervention was implemented in three hospitals in southern Ethiopia between December 2017 and September 2018 and it included training of service providers, placement of wall posters in labour rooms and post-training supportive visits for quality improvement. OUTCOME MEASURES A 25-item questionnaire asking women about mistreatment experiences was administered to 388 women (198 in the pre-intervention, 190 in the post-intervention). The outcome variable was the number of mistreatment components experienced by women, expressed as a score out of 25. Multilevel mixed-effects Poisson modelling was used to assess the change in mistreatment score from pre-intervention to post-intervention periods. RESULTS The number of mistreatment components experienced by women was reduced by 18% when the post-intervention group was compared with the pre-intervention group (adjusted regression coefficient (Aβ)=0.82, 95% CI 0.74 to 0.91). Women who had a complication during pregnancy (Aβ=1.17, 95% CI 1.01 to 1.34) and childbirth (Aβ=1.16, 95% CI 1.03 to 1.32) experienced a greater number of mistreatment components. On the other hand, women who gave birth by caesarean birth after trial of vaginal birth (Aβ=0.76, 95% CI 0.63 to 0.92) and caesarean birth without trial of vaginal birth (Aβ=0.68, 95% CI 0.47 to 0.98) experienced a lesser number of mistreatment components compared with those who had vaginal birth. CONCLUSIONS Women reported significantly fewer mistreatment experiences during childbirth following implementation of the intervention. Given the variety of factors that lead to mistreatment in health facilities, interventions designed to mitigate mistreatment need to involve structural changes.
Collapse
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
| |
Collapse
|
19
|
Habib HH, Torpey K, Maya ET, Ankomah A. Promoting respectful maternity care for adolescents in Ghana: a quasi-experimental study protocol. Reprod Health 2020; 17:129. [PMID: 32831100 PMCID: PMC7444244 DOI: 10.1186/s12978-020-00977-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Intra-partum mistreatment by healthcare providers remains a global public health and human rights challenge. Adolescents, who are typically younger, poorer and less educated have been found to be disproportionately exposed to intra-partum mistreatment. In Ghana, maternal mortality remains a leading cause of death among adolescent females, despite increasing patronage of skilled birth attendance in health facilities. In response to the the World Health Organisation Human Reproduction Programme (WHO-HRP) recommendations to address mistreatment with Respectful Maternity Care (RMC), this study aims to generate evidence on promoting respectful treatment of adolescents using an intervention that trains health providers on the concept of mistreatment, their professional roles in RMC and the rights of adolescents to RMC. METHODS This study will employ a pre-test post-test quasi-experimental design. At pre-test and post-test, quantitative surveys will be conducted among adolescents who deliver at health facilities about their labour experience with mistreatment and RMC. A total target of 392 participants will be recruited across intervention and control facilities. Qualitative interviews will also be conducted with selected adolescents and health professionals for an in-depth understanding of the phenomenon. Following the pre-test, a facility-based training module will be implemented at intervention facilities for the facility midwives. The modules will be co-facilitated by the principal investigator and key resource persons from the district health directorate Quality of Care teams. Training will cover the rights of adolescents to quality healthcare, classifications of mistreatment, RMC as a concept and the role of professionals in providing RMC. No intervention will occur in the control facilities. Descriptive statistics, logistic regressions and difference in differences analyses will be computed. Qualitative data will be transcribed and thematically analysed. DISCUSSION This study is designed to test the success of an intervention in promoting RMC and reducing intra-partum mistreatment towards adolescents. It is expected that the findings of this study will be beneficial in adding to the body of knowledge in improving maternal healthcare and reducing maternal mortality, especially for adolescents. TRIAL REGISTRATION Name of the registry: Pan African Clinical Trials Registry. PACTR202008781392078 .
Collapse
Affiliation(s)
- Helen H. Habib
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ernest Tei Maya
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | | |
Collapse
|