scholarly journals Barriers to provision of respectful maternity care in Zambia: results from a qualitative study through the lens of behavioral science

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jana Smith ◽  
Rachel Banay ◽  
Emily Zimmerman ◽  
Vivien Caetano ◽  
Maurice Musheke ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Maternity Care ◽  
Design Methodology ◽  
Behavioral Science ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Disrespectful Care ◽  
Behavioral Design ◽  
Behavioral Barriers ◽  
Respectful Care

Abstract Background Recently, a growing body of literature has established that disrespect and abuse during delivery is prevalent around the world. This complex issue has not been well studied through the lens of behavioral science, which could shed light on the psychological dimensions of health worker behavior and how their micro-level context may be triggering abuse. Our research focuses on the behavioral drivers of disrespect and abuse in Zambia to develop solutions with health workers and women that improve the experience of care during delivery. Methods A qualitative study based on the behavioral design methodology was conducted in Chipata District, Eastern Province. Study participants included postpartum women, providers (staff who attend deliveries), supervisors and mentors, health volunteers, and birth companions. Observations were conducted of client-provider interactions on labor wards at two urban health centers and a district hospital. In-depth interviews were audio recorded and English interpretation from these recordings was transcribed verbatim. Data was analyzed using thematic analysis and findings were synthesized following the behavioral design methodology. Results Five key behavioral barriers were identified: 1) providers do not consider the decision to provide respectful care because they believe they are doing what they are expected to do, 2) providers do not consider the decision to provide respectful care explicitly since abuse and violence are normalized and therefore the default, 3) providers may decide that the costs of providing respectful care outweigh the gains, 4) providers believe they do not need to provide respectful care, and 5) providers may change their mind about the quality of care they will provide when they believe that disrespectful care will assist their clinical objectives. We identified features of providers’ context – the environment in which they live and work, and their past experiences – which contribute to each barrier, including supervisory systems, visual cues, social constructs, clinical processes, and other features. Conclusions Client experience of disrespectful care during labor and delivery in Chipata, Zambia is prevalent. Providers experience several behavioral barriers to providing respectful maternity care. Each of these barriers is triggered by one or more addressable features in a provider’s environment. By applying the behavioral design methodology to the challenge of respectful maternity care, we have identified specific and concrete contextual cues that targeted solutions could address in order to facilitate respectful maternity care.

scholarly journals Promoting Respectful Maternity Care using a Behavioral Design Approach in Zambia: Results from a Mixed-Methods Evaluation

2021 ◽  
Author(s):  
Jana Smith ◽  
Allison Schachter ◽  
Rachel Banay ◽  
Emily Zimmerman ◽  
Abigail Sellman ◽  
...  
Keyword(s):  
Pain Management ◽  
Health Facility ◽  
Maternity Care ◽  
Low Cost ◽  
Design Approach ◽  
Respectful Maternity Care ◽  
Small Scale ◽  
Disrespect And Abuse ◽  
Labor And Delivery ◽  
Behavioral Design

Abstract Background: Respectful maternity care (RMC) has been elevated in the global discourse, however, instances of disrespect and abuse remain prevalent. While several studies have highlighted promising approaches to promote RMC, this body of literature is still limited and few approaches have been scaled outside the initial study sites. Building on formative research conducted through a behavioral science lens, we sought to develop and test evidence-based, low-cost solutions to promote RMC which would be well-positioned for scale-up. Our study highlights the effectiveness of the solution package on provider provision of better care and client satisfaction, as well as intermediary outcomes and behavioral mechanisms. Methods: A quasi-experimental evaluation, informed by the behavioral design approach, was completed to test the effectiveness of a 5-component solution package in Chipata, Zambia. Quantitative surveys were collected from health facility providers and postpartum clients at baseline and endline in intervention and comparison facilities. Additional qualitative interviews were conducted with health facility providers and postpartum clients at endline. We also conducted interviews with health facility in-charges and observed labor and delivery practices at intervention facilities over the course of implementation. Results: Evidence suggested that at endline, clients at implementation facilities were less likely to experience disrespect and abuse compared to clients at comparison facilities (ß= -0.15 p=.01). Clients at intervention facilities were more likely to request pain management compared to clients at comparison facilities (ß=.33, p=.003). The solutions were simple for providers to implement and were easily integrated into existing services by providers during labor and delivery. Providers at intervention facilities also described the pain management toolkit as helpful in expanding the types of pain management techniques used during labor.Conclusions: The results of this small-scale study act as a proof of concept, demonstrating that the behavioral design approach can lead to solutions that show potential for impact. In other settings where providers face similar barriers to providing RMC, an adaptation of this solution package might lead to similarly positive results. Given the global scale of disrespectful care, these low-cost solutions hold promise for improving the quality of care women receive during labor and delivery.

