Assessment of Women’s Experience of Care during Childbirth for Quality Improvement at Level 5 Health Facilities in Bungoma County, Kenya

High maternal and newborn mortality is a pressing problem in developing countries. Poor treatment during childbirth contributes directly and indirectly to this problem. Many women experience disrespectful and abusive treatment during childbirth worldwide which violates their rights. In Kenya, 20% of women report having experienced some form of disrespect and abuse (D&A). Bungoma County is among the 15 counties with the worst maternal and newborn health statistics in Kenya. The maternal mortality rate is 382 per 100,000 live births and newborn deaths 32 per 1,000 live births, while skilled birth attendance is 41.4%. This study was motivated by the poor maternal and newborn indicators, rising incidences of D&A, limited formal research on respectful maternity care. The study aimed at assessing women’s experience of care during childbirth at Level 5 health facilities in Bungoma County. The specific objectives were to determine the women’s experiences of care during childbirth, to determine factors contributing to disrespect and abuse during childbirth and to identify strategies for addressing issues affecting respectful maternity care for promoting quality of maternal and newborn care. A cross-sectional descriptive study design was used. It involved 360 mothers. Analysis of quantitative data was done using SPSS. Descriptive statistics were presented in graphs, tables, frequencies and percentages. Qualitative data was analysed thematically. The prevalence of D&A was 42.2%, younger age and lower education aggravated D&A. Autonomy, privacy and confidentiality, and absence of birth companionship were major aspects of D&A. Health workforce shortage, inadequate supervision, space and beds, poor provider-patient relationships were factors leading to D&A. It was concluded that there is a need for increased incorporation of Respectful Maternity Care (RMC) in routine care, deploy more staff, avail equipment and supplies, and enhance support supervision. The study information intends to assist stakeholders in prioritising policy actions for improving the quality of maternal and newborn health outcomes and indicators.

The “Sustainability Doctrine” in Donor-Driven Maternal Health Programs in Tanzania

Strengthening health systems to provide equitable, sustainable health care has been identified as essential for improving maternal and reproductive health. Many donors and non-governmental organizations (NGOs) have contributed to undermining health system strengthening, however, through adhering to what Swidler and Watkins call the “sustainability doctrine,” policies that prioritize time-limited, targeted interventions best suited for short-term funding streams, rather than the long-term needs of local populations. This chapter presents ethnographic data from semi-structured and key informant interviews with 16 policymakers and NGO directors in Dar es Salaam, Tanzania from 2011 to 2012. I illustrate how sustainability doctrine policies were put into practice, and how they have persisted, despite their shortcomings, using examples of donor-prioritized maternal healthcare initiatives in Tanzania rolled-out several years apart: prevention of mother-to-child transmission of HIV (PMTCT) and basic emergency obstetric and newborn care (BEmONC) programs in the late 2000s, and more recent efforts to implement respectful maternity care (RMC) programs. I focus on several issues informants identified as crippling efforts to build strong health systems, particularly the internal brain drain of healthcare workers from the public sector to higher-paying NGO jobs, and the prioritization of types of programs donors believed could be sustained after the funding period ended, specifically trainings and workshops. I describe how despite these issues, international organizations still design and implement less effective programs that often fail to account for local circumstances in their efforts to solve some of the more intractable health issues facing Tanzania today, in particular, the country’s stagnating maternal mortality rate. In this chapter, I argue that practices promoted and implemented under the guise of “sustainability” in policy papers and reports generated by donors paradoxically contribute to health system precarity in Tanzania.

