Association of Workload and Practice of Respectful Maternity Care Among the Healthcare Providers, Before and During the COVID-19 Pandemic in South Western Nepal: A Cross-Sectional Study

Abstract

Introduction: Respectful maternity care is a crucial component of intrapartum quality care. As the imbalance in demand and supply of the maternity care workforce affects intrapartum quality care, respectful maternity care might be affected by increased workload among the healthcare providers. Thus, this study was conducted to examine the association between workload among healthcare providers and their practice of respectful maternity care, both before and during the COVID-19 pandemic. Methods: A cross-sectional study was conducted in South Western Nepal. A total of 78 birthing centers and 267 healthcare providers were included. Data collection was done through telephone interviews. The exposure variable was workload among the healthcare providers, and the outcome variable was respectful maternity care practice before and during the COVID-19 pandemic. Multilevel mixed-effect linear regression was used to examine the association. Results: The median client-provider ratio before and during the pandemic was 21.7 and 13.0, respectively. The mean score of respectful maternity care practice was 44.5 (SD 3.8) before the pandemic, which was decreased to 43.6 (SD 4.5) during the pandemic. Client-provider ratio was negatively associated with respectful maternity care practice for both times; before (Coef. -5.16; 95% CI -8.41 to -1.91) and during (Coef. -7.47; 95% CI -12.72 to -2.23) the pandemic. The variance of respectful maternity care practice among the health facilities was 26% before the pandemic, and was increased to 33% during the pandemic. Being tested positive for COVID-19 in the past was negatively associated with respectful maternity care practice during the COVID-19 pandemic (Coef. -3.18; 95% CI -5.06 to -1.30). Conclusions: While a higher client-provider ratio was associated with a lower respectful maternity care practice score both before and during the COVID-19 pandemic, the coefficient was larger during the pandemic. Also, the variance among the health facilities for respectful maternity care was increased more during the COVID-19 pandemic. The findings of this study call for the decrement in the client-provider ratio for better respectful maternity care practice, especially during the pandemic. However, supplying health human resources per the population demand, especially during the pandemic, may be difficult in a resource-limited setting. The number of delivery cases at local health facilities should be increased by improving the quality of care, particularly during the pandemic. This could help equal distribution of client-provider and practice respectful maternity care, even during the pandemic. Further, healthcare providers who tested positive for COVID-19 had lower respectful maternity care practice scores. Therefore, additional physical and mental health support to healthcare providers should be considered to improve their respectful maternity care practice, particularly during the pandemic.