scholarly journals Midwives’ Perceptions of Barriers to Respectful Maternity Care for Adolescent Mothers in Jamaica: A Qualitative Study

2018 ◽  
Vol 8 (1) ◽  
pp. 18-34
Author(s):  
Karline Wilson-Mitchell ◽  
Amy Marowitz ◽  
Jody R. Lori
Keyword(s):  
Qualitative Study ◽  
Adolescent Mothers ◽  
Maternity Care ◽  
Work Experience ◽  
Care Delivery ◽  
World Health ◽  
Respectful Maternity Care ◽  
Rural And Urban ◽  
Health Organization ◽  
Respectful Care

Background:Few studies have examined respectful maternity care (RMC) of adolescent mothers in the Caribbean. The researchers’ objective was to explore the perceptions of midwives who provide care for adolescent mothers in Jamaica. Design: A pilot qualitative study was conducted in 2015. Participants were 12 community or nurse-midwives who practiced in rural and urban regions of Jamaica attended a nursing and midwifery conference.Method:Semistructured focus groups and interviews of Jamaican midwives were conducted. The World Health Organization (WHO) definitions of respectful care in relationship to sexual and reproductive health rights, and data were examined using a poststructural feminist version of Denzin’s interpretive interactionism theory. Braun and Clark’s method of reiterative content analysis was employed. Findings:Participants shared their work experience with adolescent mothers and explained that restrictive public and institutional policies culture, personal beliefs, and the location of care delivery hindered them from providing respectful care which allows for shared decision-making, informed consent, and allowing for a desired labour companion. They perceived their roles as advocates, educators, expert helpers, and worker activists. Conclusions:Out of hospital environments appeared to facilitate the advocacy role. Policies and attitudes had the potential to hinder or to promote RMC. These findings may be used to inform a national midwifery survey, educational modules, health systems change to allow for less restrictive policies and spaces.

scholarly journals Overview of Literature on RMC and Applications to Tanzania

2021 ◽  
Author(s):  
Karline Wilson-Mitchell ◽  
Lucia Eustace ◽  
Jamie Robinson ◽  
Aloisia Shemdoe ◽  
Stephano Simba
Keyword(s):  
Maternity Care ◽  
Perinatal Outcomes ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Policy Makers ◽  
Human Resource Capacity ◽  
Quality Improvement Research ◽  
Care Indicator ◽  
Outcomes Of Education ◽  
Respectful Care

Respectful maternity care research in Tanzania continues to increase. This is an overview of the literature summarizing research based on the domains which comprise this quality of care indicator, ranging from exploratory and descriptive to quantitative measurements of birth perinatal outcomes when respectful interventions are made. The domains of respectful care are reflected in the seven Universal Rights of Childbearing Women but go further to implicate facility administrators and policy makers to provide supportive infrastructure to allay disrespect and abuse. The research methodologies continue to be problematic and several ethical cautions restrict how much control is possible. Similarly, the barriers to collecting accurate accounts in qualitative studies of disrespect require astute interviewing and observation techniques. The participatory community-based and the critical sociology and human rights frameworks appear to provide a good basis for both researcher and participants to identify problems and determine possible solutions to the multiple factors that contribute to disrespect and abuse. The work-life conditions of midwives in the Global South are plagued with poor infrastructure and significantly low resources which deters respectful care while decreasing retention of workers. Researchers and policy-makers have addressed disrespectful care by building human resource capacity, by strengthening professional organizations and by educating midwives in low-resource countries. Furthermore, researchers encourage midwives not only to acquire attitudinal change and to adopt respectful maternity care skills, but also to emerge as leaders and change agents. Safe methods for conducting care while addressing low resources, skilled management of conflict and creative innovations to engage the community are all interventions that are being considered for quality improvement research. Tanzania is poised to evaluate the outcomes of education workshops that address all seven domains of respectful care.

scholarly journals Healthcare providers’ perspectives of disrespect and abuse in maternity care facilities in Nigeria: a qualitative study

2019 ◽  
Vol 64 (9) ◽  
pp. 1291-1299
Author(s):  
Joy Orpin ◽  
Shuby Puthussery ◽  
Barbara Burden
Keyword(s):  
Maternity Care ◽  
Healthcare Providers ◽  
Well Being ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Structured Interviews ◽  
Rapport Building ◽  
The Impact ◽  
Health And Well Being ◽  
Respectful Care

