Association between newborn separation, maternal consent and health outcomes: findings from a longitudinal survey in Kenya

Abstract

ObjectivesDisrespectful and poor treatment of newborns such as unnecessary separation from parents or failure to obtain parental consent for medical procedures occurs at health facilities across contexts, but little research has investigated the prevalence, risk factors or associated outcomes. This study examined these experiences and associations with healthcare satisfaction, use and breast feeding.DesignProspective cohort study.Setting3 public hospitals, 2 private hospitals, and 1 health centre/dispensary in Nairobi and Kiambu counties in Kenya.ParticipantsData were collected from women who delivered in health facilities between September 2019 and January 2020. The sample included 1014 women surveyed at baseline and at least one follow-up at 2–4 or 10 weeks post partum.Primary and secondary outcome measures(1) Outcomes related to satisfaction with care and care utilisation; (2) continuation of post-discharge newborn care practices such as breast feeding.Results17.6% of women reported newborn separation at the facility, of whom 71.9% were separated over 10 min. 44.9% felt separation was unnecessary and 8.4% reported not knowing the reason for separation. 59.9% reported consent was not obtained for procedures on their newborn. Women separated from their newborn (>10 min) were 44% less likely to be exclusively breast feeding at 2–4 weeks (adjusted OR (aOR)=0.56, 95% CI: 0.40 to 0.76). Obtaining consent for newborn procedures corresponded with 2.7 times greater likelihood of satisfaction with care (aOR=2.71, 95% CI: 1.67 to 4.41), 27% greater likelihood of postpartum visit attendance for self or newborn (aOR=1.27, 95% CI: 1.05 to 1.55), and 33% greater likelihood of exclusive breast feeding at 10 weeks (aOR=1.33, 95% CI: 1.10 to 1.62).ConclusionsNewborns, mothers and families have a right to high-quality, respectful care, including the ability to stay together, be informed and properly consent for care. The implications of these experiences on health outcomes a month or more after discharge illustrate the importance of a positive experience of postnatal care.

Quality of Informed Consent Practices around the Time of Childbirth: A Cross-Sectional Study in Italy

“…A large multi-country survey among 21,027 women in 12 European countries reported gaps in consent request, with a large heterogeneity in practices: 34.7% of women did not feel involved in choices related to the medical interventions received (21.7% in Luxemburg to 77.2% in Serbia) and, among those who underwent labour, 53.6% did not provide consent for an instrumental vaginal birth (35.9% in Sweden to 81.8% in Croatia) [ 15 ]. These data align with those from low- and middle-income countries [ 19 , 20 , 21 , 22 , 23 ]. For example, during 253 continuous observations of labour/childbirth in four African countries, 75.1% of women did not consent to episiotomy, despite receiving it [ 21 ].…”

“…For example, during 253 continuous observations of labour/childbirth in four African countries, 75.1% of women did not consent to episiotomy, despite receiving it [ 21 ]. A systematic review including 15 studies reported that in Ethiopia, 16% to 92.5% of women did not provide a written and verbal informed consent before any procedure during labour and birth [ 22 ], while another study from Kenya documented that over 60% of women reported not consenting to newborn procedures [ 23 ]. In addition, few studies have reported challenges or barriers to the informed consent process in the maternal and newborn care area from health workers’ perspectives [ 24 , 25 ].…”

Global Research Priorities for Understanding and Improving Respectful Care for Newborns: A Modified Delphi Study

“…21 The high prevalence of newborns separated from their families has also been documented, although further work is needed to understand how much, if any, is driven by medical need and how often families understand and consent to such care. 22 Despite evidence suggesting that newborns also experience violations of their rights, many of the nonclinical aspects of newborn care have received limited attention.…”