Dataset Information

Midwives' and patients' perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study.

ABSTRACT:

Background

It is increasingly recognized that disrespect and abuse of women during labor and delivery is a violation of a woman's rights and a deterrent to the use of life-saving, facility-based labor and delivery services. In Ethiopia, rates of skilled birth attendance are still only 28% despite a recent dramatic national scale up in the numbers of trained providers and facilities. Concerns have been raised that womens' perceptions of poor quality of care and fear of mistreatment might contribute to this low utilization. This study examines the experiences of disrespect and abuse in maternal care from the perspectives of both providers and patients.

Methods

We conducted 45 in-depth interviews at four health facilities in Debre Markos, Ethiopia with midwives, midwifery students, and women who had given birth within the past year. Students and providers also took a brief quantitative survey on patients' rights during labor and delivery and responded to clinical scenarios regarding the provision of stigmatized reproductive health services.

Results

We find that both health care providers and patients report frequent physical and verbal abuse as well as non-consented care during labor and delivery. Providers report that most abuse is unintended and results from weaknesses in the health system or from medical necessity. We uncovered no evidence of more systematic types of abuse involving detention of patients, bribery, abandonment or ongoing discrimination against particular ethnic groups. Although health care providers showed good basic knowledge of confidentiality, privacy, and consent, training on the principles of responsive and respectful care, and on counseling, is largely absent. Providers indicated that they would welcome related practical instruction. Patient responses suggest that women are aware that their rights are being violated and avoid facilities with reputations for poor care.

Conclusions

Our results suggest that training on respectful care, offered in the professional ethics modules of the national midwifery curriculum, should be strengthened to include greater focus on counseling skills and rapport-building. Our findings also indicate that addressing structural issues around provider workload should complement all interventions to improve midwives' interpersonal interactions with women if Ethiopia is to increase provision of respectful, patient-centered maternity care.

SUBMITTER: Burrowes S

PROVIDER: S-EPMC5567643 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Midwives' and patients' perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study.

Burrowes Sahai S Holcombe Sarah Jane SJ Jara Dube D Carter Danielle D Smith Katheryn K

BMC pregnancy and childbirth 20170822 1

<h4>Background</h4>It is increasingly recognized that disrespect and abuse of women during labor and delivery is a violation of a woman's rights and a deterrent to the use of life-saving, facility-based labor and delivery services. In Ethiopia, rates of skilled birth attendance are still only 28% despite a recent dramatic national scale up in the numbers of trained providers and facilities. Concerns have been raised that womens' perceptions of poor quality of care and fear of mistreatment might ...[more]

PMID: 28830383

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Project description:BackgroundFacility-based childbirth has increased globally. Unfortunately, there have also been reports of women experiencing disrespect and abuse by healthcare providers during childbirth. This study aimed to measure the prevalence of self-reported disrespect and abuse (D&A) by healthcare providers of women during childbirth in health facilities in Tanzania, and to clarify the factors related to D&A.MethodsA cross-sectional survey was conducted in public health facilities of three regions in Tanzania from September 2016 to October 2016. Nurses and midwives who had ever conducted deliveries completed a 22-item section about D&A and three sections about working conditions and environment. A model for predicting D&A based on several factors such as their characteristics, working conditions, and working environment was developed by conducting multiple regression analysis.ResultsThirty public health facilities in three regions within Tanzania were selected to reflect different levels of hospitals. Among 456 participants (nurses, midwives, and nursing assistants), 439 were included in the analysis. Average number of self-reported D&A out of 22 items was five, and nearly all participants (96.1%) reported enacting one form of D&A at the least and two forms of D&A at the most. About 25-44% of D&A items were in the forms related to women's experiences with childbirth psychologically. Moreover, at least 10-30% of the participants enacted some form of D&A which could directly affect the well-being of mothers and babies. D&A scores increased with an increase in 'working hours per week' and 'taking a break during evening shifts'. D&A scores decreased with an increase in the scores of the 'two components of the Index of Working Satisfaction (professional status and interaction between nurses)', and 'any type of supervision for new nurse-midwives'.ConclusionMost studies about D&A of healthcare providers previously focused on the reports of women. To our knowledge, this is the first report that focused on D&A reported by healthcare providers. Working conditions and systems including personal relationships with colleagues were both positively and negatively related to D&A of healthcare providers rather than the provider's individual and facility structural characteristics.

