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Sarikhani Y, Najibi SM, Razavi Z. Key barriers to the provision and utilization of maternal health services in low-and lower-middle-income countries; a scoping review. BMC Womens Health 2024; 24:325. [PMID: 38840156 PMCID: PMC11151574 DOI: 10.1186/s12905-024-03177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The preservation and promotion of maternal health (MH) emerge as vital global health objectives. Despite the considerable emphasis on MH, there are still serious challenges to equitable access to MH services in many countries. This review aimed to determine key barriers to the provision and utilization of MH services in low- and lower-middle-income countries (LLMICs). METHODS In this scoping review, we comprehensively searched four online databases from January 2000 to September 2022. In this study, the approach proposed by Arksey and O'Malley was used to perform the review. Consequently, 117 studies were selected for final analysis. To determine eligibility, three criteria of scoping reviews (population, concept, and context) were assessed alongside the fulfillment of the STROBE and CASP checklist criteria. To synthesize and analyze the extracted data we used the qualitative content analysis method. RESULTS The main challenges in the utilization of MH services in LLMICs are explained under four main themes including, knowledge barriers, barriers related to beliefs, attitudes and preferences, access barriers, and barriers related to family structure and power. Furthermore, the main barriers to the provision of MH services in these countries have been categorized into three main themes including, resource, equipment, and capital constraints, human resource barriers, and process defects in the provision of services. CONCLUSIONS The evidence from this study suggests that many of the barriers to the provision and utilization of MH services in LLMICs are interrelated. Therefore, in the first step, it is necessary to prioritize these factors by determining their relative importance according to the specific conditions of each country. Consequently, comprehensive policies should be developed using system modeling approaches.
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Affiliation(s)
- Yaser Sarikhani
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Seyede Maryam Najibi
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Razavi
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
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Legesse AY, Teka Tseghay H, Abraha HE, Fisseha G, Ebrahim MM, Tsadik M, Berhe B, Gebrekurstos G, Ayele B, Gebremeskel T, Gebremariam T, Hadush MY, Hagos T, Gebreziabiher A, Muez K, Mulugeta A, Tesfay H, Godefay H. Maternal mortality during war time in Tigray, Ethiopia: A community-based study. BJOG 2024; 131:786-794. [PMID: 37752662 DOI: 10.1111/1471-0528.17677] [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: 04/17/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE This study seeks to examine the impact of war on maternal mortality following an exacerbation in the dynamics of inequality in maternal health caused by the continuing conflict. DESIGN Community-based cross-sectional study. SETTING Tigray region of Northern Ethiopia, between November 2020 and May 2022. POPULATION This study surveyed a total of 189 087 households from six of the seven zones of Tigray in 121 tabiyas from 31 districts selected. A multistage cluster sampling technique was used to select the districts and tabiyas. METHODS The study was conducted in two phases. In the first phase, reproductive-age deaths that occurred during the study period were screened. In the second phase, verbal autopsies were conducted at the screened households. MAIN OUTCOME MEASURES Maternal mortality ratio level and cause-specific mortality. RESULTS The results of the study showed that the maternal mortality ratio was 840 (95% CI 739-914) per 100 000 live births. Haemorrhage, 107 (42.8%), pregnancy-induced hypertension, 21 (8.4%), and accidents, 14 (5.6%), were the main causes of mortality. Additionally, 203 (81.2%) of the mothers died outside of a health facility. CONCLUSIONS This study has shown a higher maternal mortality ratio following the dynamics of the Tigray war, as compared with the pre-war level of 186/100 000. Furthermore, potentially many of the pregnancy-related deaths could have been prevented with access to preventive and emergency services. Given the destruction and looting of many facilities, the restoration and improvement of the Tigray health system must take precedence.
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Affiliation(s)
- Awol Yemane Legesse
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Hale Teka Tseghay
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Hiluf Ebuy Abraha
- Hospital Quality, Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Girmatsion Fisseha
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Mache Tsadik
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Bereket Berhe
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Brhane Ayele
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Tsega Gebremariam
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Marta Yemane Hadush
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tigist Hagos
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Abreha Gebreziabiher
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kibrom Muez
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Afework Mulugeta
- Department of Nutrition and Dietetics, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Haile Tesfay
- Maternal and Child Health Unit, Tigray Regional Health Bureau, Mekelle, Tigray, Ethiopia
| | - Hagos Godefay
- Maternal and Child Health Unit, Tigray Regional Health Bureau, Mekelle, Tigray, Ethiopia
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Jha P, Jha VK, Sharma B, Jha A, Erlandsson K, Bogren M. Cultural adaptation and psychometric evaluation of Childbirth Experience Questionnaire 2 in Karnataka state, India. PLoS One 2023; 18:e0291591. [PMID: 38015907 PMCID: PMC10684018 DOI: 10.1371/journal.pone.0291591] [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] [Received: 02/13/2023] [Accepted: 08/25/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Women's birthing experience is a sensitive indicator of the quality of childbirth care and can impact the physical and mental health of both women and their neonates. Negligible evidence exists on Indian women's birth experiences and-to the best of authors' knowledge-no questionnaire has been tested in India for measuring women's birthing experiences. This study aimed to test the construct validity and reliability of the Kannada-translated Revised Childbirth Experience Questionnaire. METHODOLOGY A cross-sectional survey was carried out among postnatal women (n = 251, up to six months postpartum, with a live healthy neonate) who had given birth at a public or private health facility using the Kannada-translated CEQ2 in two districts of Karnataka. Data were collected at participants' homes after seeking written informed consent. Model fit was determined by Confirmatory Factor Analyses. RESULTS The 4-factor model of the CEQ2 showed good fit after deletion of one item (item 8, subcategory "participation") with CMIN = 1.33; SRMR = 0.04; GFI = 0.92, CFI = 0.98, TLI = 0.99, RMSEA = 0.037 and p value 0.002). The Cronbach alpha values were acceptable for the four subscales (0.92, 0.93, 0.97, 0.91) as well as for the overall 21-item scale (0.84). CONCLUSIONS The Kannada-translated CEQ2 is a reliable tool to measure the childbirth experiences among Kannada-speaking women and can serve as a reliable ongoing evaluation of women's birth experiences.