Abstract Objectives To explore healthcare providers’ perspectives of disrespect and abuse in maternity care and the impact on women’s health and well-being. Methods Qualitative interpretive approach using in-depth semi-structured interviews with sixteen healthcare providers in two public health facilities in Nigeria. Interviews were audio-recorded, transcribed, and analysed thematically. Results Healthcare providers’ accounts revealed awareness of what respectful maternity care encompassed in accordance with the existing guidelines. They considered disrespectful and abusive practices perpetrated or witnessed as violation of human rights, while highlighting women’s expectations of care as the basis for subjectivity of experiences. They perceived some practices as well-intended to ensure safety of mother and baby. Views reflected underlying gender-related notions and societal perceptions of women being considered weaker than men. There was recognition about adverse effects of disrespect and abuse including its impact on women, babies, and providers’ job satisfaction. Conclusions Healthcare providers need training on how to incorporate elements of respectful maternity care into practice including skills for rapport building and counselling. Women and family members should be educated about right to respectful care empowering them to report disrespectful practices.

scholarly journals From Global Rights to Local Relationships: Exploring Disconnects in Respectful Maternity Care in Malawi

2019 ◽  
Vol 30 (3) ◽  
pp. 341-355
Author(s):  
Bregje Christina de Kok ◽  
Isabelle Uny ◽  
Mari Immamura ◽  
Jacqueline Bell ◽  
Jane Geddes ◽  
...  
Keyword(s):  
Maternity Care ◽  
International Standards ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Middle Income ◽  
Middle Income Countries ◽  
Client Relationships ◽  
Local Contexts ◽  
Respectful Care ◽  
Current Emphasis

Widespread reports of “disrespect and abuse” in maternity wards in low- and middle-income countries have triggered the development of rights-based respectful maternity care (RMC) standards and initiatives. To explore how international standards translate into local realities, we conducted a team ethnography, involving observations in labor wards in government facilities in central Malawi, and interviews and focus groups with midwives, women, and guardians. We identified a dual disconnect between, first, universal RMC principles and local notions of good care and, second, between midwives and women and guardians. The latter disconnect pertains to fraught relationships, reproduced by and manifested in mechanistic care, mutual responsibilization for trouble, and misunderstandings and distrust. RMC initiatives should be tailored to local contexts and midwife-client relationships. In a hierarchical, resource-strapped context like Malawi, promoting mutual love, understanding, and collaboration may be a more productive way to stimulate “respectful” care than the current emphasis on formal rights and respect.

scholarly journals Overview of Literature on RMC and Applications to Tanzania

2021 ◽  
Author(s):  
Karline Wilson-Mitchell ◽  
Lucia Eustace ◽  
Jamie Robinson ◽  
Aloisia Shemdoe ◽  
Stephano Simba
Keyword(s):  
Maternity Care ◽  
Perinatal Outcomes ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Policy Makers ◽  
Human Resource Capacity ◽  
Quality Improvement Research ◽  
Care Indicator ◽  
Outcomes Of Education ◽  
Respectful Care

Respectful maternity care research in Tanzania continues to increase. This is an overview of the literature summarizing research based on the domains which comprise this quality of care indicator, ranging from exploratory and descriptive to quantitative measurements of birth perinatal outcomes when respectful interventions are made. The domains of respectful care are reflected in the seven Universal Rights of Childbearing Women but go further to implicate facility administrators and policy makers to provide supportive infrastructure to allay disrespect and abuse. The research methodologies continue to be problematic and several ethical cautions restrict how much control is possible. Similarly, the barriers to collecting accurate accounts in qualitative studies of disrespect require astute interviewing and observation techniques. The participatory community-based and the critical sociology and human rights frameworks appear to provide a good basis for both researcher and participants to identify problems and determine possible solutions to the multiple factors that contribute to disrespect and abuse. The work-life conditions of midwives in the Global South are plagued with poor infrastructure and significantly low resources which deters respectful care while decreasing retention of workers. Researchers and policy-makers have addressed disrespectful care by building human resource capacity, by strengthening professional organizations and by educating midwives in low-resource countries. Furthermore, researchers encourage midwives not only to acquire attitudinal change and to adopt respectful maternity care skills, but also to emerge as leaders and change agents. Safe methods for conducting care while addressing low resources, skilled management of conflict and creative innovations to engage the community are all interventions that are being considered for quality improvement research. Tanzania is poised to evaluate the outcomes of education workshops that address all seven domains of respectful care.

