Community and health system intervention to reduce disrespect and abuse during childbirth in Tanga Region, Tanzania: A comparative before-and-after study

Abstract

BackgroundAbusive treatment of women during childbirth has been documented in low-resource countries and is a deterrent to facility utilization for delivery. Evidence for interventions to address women’s poor experience is scant. We assessed a participatory community and health system intervention to reduce the prevalence of disrespect and abuse during childbirth in Tanzania.Methods and findingsWe used a comparative before-and-after evaluation design to test the combined intervention to reduce disrespect and abuse. Two hospitals in Tanga Region, Tanzania were included in the study, 1 randomly assigned to receive the intervention. Women who delivered at the study facilities were eligible to participate and were recruited upon discharge. Surveys were conducted at baseline (December 2011 through May 2012) and after the intervention (March through September 2015). The intervention consisted of a client service charter and a facility-based, quality-improvement process aimed to redefine norms and practices for respectful maternity care. The primary outcome was any self-reported experiences of disrespect and abuse during childbirth. We used multivariable logistic regression to estimate a difference-in-difference model. At baseline, 2,085 women at the 2 study hospitals who had been discharged from the maternity ward after delivery were invited to participate in the survey. Of these, 1,388 (66.57%) agreed to participate. At endline, 1,680 women participated in the survey (72.29% of those approached). The intervention was associated with a 66% reduced odds of a woman experiencing disrespect and abuse during childbirth (odds ratio [OR]: 0.34, 95% CI: 0.21–0.58, p < 0.0001). The biggest reductions were for physical abuse (OR: 0.22, 95% CI: 0.05–0.97, p = 0.045) and neglect (OR: 0.36, 95% CI: 0.19–0.71, p = 0.003). The study involved only 2 hospitals in Tanzania and is thus a proof-of-concept study. Future, larger-scale research should be undertaken to evaluate the applicability of this approach to other settings.ConclusionsAfter implementation of the combined intervention, the likelihood of women’s reports of disrespectful treatment during childbirth was substantially reduced. These results were observed nearly 1 year after the end of the project’s facilitation of implementation, indicating the potential for sustainability. The results indicate that a participatory community and health system intervention designed to tackle disrespect and abuse by changing the norms and standards of care is a potential strategy to improve the treatment of women during childbirth at health facilities. The trial is registered on the ISRCTN Registry, ISRCTN 48258486.Trial registrationISRCTN Registry, ISRCTN 48258486

Can an integrated obstetric emergency simulation training improve respectful maternity care? Results from a pilot study in Ghana

“…[7][8][9][10][11] These interventions include training health care providers in values and attitudes transformation and communication skills; setting up quality improvement teams; monitoring disrespect and abuse; improving staff conditions; maternity open days; dispute resolution, etc. [7][8][9][10][11] These interventions include training health care providers in values and attitudes transformation and communication skills; setting up quality improvement teams; monitoring disrespect and abuse; improving staff conditions; maternity open days; dispute resolution, etc.…”

“…Studies in Africa suggest that multicomponent interventions can improve various aspects of RMC including reducing disrespect and abuse. [7][8][9][10][11] These interventions include training health care providers in values and attitudes transformation and communication skills; setting up quality improvement teams; monitoring disrespect and abuse; improving staff conditions; maternity open days; dispute resolution, etc. 12 A recent systematic review concluded that while these multicomponent interventions appear to reduce some aspects of disrespect and abuse, their sustainability is unclear and the intervention components with the greatest impact have not been identified.…”

Respectful maternity care and its related factors in maternal units of public and private hospitals in Tabriz: a sequential explanatory mixed method study protocol

“…Despite the abundance of research on D&A prevalence, few studies have investigated effective measures for reducing and preventing the prevalence of D&A behaviors during labor and birth [17][18][19]. The identification of both aggravating and mitigating factors of negative and abusive care provider-patient relationships has been neglected in health systems.…”

Midwives’ experiences of implementing respectful maternity care knowledge in daily maternity care practices after participating in a four-day RMC training

“…A growing body of evidence shows that the implementation of specialized respectful maternity care programs and interventions that positively in uence the attitude and response of maternity care providers are generally effective in reducing the rate of mistreatment of childbearing women during intrapartum care services in developing countries [9][10][11][12][13][14][15]. Some of these programs and interventions include theatrebased training interventions to reduce obstetric violence [14], monitoring of midwives during practice [9], improvement in working conditions of healthcare providers [11], equipping midwives with the ability to identify and manage obstetric and neonatal emergencies [16], and the training of midwives to effectively communicate with clients [10,17].…”