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Affiliation(s)
- Paridhi Jha
- Foundation for Research in Health Systems, Bangalore, Karnataka, India
| | | | - Bharati Sharma
- Indian Institute of Public Health Gandhinagar, Gandhinagar, Gujarat, India
| | - Ajeya Jha
- Department of Management Studies, Sikkim Manipal Institute of Technology, Rangpo, Sikkim, India
| | | | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Perera SM, Isa GP, Sebushishe A, Sundararaj P, Piccirillo M, Xia S, Langaigne A, Ali J, Casey SE. "Midwives are heroes of the country": qualitative evaluation of a midwifery education program in South Sudan. Front Glob Womens Health 2023; 4:1215405. [PMID: 37705530 PMCID: PMC10497107 DOI: 10.3389/fgwh.2023.1215405] [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: 05/01/2023] [Accepted: 08/16/2023] [Indexed: 09/15/2023] Open
Abstract
Background Countries affected by armed conflict have higher maternal mortality than stable settings. South Sudan has one of the highest maternal mortality ratios in the world, with an estimated 789 maternal deaths per 100,000 live births. Long-term socio-political instability has contributed to significant challenges in its health system. To reduce maternal and newborn morbidity and mortality, South Sudan must increase the number of skilled midwives. Methods A cross-sectional mixed methods study was conducted in 2022 to assess the midwifery education program at three schools receiving support from International Medical Corps in South Sudan, including in-depth interviews with 15 midwifery school graduates currently working as midwives, their supervisors, 16 school faculty (in dyads), and two Ministry of Health officials; and nine focus group discussions with women clients of graduate midwives. Results Participants identified strengths of the schools, including being well equipped with trained and competent teaching staff, competency-based curriculum, including practical training which prepared graduate midwives to apply their skills in practice. Weaknesses of the program included its dependence on donor funding, inadequate mentorship and number of tutors, and insufficient practice for some services due to low client load at clinical sites. Additionally, participants identified challenges affecting midwives' ability to provide good quality care, including lack of equipment and supplies, low client load, low salaries, and insecurity due to conflict. Nevertheless, women in the community appreciated the immense work that midwives do. Midwives were respected by the community at large, and graduates expressed pride and satisfaction in their job, as well as the positive impact they have had in providing critical services to communities. Discussion Overall, the quality of the midwifery education program appears to be strong, however gaps in the program and the provision of quality care remain. The findings highlight the need to ensure sustained funding for midwifery education, as well as health system strengthening to ensure midwives can practice their skills. Continued investment in midwifery education and training is critical to reduce high maternal mortality and morbidity in South Sudan.
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Affiliation(s)
| | | | | | - Preethika Sundararaj
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Megan Piccirillo
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Shanell Xia
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Amaya Langaigne
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Javed Ali
- International Medical Corps, Washington, DC, United States
| | - Sara E. Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
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Smith S, Redmond M, Stites S, Sims J, Ramaswamy M, Kelly PJ. Creating an Agenda for Black Birth Equity: Black Voices Matter. Health Equity 2023; 7:185-191. [PMID: 36942314 PMCID: PMC10024576 DOI: 10.1089/heq.2021.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 03/15/2023] Open
Abstract
Background The grim inequity that Black women and infants are more than twice as likely to die during birth than their white counterparts is a public health crisis. Methods Guided by principles of critical race theory, we used content analysis to analyze the themes of the presentation made by five Black community members on a 2020 Juneteenth panel, a holiday celebrating the emancipation of those who had been enslaved in the United States. Results Panelists sparked the conversation by unpacking the traumatic experiences of health inequities and structural racism on Black families and diverse caregivers. As a part of qualitative content analysis, four major themes emerged: (1) the matrix of domination, (2) specific oppressions of the health care system, (3) empowerment reconceptualized, and (4) dimensions of racism. Participants also discussed how racial disparities may have exacerbated the complexities and challenges of elevating Black voices and creating birth equity. Discussion Based on Black families' experiences, four areas must be addressed: health care system's policies of oppression that create barriers to listening to Black women, reconceptualizing retention for providers of color and support for Black women and their families, and racism.