scholarly journals Promoting Respectful Maternity Care using a Behavioral Design Approach in Zambia: Results from a Mixed-Methods Evaluation

2020 ◽  
Author(s):  
Jana Smith ◽  
Allison Schachter ◽  
Rachel Banay ◽  
Emily Zimmerman ◽  
Abigail Sellman ◽  
...  
Keyword(s):  
Pain Management ◽  
Health Facility ◽  
Maternity Care ◽  
Low Cost ◽  
Design Approach ◽  
Respectful Maternity Care ◽  
Small Scale ◽  
Disrespect And Abuse ◽  
Labor And Delivery ◽  
Behavioral Design

Abstract Background: Respectful maternity care (RMC) has been elevated in the global discourse, however, instances of disrespect and abuse remain prevalent. While several studies have highlighted promising approaches to promote RMC, this body of literature is still limited and few approaches have been scaled outside the initial study sites. Building on formative research conducted through a behavioral science lens, we sought to develop and test evidence-based, low-cost solutions to promote RMC which would be well-positioned for scale-up. Our study highlights the effectiveness of the solution package on provider provision of better care and client satisfaction, as well as intermediary outcomes and behavioral mechanisms. Methods: A quasi-experimental evaluation, informed by the behavioral design approach, was completed to test the effectiveness of a 5-component solution package in Chipata, Zambia. Quantitative surveys were collected from health facility providers and postpartum clients at baseline and endline in intervention and comparison facilities. Additional qualitative interviews were conducted with health facility providers and postpartum clients at endline. We also conducted interviews with health facility in-charges and observed labor and delivery practices at intervention facilities over the course of implementation. Results: Evidence suggested that at endline, clients at implementation facilities were less likely to experience disrespect and abuse compared to clients at comparison facilities (ß= -0.15 p=.01). Clients at intervention facilities were more likely to request pain management compared to clients at comparison facilities (ß=.33, p=.003). The solutions were simple for providers to implement and were easily integrated into existing services by providers during labor and delivery. Providers at intervention facilities also described the pain management toolkit as helpful in expanding the types of pain management techniques used during labor.Conclusions: The results of this small-scale study act as a proof of concept, demonstrating that the behavioral design approach can lead to solutions that show potential for impact. In other settings where providers face similar barriers to providing RMC, an adaptation of this solution package might lead to similarly positive results. Given the global scale of disrespectful care, these low-cost solutions hold promise for improving the quality of care women receive during labor and delivery.

Midwives' perceptions of disrespect and abuse of women during labour and childbirth in Lusaka, Zambia

2021 ◽  
Vol 15 (3) ◽  
pp. 1-12
Author(s):  
Namayipo Stella Wamukankamba Nankamba ◽  
Catherine Mubita Ngoma ◽  
Maureen Masumo Makoleka
Keyword(s):  
Logistic Regression ◽  
Maternity Care ◽  
Health Workers ◽  
Multivariate Logistic Regression Analysis ◽  
Study Data ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Multivariate Logistic Regression ◽  
Abuse Of Women ◽  
And Training

Background/Aims Disrespect and abuse is a frequent occurrence in labour wards around the world. Disrespect and abuse during care by health workers can prevent pregnant women from seeking care during labour and childbirth, which can lead to increased maternal and neonatal mortality rates. This study aimed to explore midwives' perceptions of disrespect and abuse of women during labour and childbirth in Lusaka. Methods A concurrent convergent mixed-method approach was used for this study. Data were collected through a self-administered questionnaire given to 217 midwives actively practicing in maternal health services across Lusaka randomly sampled for the quantitative arm of the study. The data were analysed using bivariate and multivariate logistic regression, with P<0.05 used to indicate significance. For the qualitative component of the study, 13 purposively selected key informants were interviewed with an interview guide. Results Most of the respondents (88.5%) perceived disrespect and abuse of women during labour and childbirth as a negative phenomenon. However, almost half (40.1%) had provided care which was disrespectful and abusive during their practice and the majority (68.7%) had observed disrespect and abuse by other midwives. Bivariate and multivariate logistic regression analysis found an association between midwives' perception of disrespect and abuse and witnessing or participating in disrespectful and abusive behaviour during practice. In the qualitative arm of the study, midwives reported that disrespect and abuse occurred in labour wards across Lusaka, demonstrating an urgent need to prevent such practices. Midwives suggested actions such as increased sensitisation and training of midwives on respectful maternity care and improved staffing levels as ways to prevent this practice Conclusions Disrespect and abuse of women during labour and childbirth should be prevented. Increasing health education and training for both the public and midwives on respectful maternity care can help to achieve this goal. Midwives need to be motivated through good working environments, increased wages and increased time to rest while working, as the heavy workload was found to contribute to disrespect and abuse in labour wards.

