Association Between Disrespect and Abuse During Childbirth and Women’s Confidence in Health Facilities in Tanzania

Kujawski, Stephanie; Mbaruku, Godfrey; Freedman, Lynn P.; Ramsey, Kate; Moyo, Wema; Kruk, Margaret E

doi:10.1007/s10995-015-1743-9

Cited by 138 publications

(140 citation statements)

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“…A recent systematic review synthesized global evidence on mistreatment during childbirth, and presented a new typology to describe the phenomenon [7]. This review built on other work in the field, including a landscape analysis [8] and primary studies in Kenya, Tanzania and Nigeria [9–11]. In Guinea, anecdotal evidence suggests that women across the country experience mistreatment during childbirth.…”

Section: Introductionmentioning

confidence: 99%

Perceptions and experiences of the mistreatment of women during childbirth in health facilities in Guinea: a qualitative study with women and service providers

et al. 2017

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BackgroundEvery woman is entitled to respectful care during childbirth; so it is concerning to hear of informal reports of mistreatment during childbirth in Guinea. This study sought to explore the perceptions and experiences of mistreatment during childbirth, from the perspectives of women and service providers, and the analysis presents findings according to a typology of mistreatment during childbirth.MethodsThis study used qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) and was conducted with four groups of participants: women of reproductive age, midwives, doctors, and administrators. The study took place in two sites in Guinea, an urban area (Mamou) and peri-urban (Pita). Data collection was conducted in two health facilities for providers and administrators, and in the health facility catchment area for women. Data were collected in local languages (Pular and Malinké), then transcribed and analyzed in French. We used a thematic analysis approach and coded transcripts manually.ResultsA total of 64 IDIs and eight FGDs were conducted and are included in this analysis, including 40 IDIs and eight FGDs with women of reproductive age, 5 IDIs with doctors, 13 IDIs with midwives, and 6 IDIs with administrators. Participants described their own personal experiences, experiences of women in their communities and perceptions regarding mistreatment during childbirth. Results were organized according to a typology of mistreatment during childbirth, and included instances of physical abuse, verbal abuse, abandonment and neglect. Women described being slapped by providers, yelled at for noncompliance with provider requests, giving birth on the floor and without skilled attendance in the health facility. Poor physical conditions of health facilities and health workforce constraints contributed to experiences of mistreatment.ConclusionsThese results are important because they demonstrate that the mistreatment of women during childbirth exists in Guinea and occurs in multiple forms. These data should be used by the Ministry of Health and other stakeholders to develop strategies to reduce and prevent the mistreatment of women during childbirth.

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Section: Introductionmentioning

confidence: 99%

Perceptions and experiences of the mistreatment of women during childbirth in health facilities in Guinea: a qualitative study with women and service providers

et al. 2017

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“…For example this may include slapping, pinching, verbal abuse, lack of privacy and discrimination [3]. In recent years, evidence from several sub-Saharan African countries, including Tanzania [4, 5], Kenya [6, 7], Nigeria [8] and Ghana [9–11], suggests that mistreatment during childbirth may be a common occurrence, and may be exacerbated by certain characteristics of the woman, including age and HIV status. This work has been groundbreaking to better understand women’s experiences of mistreatment during childbirth, as well as efforts to measure mistreatment that does occur, through observations of labor and childbirth, and follow-up surveys with women.…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of women’s and health providers’ attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea