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Affiliation(s)
- Sharla Smith
- Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
- Address correspondence to: Sharla Smith, PhD, MPH, Population Health, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA,
| | - Michelle Redmond
- Population Health, University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Sierra Stites
- Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Jaleen Sims
- Department of Obstetrics and Gynecology, Jackson-Hinds Comprehensive Health Center Jackson, Mississippi, USA
| | - Megha Ramaswamy
- Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Patricia J. Kelly
- Retired-School of Nursing, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Afrin S, Dogne C, Dudi J, Dogne N, Singh A, Raghunath D, Sakalle S, Chellaiyan V. Perception of beneficiaries regarding quality of care and respectful maternity care being provided in delivery room using LaQshya guidelines. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2023. [DOI: 10.4103/injms.injms_108_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Alibhai KM, Ziegler BR, Meddings L, Batung E, Luginaah I. Factors impacting antenatal care utilization: a systematic review of 37 fragile and conflict-affected situations. Confl Health 2022; 16:33. [PMID: 35690840 PMCID: PMC9188725 DOI: 10.1186/s13031-022-00459-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is estimated that over 930 million people live in fragile and conflict-affected situations (FCAS) worldwide. These regions, characterized by violence, civil unrest, and war, are often governed by corrupt administrations who are unwilling to provide their citizens with basic human rights. Individuals living in FCAS face health inequities; however, women are disproportionally affected and face additional barriers to accessing sexual and reproductive services, including antenatal care (ANC). This systematic review aims to identify the factors that impact ANC usage in the 37 countries or regions classified as FCAS in 2020 by The World Bank. METHODS Using the PRISMA guidelines, a systematic search of five databases (SCOPUS, Web of Science, PubMed, EMBASE, and CINAHL) was conducted. Results were limited to human studies, written in English, and published between January 2002 and January 2022. Studies that identified factors affecting utilization of ANC or maternal health services were included for review and critically appraised using the National Institute of Health's Quality Assessment Tools. Findings were summarized using a narrative synthesis approach. RESULTS The database search yielded 26,527 studies. After title, abstract and full-text review, and exclusion of duplicate articles, 121 studies remained. Twenty-eight of the 37 FCAS were represented in the included studies. The studies highlighted that women in FCAS' are still not meeting the World Health Organization's 2002 recommendation of four ANC visits during pregnancy, a recommendation which has since been increased to eight visits. The most cited factors impacting ANC were socioeconomic status, education, and poor quality of ANC. Despite all studies being conducted in conflict-affected regions, only nine studies explicitly identified conflict as a direct barrier to accessing ANC. CONCLUSION This review demonstrated that there is a paucity in the literature examining the direct and indirect impacts of conflict on ANC utilization. Specifically, research should be conducted in the nine FCAS that are not currently represented in the literature. To mitigate the barriers that prevent utilization of maternal health services identified in this review, policy makers, women utilizing ANC, and global organizations should attempt to collaborate to enact policy change at the local level.
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Affiliation(s)
| | - Bianca R Ziegler
- DeGroote School of Medicine, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
| | - Louise Meddings
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Evans Batung
- Department of Geography, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
- Environment Health and Hazards Lab, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
- Environment Health and Hazards Lab, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
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Hameed W, Khan B, Siddiqi S, Asim M, Avan BI. Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000550. [PMID: 36962395 PMCID: PMC10021678 DOI: 10.1371/journal.pgph.0000550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/09/2022] [Indexed: 11/19/2022]
Abstract
Mistreatment with women during childbirth is prevalent in many in low- and middle-income countries. There is dearth of evidence that informs development of health system interventions to promote supportive and respectful maternity care in facility-based settings. We examined health systems bottlenecks that impedes provision of supportive and respectful maternity care in secondary-level public healthcare system of Pakistan. Using a qualitative exploratory design, forty in-depth interviews conducted with maternity care staff of six public health facilities in southern Pakistan. Development of interview guide and data analyses were guided by the WHO's six health system building blocks. A combination of inductive and deductive approach was used for data analyses. Our study identified range of bottlenecks impeding provision of RMC. In terms of leadership/governance, there was lack of institutional guidelines, supervision and monitoring, and patient feedback mechanism. No systematic mechanism existed to screen and record patient psychosocial needs. Health workforce lacked training opportunities on RMC that resulted in limited knowledge and skills; there were also concerns about lack of recognition from leadership for good performers, and poor relationship and coordination between clinical and non-clinical staff. Regarding the domain of service delivery, we found that patients were perceived as un-cooperative, non-RMC manifestations were acceptable and normalized under certain conditions, and restrictive policies for active engagement of companions. Finally, lack of cleanliness, curtains for privacy, seating arrangement for companion were the identified issues infrastructural issues. A service-delivery intervention package is needed that effectively uses all six components of the health system: from investments in capacity building of maternity teams to creating a conducive facility environment via proper governance and accountability mechanisms. Such interventions should not only focus on provision of maternity care in a respectful and dignified manner, but also ensure that care is responsive to the psychosocial needs of pregnant women without any discrimination.