A Study to Assess the Knowledge on Respectful Maternal Care Among the Health Workers Working in Selected Hospital/Health Centers at Meerut

The pregnancy and mother hood is the right of a women. During the time of labour, the women suffer shouting, slapping, pinching, hitting, and also application of extreme fundal pressure which is against human rights. Respectful maternity care (RMC) is a rightful expectation of every woman. Care during this period needs to encompass basic human rights, including the rights to respect, dignity, confidentiality, information and informed consent, the right to the highest attainable standard of health, and freedom from discrimination and from all forms of ill-treatment including making abuse to mother in labour including lack of treatment with dignity, delivery by unqualified personnel, lack of privacy, demand for informal payments, and lack of basic infrastructure, hygiene, and sanitation . Objectives 1) To assess the knowledge on respectful maternity care among the health worker. 2) To determine the association between the knowledge on respectful maternity care with the selected demographic variable. Hypothesis H1-There will be significant difference on knowledge about respectful maternity care. H2-There will be significant association between the knowledge and the socio demographic variable. Methodology: A descriptive research design was undertaken for this study. The population of the study consists of health workers at selected hospitals of Meerut. With the sample size of 30 were selected by using non probability convenient sampling. Result: Among 30 Health Workers Sample 15(50%) Were Having Moderate Knowledge ,12(40%) Were Having Adequate Knowledge and Only 03(10%) Were Having Inadequate Knowledge About Respectful Maternity Care. And there was significant association with number of deliveries whereas there is no significant association between age, sex, education, years of experience, area of working and attending any midwifery related training Conclusion: The study concluded that the most of the health workers are having moderate knowledge regarding the respectful maternity care and there was significant association among the students. Keywords: Respectful maternity care, assess, knowledge

Effectiveness of Respectful Maternity Care Interventions for Women Using Maternal Health Care: A Systematic Review Protocol

Background: Studies have indicated the mistreatment of women during maternal health care provision as being a driving factor for women eschewing professional care. The mistreatment of women is not only a violation of human rights, but also a significant contributor to poor-quality maternal care. Various strategies aimed at preventing the mistreatment of women and enhancing respectful maternity have been proposed, however, the positive effects and outcomes of these interventions necessitate further clarity. This systematic review will examine the effectiveness of respectful maternity care intervention programs in preventing the mistreatment of women whilst enhancing respectful maternity care in health facilities.Methods: A systematic review will be undertaken according to the Preferred Reporting Items for Systematic and Meta-Analysis (PRISMA)2020. Both published and unpublished randomised, non-randomised controlled and observational studies obtained from PubMed, CINHAL, EMBASE, AJOL, and other databases and grey literature sources will be assessed against an inclusion and exclusion criteria to include in the review. Two independent reviewers will assess the papers selected for retrieval to ensure methodological validity. Standardised critical appraisal instruments from the Critical Appraisal Skills Program (CASP) and Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) will be used. The data will be extracted from papers included in the review using two independent reviewers' standardised data extraction tool. Evidence synthesis and, wherever possible, meta-analysis will be performed. Certainty of the evidence will be assessed by using GRADE criteria. Systematic review protocol registration: Submitted to PROSPERO on 9th of November 2021 (ID. 287049).

Innovation in Nursing; Nurse Practitioner in Midwifery(NPM)-The Future of Indian Nursing

Nursing innovation is a fundamental source of progress for health care systems around the world. According to a report by ICN (2009), innovation in nursing applications is extremely important for improving health, preventing diseases, describing and avoiding risk factors, developing healthy life standard attitudes because innovation helps updated knowledge, method and services be invented and discovered by the institutions. Innovation starts with a good idea, but it is much more than that. It also refers to the process of turning that good idea into something that can be used, something that is implementable and achievable, and hopefully, will bring about better health promotion, disease prevention and better patient care [4]. Considering the necessity for trained human resources to give quality care to 30 million pregnancies each year in India and at a similar time recognizing the challenges earlier, Government of India has proposed an alternate model of service provision for strengthening reproductive, maternal and neonatal health services by nurse practitioners in midwifery through Midwife Led Care Units (MLCUs). The ‘Guidelines on Midwifery Services in India’ set transformative change must be at the center of midwifery education. The ‘Midwifery Services Initiative’ aims to create a new cadre of midwives titled “Nurse Practitioner in Midwifery” (NPM) who are skilled in accordance with ICM competencies, knowledgeable and capable of providing compassionate women centered, reproductive, maternal and new-born health services (RMNCH) and to develop an enabling environment for integration of this cadre into the general public health system so as to achieve the SDGs for maternal and new-born health (MoHFW, 2018). The Nurse Practitioner in Midwifery (NPM) will be responsible for promotion of health of women throughout their life cycle, with special focus on women during their childbearing years and their new-born's. She will be responsible for providing respectful maternity care during preconception, pregnancy, childbirth, and post-natal period including the care of new born. Introduction of NPM will help to strengthen our health work force, and will go a long way in addressing the country’s core need of strengthening human resources for health, and it will empower the nurse practitioner in midwifery as leaders, in tandem with the global movement of role expansion and empowerment of nurse midwives.

