Disrespect and abuse during facility-based childbirth in Pokhara metropolitan city

Introduction: Respectful maternity care is the universal right of every childbearing woman, which promotes the practices that recognize women’s preferences and women’s and newborns’ needs. The objective of the study was to assess disrespect and abuse during facility-based childbirth in Pokhara. Methods: Postnatal mothers having vaginal institutional delivery were included in the study. Non-probability purposive sampling technique was done to select 231 samples. Face to face interview technique with structured interview schedule was used. Descriptive and inferential statistics were used for data analysis. Results: Most (88.3%) of the mothers were between the age of 20 and 34 years with the mean age of 25.39±4.799 years. More than half of them had spontaneous vaginal delivery with episiotomy and (87%) of mothers had no any complications during childbirth. The overall disrespect and abuse during facility-based childbirth was (70.1%) and only (29.9%) of the postnatal mothers received respectful and non-abusive care. Regarding types of disrespect and abuse, (34.6%) of them were suffered from physical abuse, (68%) received non-consented care, (22.5%) of them received non-confidential and non-dignified care, (1.3%) experienced discrimination based on specific attributes and (26%) suffered from abandonment or neglect of care. There was no significant association between the prevalence of disrespect and abuse with socio-demographic and obstetric characteristics of the mothers. The association was found with place of delivery. Conclusion: It is concluded that near to three fourth of the postnatal mothers suffer from disrespect and abuse during facility based child birth in Pokhara. Thus, to increase respectful and non-abusive care during facility based childbirth, practice of respectful maternity care should be promoted including development of clinical guidelines and protocols.

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

African Journal of Midwifery and Women s Health ◽

10.12968/ajmw.2020.0042 ◽

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.

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

10.21203/rs.3.rs-72775/v1 ◽

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.

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17103667 ◽

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

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2579-x ◽

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.

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Respectful Maternity Care Interventions: A Systematic Literature Review.

East African Journal of Health and Science ◽

10.37284/eajhs.3.1.330 ◽

2021 ◽

Vol 3 (1) ◽

pp. 45-58

Author(s):

Lucy Natecho Namusonge ◽

Jacob Odhiambo Ngachra

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Maternity Care ◽

Grey Literature ◽

Respectful Maternity Care ◽

Disrespect And Abuse ◽

Data Bases ◽

New Born ◽

The Impact

High maternal and new born mortality remains a pressing problem in developing settings. Poor treatment during childbirth contributes directly and indirectly to this problem at a rate of 82%. Many women experience disrespectful and abusive treatment during childbirth in facilities worldwide which violates their rights to respectful care and a threat to their right to life, health, bodily integrity and freedom from discrimination. Majority of women report to have experienced some form of disrespect and abuse during childbirth. This systematic literature review aimed at reviewing studies on Respectful Maternity Care interventions aimed at promoting Quality of Maternal and New born Care. Objectives were to assess literature on how mothers are treated during childbirth (experience of care/respectful maternity care), to find out the factors contributing to disrespect and abuse during childbirth, to identify strategies for addressing issues affecting respectful maternity care. The literature review employed a quality assessment tool ‘PRISMA’, by the WHO. Eligibility criteria was studies published between 1992 and 2020 in indexed national and international journals in English language focusing on Respectful Maternity Care interventions in promoting Quality of Maternal and New born Care. Literature was reviewed from academic databases, project reports and documents. Electronic searches included reference libraries: PubMed, Cochrane Reference Libraries, google scholar, Medline on Mega scope data bases, CINAHL, Embase data bases and grey literature. Studies meeting the following criteria were included in the review: 1) Respectful Maternity Care; 2) Facilitators to dignity and respect during childbirth; and 3) Quality of Maternal and New born Care (QMNC). Disrespect and abuse appear to be widespread and research and implementation efforts must continue, there is lack of standardized definitions, instruments hence affecting generalizability and comparability, there are no adequate available data to quantify the prevalence of these behaviours. No matter the conceptual framework used in future investigations, studies should seek to accomplish three objectives: (1) to measure the perceived and observed frequencies of mistreatment in maternal health settings, (2) to examine the macro and micro level factors that drive mistreatment, (3) to assess the impact of mistreatment on the health outcomes of women and their new borns, and 4) to employ mixed method design as an optimal strategy to evaluate mistreatment and include direct observations to bridge the gap between observed measures and participants’ self-reported experiences of mistreatment.

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“I wouldn’t have hit you, but you would have killed your baby:” Exploring Midwives’ Perspectives on Disrespect and Abusive Care in Ghana.

10.21203/rs.2.12607/v4 ◽

2019 ◽

Author(s):

Millicent Veronica Dzomeku ◽

Boamah Mensah Adwoa Bemah ◽

Emmanuel Kweku Nakua ◽

Pascal Agbadi ◽

Jody R. Lori ◽

...