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Affiliation(s)
- Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Pakistan
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bilal Iqbal Avan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lakin K, Kane S. Peoples' expectations of healthcare: A conceptual review and proposed analytical framework. Soc Sci Med 2022; 292:114636. [PMID: 34894457 DOI: 10.1016/j.socscimed.2021.114636] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
Expectations shape how one experiences the healthcare one receives. In this paper we argue that the current conceptualisations of expectations within the healthcare literature have much to gain from the many recent and adjacent conceptual developments in other disciplines. The concept of expectations has been extensively studied across disciplines - we review the key texts on the subject in the business, management, social psychology, and sociology literatures to provide a conceptual overview and propose an integrative analytical framework for better understanding individuals' expectations in healthcare. We argue that peoples' expectations of a care encounter are usefully understood as being shaped by their social locations at particular points of time, which is at the intersection of multiple social structures and relations. Peoples' future expectations of care may also be influenced by the experiences of past and current care encounters, framed again by intersecting social structures and relations at that point in time. We demonstrate how an intersectional, translocational and relational analytical approach can allow researchers and practitioners to consider how peoples' social locations shape their expectations of care, not only within a given social environment, but at certain points in time and over time. We emphasise that, given the mobilities and mixing societies are experiencing globally, such an approach is particularly useful for understanding healthcare-related expectations and experiences of all.
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Affiliation(s)
- Kimberly Lakin
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
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Minckas N, Gram L, Smith C, Mannell J. Disrespect and abuse as a predictor of postnatal care utilisation and maternal-newborn well-being: a mixed-methods systematic review. BMJ Glob Health 2021; 6:bmjgh-2020-004698. [PMID: 33883187 PMCID: PMC8061800 DOI: 10.1136/bmjgh-2020-004698] [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] [Received: 12/08/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Globally, a substantial number of women experience abusive and disrespectful care from health providers during childbirth. As evidence mounts on the nature and frequency of disrespect and abuse (D&A), little is known about the consequences of a negative experience of care on health and well-being of women and newborns. This review summarises available evidence on the associations of D&A of mother and newborns during childbirth and the immediate postnatal period (understood as the first 24 hours from birth) with maternal and neonatal postnatal care (PNC) utilisation, newborn feeding practices, newborn weight gain and maternal mental health. Methods We conducted a systematic review of all published qualitative, quantitative and mixed-methods studies on D&A and its postnatal consequences across all countries. Pubmed, Embase, Web of Science, LILACS and Scopus were searched using predetermined search terms. Quantitative and qualitative data were analysed and presented separately. Thematic analysis was used to synthesise the qualitative evidence. Results A total of 4 quantitative, 1 mixed-methods and 16 qualitative studies were included. Quantitative studies suggested associations between several domains of D&A and use of PNC as well as maternal mental health. Different definitions of exposure meant formal meta-analysis was not possible. Three main themes emerged from the qualitative findings associated with PNC utilisation: (1) women’s direct experiences; (2) women’s expectations and (3) women’s agency. Conclusion This review is the first to examine the postnatal effect of D&A of women and newborns during childbirth. We highlight gaps in research that could help improve health outcomes and protect women and newborns during childbirth. Understanding the health and access consequences of a negative birth experience can help progress the respectful care agenda.
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Affiliation(s)
- Nicole Minckas
- Institute for Global Health, University College London, London, UK
| | - Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Colette Smith
- Institute for Global Health, University College London, London, UK
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Risk Factors for Positive Appraisal of Mistreatment during Childbirth among Ethiopian Midwifery Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082682. [PMID: 32295137 PMCID: PMC7216170 DOI: 10.3390/ijerph17082682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022]
Abstract
The maternal mortality ratio and neonatal mortality rate remain high in Ethiopia, where few births are attended by qualified healthcare staff. This is partly due to care providers’ mistreatment of women during childbirth, which creates a culture of anxiety that decreases the use of healthcare services. This study employed a cross-sectional design to identify risk factors for positive appraisal of mistreatment during childbirth. We asked 391 Ethiopian final year midwifery students to complete a paper-and-pen questionnaire assessing background characteristics, prior observation of mistreatment during education, self-esteem, stress, and mistreatment appraisal. A multivariable linear regression analysis indicated age (p = 0.005), stress (p = 0.019), and previous observation of mistreatment during education (p < 0.001) to be significantly associated with mistreatment appraisal. Younger students, stressed students, and students that had observed more mistreatment during their education reported more positive mistreatment appraisal. No significant association was observed for origin (p = 0.373) and self-esteem (p = 0.445). Findings can be utilized to develop educational interventions that counteract mistreatment during childbirth in the Ethiopian context.