Disrespect and Abuse During Facility‐Based Childbirth in North Showa Zone, Ethiopia

2020 ◽  
Author(s):  
Yohannes Mehretie Adinew ◽  
Helen Hall ◽  
Amy Marshall ◽  
Janet Kelly
Keyword(s):  
Maternity Care ◽  
Positive Association ◽  
Cross Sectional Study ◽  
Public Health Facility ◽  
Respectful Maternity Care ◽  
P Value ◽  
Disrespect And Abuse ◽  
Structural Factors ◽  
Care Providers ◽  
Cross Sectional

Abstract Background: Respectful maternity care is a fundamental human right, and an important component of quality maternity care that every childbearing woman should receive. Disrespect and abuse during childbirth is not only a violation of a women’s rights, it is associated with a reduction in the number of women accessing professional maternity services and increases the risk of maternal mortality. This study investigated women’s experience of disrespect and abuse during facility-based childbirth in Ethiopia. Methods: A cross-sectional study was conducted with 435 randomly selected women who had given birth at public health facility within the previous twelve months in North showa zone of Ethiopia. A structured, researcher administered questionnaire was used with data collected using digital, tablet-based tools. Participants’ experiences were measured using the seven categories and verification criteria of disrespect and abuse identified by White Ribbon Alliance. Multivariable logistic regression was used to identify the association between experience of disrespect and abuse and interpersonal and structural factors at p-value < 0.05 and OR values with 95% confidence interval. Results: All participants reported at least one form of disrespect and abuse during childbirth. Types of disrespect and abuse experienced by participants were; physical abuse 435(100%), non-consented care 423(97.2%), non-confidential care 288 (66.2%), abandonment/ neglect (34.7%), non-dignified care 126(29%), discriminatory care 99(22.8%) and detention 24(5.5%). Hospital birth [AOR: 3.04, 95% CI: 1.75, 5.27], rural residence [AOR: 1.44, 95% CI: 0.76, 2.71], monthly household income less than 1,644 Birr (USD 57) [AOR: 2.26, 95% CI: 1.20, 4.26], being attended by female providers [AOR: 1.74, 95% CI: 1.06, 2.86] and midwifery nurses [AOR: 2.23, 95% CI: 1.13, 4.39] showed positive association with experience of disrespect and abuse. Conclusion: The level of disrespect and abuse is high and its drivers and enablers include both structural and interpersonal factors. Expanding the size and skill mix of professionals in the preferred facilities (hospitals), and sensitizing care providers and health managers regarding the magnitude and consequences of D&A are strategies that could possibly promote more dignified and respectful maternity care.

scholarly journals Disrespect and Abuse Experienced by Women during Childbirth in Midwife-Led Obstetric Units in Tshwane District, South Africa: A Qualitative Study

2020 ◽  
Vol 17 (10) ◽  
pp. 3667
Author(s):  
Refilwe Malatji ◽  
Sphiwe Madiba
Keyword(s):  
South Africa ◽  
Maternity Care ◽  
Computer Software ◽  
Verbal Abuse ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Focus Group Interviews ◽  
Postnatal Women ◽  
The Common ◽  
Group Interviews

The disrespect and abuse (D&A) of women during childbirth is common and a great concern in midwifery-led obstetric units (MOUs) in South Africa. This paper used the seven chapters of the Respectful Maternity Care Charter as a framework to explore women’s experiences of care during childbirth and examine the occurrence of D&A during childbirth in MOUs. Five focus group interviews were conducted with postnatal women aged 18 to 45 years selected purposively from MOUs in Tshwane District in South Africa. The discussions were audio-recorded, transcribed, and analyzed using a thematic approach and NVivo11 computer software. D&A of women was common during labor and childbirth. Verbal abuse in the form of shouting, labeling, judging, and rude remarks was the common form of D&A. Some of the women were abandoned and neglected, which resulted in their giving birth without assistance. Furthermore, the midwives violated their rights and denied them care such as pain relief medication, birth companions during childbirth, and access to ambulance services. Midwives are at the center of the provision of maternity care in MOUs in South Africa. Therefore, there is a need to strengthen interventions to adopt and implement policies that promotes respectful, nonabusive care during childbirth in MOUs.

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