Project description:BACKGROUND:Quality maternal health reduces maternal and neonatal mortality and morbidity. Healthcare professionals, including midwives, are significant agents for the promotion of quality maternal health. Frequents reports of disrespect and abuse of childbearing women by midwives during intrapartum care are becoming common, suggesting that many of these agents are engaging in care practices that compromise quality maternal health. Thus, understanding midwives' descriptions and experiences of the phenomenon is critical to addressing the threat. This paper, therefore, explored the understanding of midwives on D&AC and their occurrence in professional practice in a tertiary health facility in Kumasi, Ghana. METHODS:An exploratory descriptive qualitative research design using an interpretative approach was employed in the study. Data were generated through individual in-depth interviews. Data saturation was reached with fifteen interviews. The interviews were audio-recorded and transcribed verbatim. Open Code 4.03 was used to manage and analyse the data. RESULTS:The midwives understood D&AC. They also confirmed meting out or witnessing colleagues engage in D&AC in their professional practice. The midwives described D&AC as the provision of inadequate care and the overlooking of patient-centred care, and verbal, physical, and psychological abuse. The themes revealed that socio-economic inequalities, provider perception and victim-blaming, and health system-related factors facilitate D&AC. It emerged that the following marginalized groups were at high risk for D&AC: the non-compliant, mentally ill, HIV/AIDs+, teenagers, poor, and childbearing women on admission at the general labour ward. CONCLUSION:The midwives understood D&AC and revealed that it frequently occurred in their professional practice. Frequent in-service training on respectful maternity care and monitoring of care provision in healthcare facilities are needed to eliminate the incidence of D&AC.

Project description:Objectives: Maternal disrespect and abuse are the top significant barriers to the use of maternal health services. However, poor attention has been given to the hospitality and suitability of care provided to women in the facilities where they have been moved to utilize health services. This study is aimed to assess the prevalence of maternal disrespect and abuse during focused antenatal care and its associated factors among pregnant women who visit public health facilities in Awsi Rasu of Afar Region Northeast Ethiopia. Methods: Institution-based cross-sectional study design was employed from March 1 to 30, 2022 in selected health facilities of the Awsi Rasu of Afar Region, Northeast Ethiopia. A total of 1278 mothers were included using consecutive sampling techniques. The data were entered into Epi-data version 3.1 and exported to SPSS version 23.0 for statistical analysis. Statistical significance is declared using adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI). Results: The overall prevalence of disrespect and the abusive experience was 56.7% (95% CI: 54–59.3%). A low average monthly income of less than or equal to 3000 Ethiopian birrs (AOR = 0.72; 95% CI: 0.55–0.94), Age (20–25) years (AOR = 2.33; 95% CI 1.72–3.2), having no formal education (AOR = 2.01; 95% CI: 1.35–3.15), and having unplanned pregnancy (AOR = 1.6; 95% CI: 1.21–2.01) were significantly associated with disrespect and abuse during focused antenatal care. Conclusion: The prevalence of disrespect and abusive experience during antenatal care in the study area was high relative to other studies. In the multivariable logistic regression model age of the mother (20–25 years), no formal education, low family income, and unplanned pregnancy are the predictors of disrespect and abusive care. Providing respectful health care during antenatal care with a suitable approach for all mothers irrespective of their age, unplanned pregnancies, and educational status is the most substantial to encourage maternal service use.

Project description:BackgroundThe availability of a skilled birth attendant is widely recognized as a critical factor in reducing maternal and newborn mortality. Competence of maternal healthcare providers directly affects quality of care and health outcomes. This study assessed competence of midwives and associated factors in provision of care during labor, and the immediate postpartum period at public health facilities in Tigray, Ethiopia.MethodsA cross-sectional study design was employed to collect data through direct observation of the performance of 144 midwives selected from 57 health facilities. Data were collected from January to February 2015 by 12 experienced midwives who were trained on basic emergency obstetric care and had previous experience with data collection. Using a standardized competence checklist, adapted from International confederation of midwives, data collectors interviewed and directly observed the performance of midwives from admission of laboring mothers to six hours after delivery. Multivariable linear regression was used to identify predicators associated with overall clinical competence of midwives.ResultThe mean competence score of midwives was found to be 51%. In multivariable linear regression, male midwifery professionals (p = 0.022), availability of up to date job aids in work place (p = 0.04) and being recognized for improved performance (p = 0.005) were significantly associated with competence of midwives in the provision of care during labor, childbirth and immediate postpartum period.ConclusionCompetence of midwives was found to be low to provide safe and quality maternity care in the region. Male gender, availability of complete job aids and receiving recognition/awards for better performance were predicted competence. This requires attention and investment from Tigray regional health bureau and health development partners working on maternal and child health. Competence based in-service training, on-the-job mentoring, availing up to dated standard job aids, recognition of high performing midwives are recommended to improve the quality of maternity care in public health facilities of the region. Moreover, affirmative actions including on-the-job training and supervision are needed to improve the competence of female midwives.

Dataset Information

Midwives' and patients' perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study.

Background

Methods

Results

Conclusions

Publications

Midwives' and patients' perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study.

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