et al. 2017

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BackgroundReducing maternal morbidity and mortality remains a key health challenge in Guinea. Anecdotal evidence suggests that women in Guinea are subjected to mistreatment during childbirth in health facilities, but limited research exists on this topic. This study was conducted to better understand the social norms and the acceptability of four scenarios of mistreatment during childbirth, from the perspectives of women and service providers.MethodsThis study used qualitative methods including in-depth interviews (IDIs) and focus group discussions (FGDs) with women of reproductive age, midwives, nurses and doctors. This study was conducted in one urban area (Mamou) and one peri-urban area (Pita) in Guinea. Participants were presented with four scenarios of mistreatment during childbirth, including a provider: (1) slapping a woman; (2) verbally abusing a woman; (3) refusing to help a woman; and (4) forcing a woman to give birth on the floor. Data were collected in local languages (Pular and Malinké) and French, and transcribed and analyzed in French. We used a thematic analysis approach and manually coded the data using a codebook developed for the project.ResultsA total of 40 IDIs and eight FGDs were conducted with women of reproductive age, 5 IDIs with doctors, and 13 IDIs with midwives. Most women were not accepting of any of the scenarios, unless the action was perceived to be used to save the life of the mother or child. However, they perceived a woman’s disobedience and uncooperativeness to contribute to her poor treatment. Women reacted to this mistreatment by accepting poor treatment, refusal to use the same hospital, revenge against the provider or complaints to hospital management. Service providers were accepting of mistreatment when women were disobedient, uncooperative, or to save the life of the baby.ConclusionsThis is the first known study on mistreatment of women during childbirth to be conducted in Guinea. Both women and service providers were accepting of mistreatment during childbirth under certain conditions. Any approach to preventing and eliminating mistreatment during childbirth must consider these important contextual and social norms and develop a comprehensive intervention that addresses root causes. Further research is needed on how to measure mistreatment during childbirth in Guinea.

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“…Sub-standard quality of care contributes towards maternal mortality; for example, a study assessing all maternal deaths in tertiary care hospitals in Sri Lanka found that the majority of maternal deaths were preventable, with 79 % attributable to substandard care [7]. Beyond poor health outcomes, a study in Tanzania suggests that women who experience disrespectful or abusive care reported less satisfaction with their delivery, perceived quality of care for delivery, and were less likely to deliver in the same facility [8]. Analyses suggest that were respectful care and availability of drugs/equipment to improve, that the proportion of women preferring a facility delivery would increase from 43 to 88 % [5].…”

Section: Introductionmentioning

confidence: 99%

Women’s status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory

Sudhinaraset

Treleaven

Melo

et al. 2016

BMC Pregnancy Childbirth

119

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BackgroundMistreatment of women in healthcare settings during childbirth has been gaining attention globally. Mistreatment during childbirth directly and indirectly affects health outcomes, patient satisfaction, and the likelihood of delivering in a facility currently or in the future. It is important that we study patients’ reports of mistreatment and abuse to develop a deeper understanding of how it is perpetrated, its consequences, and to identify potential points of intervention. Patients’ perception of the quality of care is dependent, not only on the content of care, but importantly, on women’s expectations of care.MethodsThis study uses rich, mixed-methods data to explore women’s characteristics and experiences of mistreatment during childbirth among slum-resident women in Uttar Pradesh, India. To understand the ways in which women’s social and cultural factors influence their expectations of care and consequently their perceptions of respectful care, we adopt a Cultural Health Capital (CHC) framework. The quantitative sample includes 392 women, and the qualitative sample includes 26 women.ResultsQuantitative results suggest high levels of mistreatment (over 57 % of women reported any form of mistreatment). Qualitative findings suggest that lack of cultural health capital disadvantages patients in their patient-provider relationships, and that women use resources to improve care they receive. Participants articulated how providers set expectations and norms regarding behaviors in facilities; patients with lower social standing may not always understand standard practices and are likely to suffer poor health outcomes as a result. Of importance, however, patients also blame themselves for their own lack of knowledge.ConclusionsLack of cultural health capital disadvantages women during delivery care in India. Providers set expectations and norms around behaviors during delivery, while women are often misinformed and may have low expectations of care.

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Association Between Disrespect and Abuse During Childbirth and Women’s Confidence in Health Facilities in Tanzania

Abstract: Our study highlights disrespectful and abusive treatment during childbirth as an important factor in reducing women's confidence in health facilities. Improving interpersonal care must be an integral part of quality improvement in maternal health.

Cited by 138 publications

References 35 publications

Perceptions and experiences of the mistreatment of women during childbirth in health facilities in Guinea: a qualitative study with women and service providers

Perceptions and experiences of the mistreatment of women during childbirth in health facilities in Guinea: a qualitative study with women and service providers

A qualitative study of women’s and health providers’ attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea

Women’s status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory

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