Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal

Abstract

Background Respectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns. Methods At one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017–July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health – ethnicity, age, sex, mode of birth – as possible predictors for reporting poor care. Results Among 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (β = 0.23, p-value < 0.0001). Women from Madeshi (a disadvantaged ethnic group) were more likely to report poor care (β = − 0.34; p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (β = − 0.42; p-value < 0.0001) than women with a vaginal birth. However, babies born by caesarean had a 98% decrease in the odds (aOR = 0.02, 95% CI, 0.01–0.05) of receiving skin-to-skin contact than those with vaginal births. Conclusions Measurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women’s age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.

Perceptions of Good-Quality Antenatal Care and Birthing Services among Postpartum Women in Nepal

“…A higher percentage of our participants were young, belonged to minority ethnicities, and were from a marginalized population. Contrary to our study's findings, previous studies showed that women felt entitled to receive respectful care without any abuse from healthcare providers [8,43,56]. In contrast, our participants showed a forgiving attitude towards the providers' rude behavior, understanding that their intended motivation was for the women's welfare.…”

Count every newborn: EN-BIRTH study improving facility-based coverage and quality measurement in routine information systems

“…EN-BIRTH clearly adds to findings from previous research that surveys are not an appropriate tool for capturing valid information on clinical interventions provided around the time of birth, and that more work is needed to refine survey indicators based on timing of care, such as early initiation of breastfeeding [30,31]. Surveys may be useful for measuring experience of care, but there are notable challenges in women's ability to report their experience of care, especially when asking questions in or near the facility [26,32].…”

“…Two papers assess validity and data quality for the outcomes of birthweight [24] and stillbirth [25]. Measurement of respectful maternal and newborn care is assessed in one site (Nepal) [26]. Processes and perceptions for birthweight [27] and birth registration measurement [28] are examined in the Tanzanian sites.…”

Women’s report of mistreatment during facility-based childbirth: validity and reliability of community survey measures

“…12 Measurement of respectful and person-centred care for reproductive health is rapidly advancing in many countries. [13][14][15][16][17][18] A critical question is whether treatment during childbirth can similarly be measured in a valid and comparable way between subgroups in a given health system as well as across health systems.…”