Community Perceptions of Person-Centered Maternity Care in Migori County, Kenya

Odiase, Osamuedeme; Akinyi, Beryl; Kinyua, Joyceline; Afulani, Patience A.

doi:10.3389/fgwh.2021.668405

Cited by 6 publications

(3 citation statements)

References 35 publications

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“…Perceived risk in peri-urban Kenya covers both social and biomedical aspects of prior experience at facilities. Positive and negative facility-based maternity experiences, as described in extant respectful maternity care (RMC) and person-centered maternity care (PCMC) literatures ( 36 , 37 ), have implications for care-seeking; our study elaborates on how these relationships can be mediated by individual and collective care-user trust in maternity care. While positive patient-facility interactions increase service use due to elevated trust generally, we saw from women's and men's recollection of past inequitable treatment (detention for inability to pay) that lower trust among historically marginalized groups deters care seeking, similar to other studies ( 38 ).…”

Section: Discussionmentioning

confidence: 94%

Determining a Trusting Environment for Maternity Care: A Framework Based on Perspectives of Women, Communities, Service Providers, and Managers in Peri-Urban Kenya

Sripad¹,

Merritt²,

Kerrigan³

et al. 2022

Front. Glob. Womens Health

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Trust in health service providers and facilities is integral to health systems accountability. Understanding determinants of trust, a relational construct, in maternity settings necessitates exploring hierarchical perspectives of users, providers, and influencers in the care environment. We used a theoretically driven qualitative approach to explore trust determinants in a maternity setting across patient-provider, inter-provider, and community-policymaker interactions and relationships in peri-urban Kenya. Focus groups (n = 8, N = 70) with women who recently gave birth (WRB), pregnant women, and male partners, and in-depth-interviews (n = 33) with WRB, health care providers and managers, and community health workers (CHWs) were conducted in 2013, soon after the national government's March 2013 introduction of a policy mandate for “Free Maternity Care.” We used thematic coding, memo writing, and cross-perspective triangulation to develop a multi-faceted trust determinants framework. We found that determinants of trust in a maternity setting can be broadly classified into six types of factors, where each type of factor represents a cluster of determinants that may each positively or negatively influence trust: patient, provider, health facility, community, accountability, and structural. Patient factors are prior experiences, perceived risks and harms, childbirth outcomes, and maternal health literacy. Provider factors are empathy and respect, responsiveness, and perceived capability of providers. Health facility factors are “good services” as perceived by patients, physical environment, process navigability, provider collaboration and oversight, discrimination, and corruption. Community factors are facility reputation and history, information channels, and maternal health literacy. Accountability factors are alignment of actions with expectations, adaptations to policy changes, and voice and feedback. Structural factors are institutional hierarchies and policies in the form of professional codes. Trust determinants are complex, nuanced and reflect power dynamics across relationships. Findings offer insight into socio-political maternity norms and demand a more equitable care interface between users and providers.

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Section: Discussionmentioning

confidence: 94%

Determining a Trusting Environment for Maternity Care: A Framework Based on Perspectives of Women, Communities, Service Providers, and Managers in Peri-Urban Kenya

Sripad¹,

Merritt²,

Kerrigan³

et al. 2022

Front. Glob. Womens Health

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“…If women believe they will receive adequate care during childbirth in a health facility, based on their antenatal care experience and birth preparation education, women may regard a health facility delivery with an SBA more highly. A potential reason why the association between facility-based childbirth and perceived antenatal experience of care was not significant in the multivariate analysis is the widespread perceptions of disrespect and abuse during facility-based childbirth [ 40 ]. These widespread negative community perceptions of the facility-based birth experience might outweigh women’s perceptions of how their individual interactions with providers during antenatal care may influence their childbirth experience.…”