Keyword(s):

Maternal Health ◽

Professional Practice ◽

Maternity Care ◽

Study Data ◽

Respectful Maternity Care ◽

Disrespect And Abuse ◽

Related Factors ◽

Mortality And Morbidity ◽

Healthcare Facilities ◽

Childbearing Women

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

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A Comparative Study to Assess The Effectiveness of Breast Crawl on Infant Delivery among mothers who underwent Cesarean Delivery Vs Spontaneous Vaginal Delivery

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.3998 ◽

2020 ◽

Vol 11 (SPL4) ◽

pp. 584-588

Author(s):

Padmapriya D ◽

Babu Devi ◽

Dhovarani

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Demographic Data ◽

Sampling Technique ◽

Intensity Level ◽

Spontaneous Vaginal Delivery ◽

Medical College ◽

Postnatal Mothers ◽

The Mean ◽

Questionnaire Method

Breast crawl has been described as an instinctive postpartum behavior for full-term children after vaginal birth. The present aim was to assess the effectiveness of breast crawl on infant delivery among postnatal mothers who underwent cesarean delivery vs spontaneous vaginal delivery at Saveetha Medical College and Hospital. A quantitative approach with comparative research design was adopted for the present study. A total of 60samples among which in spontaneous vaginal delivery (n=30) and cesarean delivery (n=30) were selected by using a non-probability convenient sampling technique. A self-structured questionnaire method was used to collect the demographic data followed by that breast crawl was initiated between infant delivery by vaginal delivery and cesarean delivery among mothers. Among 60 samples, the mean score on the intensity level of pain among mothers delivery infant by vaginal delivery was 3.70±1.29 and the mean score on the intensity level of pain among mothers delivered infant by cesarean delivery was 6.13±1.25. The calculated student independent 't’ test was 7.412, which was found to be effectively significant. This clearly infers that breast crawl was found to be effective in minimizing the intensity level of pain among the mother's delivered infant by spontaneous vaginal delivery than the mother's delivered infant by cesarean delivery.

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

10.21203/rs.3.rs-97772/v2 ◽

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.

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Development of a Phone Survey Tool to Measure Respectful Maternity Care During Pregnancy and Childbirth in India: Study Protocol (Preprint)

10.2196/preprints.12173 ◽

2018 ◽

Author(s):

Amnesty E LeFevre ◽

Kerry Scott ◽

Diwakar Mohan ◽

Neha Shah ◽

Aarushi Bhatnagar ◽

...

Keyword(s):

Quality Of Care ◽

Maternity Care ◽

Quality Data ◽

Respectful Maternity Care ◽

Validity And Reliability ◽

Survey Tool ◽

Face To Face ◽

Pregnancy And Childbirth ◽

Phone Survey

BACKGROUND Respectful maternity care (RMC) is a key barometer of the underlying quality of care women receive during pregnancy and childbirth. Efforts to measure RMC have largely been qualitative, although validated quantitative tools are emerging. Available tools have been limited to the measurement of RMC during childbirth and confined to observational and face-to-face survey modes. Phone surveys are less invasive, low cost, and rapid alternatives to traditional face-to-face methods, yet little is known about their validity and reliability. OBJECTIVE The primary objective of this study was to develop validated face-to-face and phone survey tools for measuring RMC during pregnancy and childbirth for use in India and other low resource settings. The secondary objective was to optimize strategies for improving the delivery of phone surveys for use in measuring RMC. METHODS To develop face-to-face and phone surveys for measuring RMC, we describe procedures for assessing content, criterion, and construct validity as well as reliability analyses. To optimize the delivery of phone surveys, we outline plans for substudies, which aim to assess the effect of survey modality, and content on survey response, completion, and attrition rates. RESULTS Data collection will be carried out in 4 districts of Madhya Pradesh, India, from July 2018 to March 2019. CONCLUSIONS To our knowledge, this is the first RMC phone survey tool developed for India, which may provide an opportunity for the rapid, routine collection of data essential for improving the quality of care during pregnancy and childbirth. Elsewhere, phone survey tools are emerging; however, efforts to develop these surveys are often not inclusive of rigorous pretesting activities essential for ensuring quality data, including cognitive, reliability, and validity testing. In the absence of these activities, emerging data could overestimate or underestimate the burden of disease and health care practices under assessment. In the context of RMC, poor quality data could have adverse consequences including the naming and shaming of providers. By outlining a blueprint of the minimum activities required to generate reliable and valid survey tools, we hope to improve efforts to develop and deploy face-to-face and phone surveys in the health sector. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12173

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