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Belaid L, Bayo P, Kamau L, Nakimuli E, Omoro E, Lobor R, Samson B, Dimiti A. Health policy mapping and system gaps impeding the implementation of reproductive, maternal, neonatal, child, and adolescent health programs in South Sudan: a scoping review. Confl Health 2020; 14:20. [PMID: 32313550 PMCID: PMC7155266 DOI: 10.1186/s13031-020-00258-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/06/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pregnant women, neonates, children, and adolescents are at higher risk of dying in fragile and conflict-affected settings. Strengthening the healthcare system is a key strategy for the implementation of effective policies and ultimately the improvement of health outcomes. South Sudan is a fragile country that faces challenges in implementing its reproductive, maternal, neonatal, child, and adolescent health (RMNCAH) policies. In this paper, we map the key RMNCAH policies and describe the current status of the WHO health system building blocks that impede the implementation of RMNCAH policies in South Sudan. METHODS We conducted a scoping review (39 documents) and individual interviews (n = 8) with staff from the national Ministry of Health (MoH) and implementing partners. We organized a workshop to discuss and validate the findings with the MoH and implementing partner staff. We synthesized and analyzed the data according to the WHO health system building blocks. RESULTS The significant number of policies and healthcare strategic plans focused on pregnant women, neonates, children, and adolescents evidence the political will of the MoH to improve the health of members of these categories of the population. The gap in the implementation of policies is mainly due to the weaknesses identified in different health system building blocks. A critical shortage of human resources across the blocks and levels of the health system, a lack of medicines and supplies, and low national funding are the main identified bottlenecks. The upstream factors explaining these bottlenecks are the 2012 suspension of oil production, ongoing conflict, weak governance, a lack of accountability, and a low human resource capacity. The combined effects of all these factors have led to poor-quality provision and thus a low use of RMNCAH services. CONCLUSION The implementation of RMNCAH policies should be accomplished through innovative and challenging approaches to building the capacities of the MoH, establishing governance and accountability mechanisms, and increasing the health budget of the national government.
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Affiliation(s)
- Loubna Belaid
- Family Medicine Department, McGill University, 5858 Chemin de la Côte des Neiges, Montréal, Québec Canada
| | | | - Lynette Kamau
- African population and health research center, Nairobi, Kenya
| | - Eva Nakimuli
- Partners in Population and Development Africa Regional Office, Kampala, Uganda
| | - Elijo Omoro
- Torit State Ministry of Health, Juba, South Sudan
| | - Robert Lobor
- WHO, South Sudan Country Office, Juba, South Sudan
| | | | - Alexander Dimiti
- Department of Reproductive of Health, Ministry of Health, Juba, South Sudan
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13
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Henning MJ, Zulu JM, Michelo C, Simmons Zuilkowski S, Hubner C. Adolescent Mothers' Experiences With Community Health Assistants in Rural Zambia. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 40:353-361. [PMID: 31876258 DOI: 10.1177/0272684x19896737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescent health demands specific attention because adolescents have the lowest levels of health-care coverage of any age-group globally. The main objective as addressed in this article was to explore the lived experience of adolescent mothers and the services provided to them by community health assistants (CHAs) in rural Zambia. Because the number of adolescent mothers in rural Zambia is so high, it is even more critical to describe the lived experiences of health care among these young women with particular emphasis on primary health care as delivered by CHAs in rural Zambia. We used a mixed-methods design to address our research questions. Data were collected from nine focus groups, which were conducted with young mothers from four provinces and 10 districts (n = 60). To support our effort to better understand the delivery of maternal and child health care in rural Zambia, key informant interviews were conducted with adolescent mothers (n = 12). We also conducted surveys (n = 44) and one-on-one interviews (n = 22) with CHAs. To the best of our knowledge, this is the largest study focused on the intersection of adolescents, maternal child health, and CHA delivery of care in Zambia. The results of our study suggest opportunities for change to operational practices within the rural health-care setting and the need to develop structured and age-appropriate services that focus on adolescents. This work addresses the gap in research for adolescents in health care in rural Zambia and brings attention to the unique health-care needs of adolescent mothers within the rural health-care setting.