Vaginal examinations and mistreatment of women during facility-based childbirth in health facilities: secondary analysis of labour observations in Ghana, Guinea and Nigeria

BackgroundPrevious research on mistreatment of women during childbirth has focused on physical and verbal abuse, neglect and stigmatisation. However, other manifestations of mistreatment, such as during vaginal examinations, are relatively underexplored. This study explores four types of mistreatment of women during vaginal examinations: (1) non-consented care, (2) sharing of private information, (3) exposure of genitalia and (4) exposure of breasts.MethodsA secondary analysis of data from the WHO multicountry study ‘How Women Are Treated During Childbirth’ was conducted. The study used direct, continuous labour observations of women giving birth in facilities in Ghana, Guinea and Nigeria. Descriptive and multivariable logistic regression analyses were used to describe the different types of mistreatment of women during vaginal examinations and associated privacy measures (ie, availability of curtains).ResultsOf the 2016 women observed, 1430 (70.9%) underwent any vaginal examination. Across all vaginal examinations, 842/1430 (58.9%) women were observed to receive non-consented care; 233/1430 (16.4%) women had their private information shared; 397/1430 (27.8%) women had their genitalia exposed; and 356/1430 (24.9%) had their breasts exposed. The observed prevalence of mistreatment during vaginal examinations varied across countries. There were country-level differences in the association between absence of privacy measures and mistreatment. Absence of privacy measures was associated with sharing of private information (Ghana: adjusted OR (AOR) 3.8, 95% CI 1.6 to 8.9; Nigeria: AOR 4.9, 95% CI 1.9 to 12.7), genitalia exposure (Ghana: AOR 6.7, 95% CI 2.9 to 14.9; Nigeria: AOR 6.5, 95% CI 2.9 to 14.5), breast exposure (Ghana: AOR 5.9, 95% CI 2.8 to 12.9; Nigeria: AOR 2.7, 95% CI 1.3 to 5.9) and non-consented vaginal examination (Ghana: AOR 2.5, 95% CI 1.4 to 4.7; Guinea: AOR 0.21, 95% CI 0.12 to 0.38).ConclusionOur results highlight the need to ensure better communication and consent processes for vaginal examination during childbirth. In some settings, measures such as availability of curtains were helpful to reduce women’s exposure and sharing of private information, but context-specific interventions will be required to achieve respectful maternity care globally.

Experiences and perceptions of birth companions supporting women in labour at a District Hospital in Limpopo, South Africa

Background: South Africa has included birth companions in its national guidelines for maternity care and the revised Maternity Case Record, in and effort to improve the quality and experience of care. However, reservations amongst healthcare providers remain about the acceptability of birth companions in the labour ward.Objectives: To document the experiences and perceptions of birth companions who supported women in labour in a rural hospital in Limpopo Province where a Respectful Maternity Care (RMC) project was piloted.Method: An institution-based cross-sectional study design was employed. Purposive sampling was employed where all birth companions who supported a woman during labour and birth were included in the study. The experiences and perceptions of birth companions were captured using a birth companion feedback book during the period of 1st April to 30th August 2019. Thematic analysis was used to analyse the data.Results: Seventy-one (71) of the 73 birth companions only had positive responses about the birthing experience and how both the birth companion and woman in labour were treated. Two birth companions were dissatisfied with the treatment provided by the midwife that supported the birth.Conclusion: It is important for healthcare providers to understand the far reaching emotional and psychological impact of their attitudes and behaviour on, not only women in labour but also on others who witness their (healthcare providers) behaviour. Mechanisms to obtain feedback from birth companions should be integrated into strategies to improve the quality and experience of care for women during childbirth.