Section: Discussionmentioning

confidence: 99%

Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care

Kapula

Shiboski

Dehlendorf

et al. 2022

BMC Pregnancy Childbirth

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Background Giving birth in health facilities with skilled birth attendants (SBAs) is one of the key efforts promoted to reduce preventable maternal deaths in sub-Saharan Africa. However, research has revealed large socioeconomic status (SES) disparities in facility-based childbirth. We seek to extend the literature on the factors underlying these SES disparities. Drawing on the Disparities in Skilled Birth Attendance (DiSBA) framework, we examined the contribution of three proximal factors—perceived need, accessibility, and quality of care—that influence the use of SBAs. Methods We used data from a survey conducted in Migori County, Kenya in 2016, among women aged 15–49 years who gave birth nine weeks before the survey (N = 1020). The primary outcome is facility-based childbirth. The primary predictors are wealth, measured in quintiles calculated from a wealth index based on principal component analysis of household assets, and highest education level attained. Proposed mediating variables include maternal perceptions of need, accessibility (physical and financial), and quality of care (antenatal services received and experience of care). Logistic regression with mediation analysis was used to investigate the mediating effects. Results Overall, 85% of women in the sample gave birth in a health facility. Women in the highest wealth quintile were more likely to give birth in a facility than women in the lowest quintile, controlling for demographic factors (adjusted odds ratio [aOR]: 2.97, 95% CI: 1.69–5.22). College-educated women were five times more likely than women with no formal education or primary education to give birth in a health facility (aOR: 4.96; 95% CI: 1.43–17.3). Women who gave birth in health facilities had higher perceived accessibility and quality of care than those who gave birth at home. The five mediators were estimated to account for between 15% and 48% of the differences in facility births between women in the lowest and higher wealth quintiles. Conclusion Our results confirm SES disparities in facility-based childbirth, with the proximal factors accounting for some of these differences. These proximal factors – particularly perceived accessibility and quality of care – warrant attention due to their relationship with facility-birth overall, and their impact on inequities in this care.

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“…Such poor PCMC leads to lack of, delayed, inadequate, unnecessary, or harmful care [10]. Mistreatment deters women from giving birth in health facilities; the experience of poor PCMC, even by a few women, leads to negative community perceptions of quality of care, which discourages other women from giving birth in health facilities [11][12][13][14]. On the other hand, positive healthcare experiences can improve health outcomes through pathways such as patient engagement, safety, trust, higher patient and provider satisfaction, and improved psychosocial health , [15,16].…”

Section: Introductionmentioning

confidence: 99%

Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana

Afulani

Okiring

Aborigo

et al. 2022

Preprint

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Background Person-centered maternity care (PCMC) has become a priority in the global health discourse on the quality of care due to the high prevalence of disrespectful and lack of responsive care during facility-based childbirth. Although PCMC is generally sub-optimal, there are significant disparities. On average, women of low socioeconomic status (SES) tend to receive poorer PCMC than women of higher SES. Yet few studies have explored factors underlying these inequities. In this study, we examined provider implicit and explicit biases that could lead to inequities PCMC based on SES. Methods Data are from a cross-sectional survey with 150 providers recruited from 19 health facilities in the Upper East region of Ghana from October 2020 to January 2021. Explicit SES bias was assessed using situationally-specific vignettes (low SES and high SES characteristics) on providers’ perceptions of women’s expectations, attitudes, and behaviors. Implicit SES bias was assessed using an Implicit Association Test (IAT) that measures associations between women’s SES characteristics and providers’ perceptions of women as ‘difficult’ or ‘good’. Analysis included descriptive statistics, mixed-model ANOVA, and bivariate and multivariate linear regression. Results The average explicit bias score was 18.1 out of 28 (SD = 3.60) for the low SES woman vignette and 16.9 out of 28 (SD = 3.15) for the high SES woman vignette (p < 0.001), suggesting stronger explicit bias towards the lower SES woman. These biases manifested in higher agreement to statements such as the low SES woman in the vignette is not likely to expect providers to introduce themselves and is not likely to understand explanations. The average IAT score was 0.80 (SD = 0.34), indicating a significant bias in associating positive characteristics with high SES women and negative characteristics with low SES women. Providers with higher education and years of experience had significantly lower explicit bias scores than those with lower education and experience. Providers in private facilities had higher IAT scores than those in government hospitals. Conclusions The findings provide evidence of both implicit and explicit SES bias among maternity providers. These biases need to be addressed in interventions to achieve equity in PCMC and to improve PCMC for all women.

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Community Perceptions of Person-Centered Maternity Care in Migori County, Kenya

Cited by 6 publications

References 35 publications

Determining a Trusting Environment for Maternity Care: A Framework Based on Perspectives of Women, Communities, Service Providers, and Managers in Peri-Urban Kenya

Determining a Trusting Environment for Maternity Care: A Framework Based on Perspectives of Women, Communities, Service Providers, and Managers in Peri-Urban Kenya

Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care

Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana

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