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Affiliation(s)
- Margaret J Henning
- Department of Public Health, School of Science, Sustainability, and Health, Keene State College, NH, USA
| | - Joseph M Zulu
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Charles Michelo
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Stephanie Simmons Zuilkowski
- Learning Systems Institute, Tallahassee, FL, USA.,Department of Educational Leadership and Policy Studies, Florida State University, Tallahassee, FL, USA
| | - Candace Hubner
- Center for Population Health, Cheshire Medical Center, Keene, NH, USA
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Doria S, Diba F, Susanti SS, Vollmer S, Monfared IG. Mothers' experiences of quality of care and potential benefits of implementing the WHO safe childbirth checklist: a case study of Aceh Indonesia. BMC Pregnancy Childbirth 2019; 19:461. [PMID: 31795951 PMCID: PMC6891962 DOI: 10.1186/s12884-019-2625-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/22/2019] [Indexed: 12/24/2022] Open
Abstract
Background In an effort to mitigate missed opportunities to provide high-quality care, the World Health Organization (WHO) has developed the Safe Childbirth Checklist (SCC) to support health providers perform essential tasks. Our qualitative study is a baseline assessment of quality of care (QoC) perceived by mothers who gave birth at health facilities aiming to highlight areas where implementing the SCC can potentially improve the QoC as well as areas that are not part of the SCC yet require improvement. Methods Assessing the overall experience of care, our qualitative study focuses on 8 out of 29 items in the checklist that are related to the personal interactions between healthcare provider and mothers. Using a set of semi-structured questions, we interviewed 26 new mothers who gave institutional births in Aceh province in Indonesia. Results Our findings revealed some gaps where implementing the SCC can potentially improve safety and QoC. They include communicating danger signs at critical points during birth and after discharge, encouraging breastfeeding, and providing mothers with information on family planning. Moreover, taking a qualitative approach allowed us to identify additional aspects such as need for clarity at the point of admission, maintaining dignity, and protecting mothers’ rights in the decision-making process to be also essential for better QoC. Conclusions Our study highlights the need to actively listen to and engage with the experiences of women in the adaptation and implementation of the checklist. While our findings indicate that implementing the SCC has the potential to improve the quality of maternal care and overall birth experience, a more holistic understanding of the lived experiences of women and the dynamics of their interactions with health facilities, care providers, and their birth companions can complement the implementation of the checklist.
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Affiliation(s)
- Siobhan Doria
- Centre for Modern Indian Studies & Department of Economics, University of Goettingen, Göttingen, Germany
| | - Farah Diba
- Universitas Syiah Kuala, Banda Aceh, Indonesia
| | | | - Sebastian Vollmer
- Centre for Modern Indian Studies & Department of Economics, University of Goettingen, Göttingen, Germany
| | - Ida G Monfared
- Centre for Modern Indian Studies & Department of Economics, University of Goettingen, Göttingen, Germany.
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15
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Kane S, Miedema E, Dieleman M, Broerse J. 'You have a child who will call you "mama" ': understanding adolescent pregnancy in South Sudan. Glob Health Action 2019; 12:1553282. [PMID: 30620262 PMCID: PMC6327934 DOI: 10.1080/16549716.2018.1553282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Pregnancy amongst adolescent girls is common in many parts of the world. The dominant discourse in public health unquestioningly paints this as a problem; it does not pay sufficient attention to girls' views. OBJECTIVES This paper presents a critical account of adolescent South Sudanese girls' reasons for and explanations of childbearing. It discusses their experiences and views on childbearing and attempts to explain their reproductive choices and actions, in context. METHODS The study draws upon 24 interviews with adolescent boys, girls and parents from Wau, South Sudan. Data was analysed using the framework analysis approach. RESULTS Three interacting themes within which adolescent girls framed their views and decisions about childbearing are identified. The local society places high value on motherhood - adolescent girls' desires to become mothers is a reproduction of this social norm. Girls linked having a child to the possibility of making one's 'own home'; in the difficult and uncertain context they lived in, for many girls, having a child (and making a home) appeared as one of the few means to be happy. In making the decision to bear a child, the girls navigated multiple dilemmas and trade-offs between an unpromising present and an uncertain future. Bearing a child and making one's 'own home' was seen as a way to exit into the world of adults, and as a strategy towards achieving security and stability. CONCLUSIONS Instead of simplistically problematizing adolescent pregnancy in South Sudan, it is important to take into account the experiences and standpoints of adolescent girls, and to recognize that in choosing to become mothers, they are in many ways exercising agency despite being severely constrained by complex, insecure and unfair social circumstances. We argue that such an approach will allow the development of more appropriate, realistic and inclusive health and social policies and programs.
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Affiliation(s)
- Sumit Kane
- a KIT Health , KIT Royal Tropical Institute , Amsterdam , The Netherlands.,b Nossal Institute for Global Health, Melbourne School of Population and Global Health , University of Melbourne , Melbourne , Australia
| | - Esther Miedema
- c Governance and Inclusive Development Programme , University of Amsterdam , Amsterdam , The Netherlands
| | - Marjolein Dieleman
- a KIT Health , KIT Royal Tropical Institute , Amsterdam , The Netherlands.,d Faculty of Earth and Life Sciences, Athena Institute for Research on Innovation and Communication in Health and Life Sciences , VU University Amsterdam , Amsterdam , The Netherlands
| | - Jacqueline Broerse
- d Faculty of Earth and Life Sciences, Athena Institute for Research on Innovation and Communication in Health and Life Sciences , VU University Amsterdam , Amsterdam , The Netherlands
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16
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Tongun JB, Mukunya D, Tylleskar T, Sebit MB, Tumwine JK, Ndeezi G. Determinants of Health Facility Utilization at Birth in South Sudan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2445. [PMID: 31324060 PMCID: PMC6651414 DOI: 10.3390/ijerph16132445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/02/2019] [Accepted: 07/06/2019] [Indexed: 11/16/2022]
Abstract
South Sudan has a high maternal mortality ratio estimated at 800 deaths per 100,000 live births. Birth in health facilities with skilled attendants can lower this mortality. In this cross-sectional study, we determined the level and determinants of health facility utilization and skilled birth attendance in Jubek State, South Sudan. Mothers of children aged less than two years were interviewed in their homes. Multivariable regression analysis was performed to determine factors associated with health facility births. Only a quarter of the mothers had given birth at health facilities, 209/810 (25.8%; 95% CI 18.2-35.3) and 207/810 had a skilled birth attendant (defined as either nurse, midwife, clinical officer, or doctor). Factors positively associated with health facility births were four or more antenatal visits (adjusted odds ratio (AOR) 19; 95% CI 6.2, 61), secondary or higher education (AOR 7.9; 95% CI 3, 21), high socio-economic status (AOR 4.5; 95% CI 2.2, 9.4), and being primipara (AOR 2.9; 95% CI 1.5, 5.4). These findings highlight the need for efforts to increase health facility births in South Sudan.
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Affiliation(s)
- Justin Bruno Tongun
- Centre for International Health, University of Bergen, 7804 Bergen, Norway.
- Department of Paediatrics, University of Juba, Juba P.O. Box 82, South Sudan.
| | - David Mukunya
- Centre for International Health, University of Bergen, 7804 Bergen, Norway
| | - Thorkild Tylleskar
- Centre for International Health, University of Bergen, 7804 Bergen, Norway
| | - Mohamedi Boy Sebit
- Department of Internal Medicine, University of Juba, Juba P.O. Box 82, South Sudan
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda
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Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, McLemore M, Cadena M, Nethery E, Rushton E, Schummers L, Declercq E. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health 2019. [PMID: 31182118 DOI: 10.1186/s12978-019-0729-2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)-US study. METHODS Our multi-stakeholder team distributed an online cross-sectional survey to capture lived experiences of maternity care in diverse populations. Patient-designed items included indicators of verbal and physical abuse, autonomy, discrimination, failure to meet professional standards of care, poor rapport with providers, and poor conditions in the health system. We quantified the prevalence of mistreatment by race, socio-demographics, mode of birth, place of birth, and context of care, and describe the intersectional relationships between these variables. RESULTS Of eligible participants (n = 2700), 2138 completed all sections of the survey. One in six women (17.3%) reported experiencing one or more types of mistreatment such as: loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help. Context of care (e.g. mode of birth; transfer; difference of opinion) correlated with increased reports of mistreatment. Experiences of mistreatment differed significantly by place of birth: 5.1% of women who gave birth at home versus 28.1% of women who gave birth at the hospital. Factors associated with a lower likelihood of mistreatment included having a vaginal birth, a community birth, a midwife, and being white, multiparous, and older than 30 years. Rates of mistreatment for women of colour were consistently higher even when examining interactions between race and other maternal characteristics. For example, 27.2% of women of colour with low SES reported any mistreatment versus 18.7% of white women with low SES. Regardless of maternal race, having a partner who was Black also increased reported mistreatment. CONCLUSION This is the first study to use indicators developed by service users to describe mistreatment in childbirth in the US. Our findings suggest that mistreatment is experienced more frequently by women of colour, when birth occurs in hospitals, and among those with social, economic or health challenges. Mistreatment is exacerbated by unexpected obstetric interventions, and by patient-provider disagreements.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Tanya Khemet Taiwo
- University of California Davis School of Medicine, Sacramento, California, USA.,Department of Midwifery, Bastyr University, Seattle, WA, USA
| | - Nicholas Rubashkin
- Department of Obstetrics and Gynecology, University of California San Francisco and the Institute for Global Health Sciences, California, USA
| | - Melissa Cheyney
- Department of Anthropology, Oregon State University, Corvallis, Oregon, USA
| | | | - Monica McLemore
- Department of Family Health Care Nursing and ANSIRH Bixby Center for Global Reproductive Health, University of California, San Francisco, USA
| | | | - Elizabeth Nethery
- School of Population & Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eleanor Rushton
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Laura Schummers
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eugene Declercq
- School of Public Health, Boston University, Massachusetts, Boston, USA
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18
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Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, McLemore M, Cadena M, Nethery E, Rushton E, Schummers L, Declercq E. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health 2019; 16:77. [PMID: 31182118 PMCID: PMC6558766 DOI: 10.1186/s12978-019-0729-2] [Citation(s) in RCA: 356] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/30/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)-US study. METHODS Our multi-stakeholder team distributed an online cross-sectional survey to capture lived experiences of maternity care in diverse populations. Patient-designed items included indicators of verbal and physical abuse, autonomy, discrimination, failure to meet professional standards of care, poor rapport with providers, and poor conditions in the health system. We quantified the prevalence of mistreatment by race, socio-demographics, mode of birth, place of birth, and context of care, and describe the intersectional relationships between these variables. RESULTS Of eligible participants (n = 2700), 2138 completed all sections of the survey. One in six women (17.3%) reported experiencing one or more types of mistreatment such as: loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help. Context of care (e.g. mode of birth; transfer; difference of opinion) correlated with increased reports of mistreatment. Experiences of mistreatment differed significantly by place of birth: 5.1% of women who gave birth at home versus 28.1% of women who gave birth at the hospital. Factors associated with a lower likelihood of mistreatment included having a vaginal birth, a community birth, a midwife, and being white, multiparous, and older than 30 years. Rates of mistreatment for women of colour were consistently higher even when examining interactions between race and other maternal characteristics. For example, 27.2% of women of colour with low SES reported any mistreatment versus 18.7% of white women with low SES. Regardless of maternal race, having a partner who was Black also increased reported mistreatment. CONCLUSION This is the first study to use indicators developed by service users to describe mistreatment in childbirth in the US. Our findings suggest that mistreatment is experienced more frequently by women of colour, when birth occurs in hospitals, and among those with social, economic or health challenges. Mistreatment is exacerbated by unexpected obstetric interventions, and by patient-provider disagreements.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Tanya Khemet Taiwo
- University of California Davis School of Medicine, Sacramento, California, USA
- Department of Midwifery, Bastyr University, Seattle, WA USA
| | - Nicholas Rubashkin
- Department of Obstetrics and Gynecology, University of California San Francisco and the Institute for Global Health Sciences, California, USA
| | - Melissa Cheyney
- Department of Anthropology, Oregon State University, Corvallis, Oregon, USA
| | | | - Monica McLemore
- Department of Family Health Care Nursing and ANSIRH Bixby Center for Global Reproductive Health, University of California, San Francisco, USA
| | | | - Elizabeth Nethery
- School of Population & Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eleanor Rushton
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Laura Schummers
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eugene Declercq
- School of Public Health, Boston University, Massachusetts, Boston, USA
| | - the GVtM-US Steering Council
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
- University of California Davis School of Medicine, Sacramento, California, USA
- Department of Midwifery, Bastyr University, Seattle, WA USA
- Department of Obstetrics and Gynecology, University of California San Francisco and the Institute for Global Health Sciences, California, USA
- Department of Anthropology, Oregon State University, Corvallis, Oregon, USA
- Every Mother Counts, New York City, USA
- Department of Family Health Care Nursing and ANSIRH Bixby Center for Global Reproductive Health, University of California, San Francisco, USA
- Young Women United, Albuquerque, New Mexico, USA
- School of Population & Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- School of Public Health, Boston University, Massachusetts, Boston, USA
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19
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Neke N, Reifferscheid A, Buchberger B, Wasem J. Time and cost associated with utilization of services at mobile health clinics among pregnant women. BMC Health Serv Res 2018; 18:920. [PMID: 30509269 PMCID: PMC6276179 DOI: 10.1186/s12913-018-3736-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 11/19/2018] [Indexed: 11/23/2022] Open
Abstract
Background Antenatal care (ANC) is provided for free in Tanzania in all public health facilities. Yet surveys suggested that long distances to the facilities limit women from accessing these services. Mobile health clinics (MHC) were introduced to address this problem; however, little is known about the client cost and time associated with utilizing ANC at MHC and whether these costs deter women from using the provided services. Methods Client-exit interviews were conducted by interviewing 293 pregnant women who visited the MHC in rural Tanzania. Two subgroups were created, one with women who travelled more than 1.5 h to the MHC, and the other with women who travelled within 1.5 h. For each subgroup we estimated the direct cost in US$ and time in hours for utilizing services and they hinder service utilization. The Wilcoxon–Mann–Whitney rank sum test was performed to compare the differences between the estimated mean values in the two groups. Result Total direct cost per visit was: US$2.27 (SD = 0.90) for overall, US$2.29 (SD = 1.03) for those women who travelled less than 1.5 h and US$2.53 (SD = 0.63) for those who travelled more than 1.5 h (p = 0.08). Laboratory and medicine cost accounted for 70 and 16% of the total direct cost and were similar across the groups. Total time cost per visit (in hours) was: 3.75 (SD = 1.83), 2.88 (SD = 1.27) for those women who travelled less than 1.5 h and 5.02 (SD = 1.81) for those who travelled more than 1.5 h (p < 0.01). The major contributor of time cost was waiting time; 1.89 (SD = 1.29) for overall, 1.68 (SD = 1.02) for those women who travelled less than 1.5 h and 2.17 (SD = 1.57) for those who travelled more than 1.5 h (p = 0.07). Participants reported having missed their scheduled visit due to lack of money (15%) and time (9%). Conclusion Women receiving nominally free ANC incur considerable time and direct cost, which may result in an unsteady use of maternal care. Improving availability of essential medicine and supplies at health facilities, as well as focusing on efficient utilization of community health workers may reduce these costs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3736-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nyasule Neke
- National Institute for Medical Research, Mwanza Centre, Isamilo Street, P O BOX 1462, Mwanza, Tanzania. .,Alfried Krupp von Bohlen und Halbach, Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany.
| | - Antonius Reifferscheid
- Alfried Krupp von Bohlen und Halbach, Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - Barbara Buchberger
- Alfried Krupp von Bohlen und Halbach, Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - Jürgen Wasem
- Alfried Krupp von Bohlen und Halbach, Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
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