Directly observed and reported respectful maternity care received during childbirth in public health facilities, Ibadan Metropolis, Nigeria

Abstract

Respectful maternity care (RMC) is believed to improve women’s childbirth experience and increase health facility delivery. Unfortunately, few women in low- and middle-income countries experience RMC. Patient surveys and independent observations have been used to evaluate RMC, though seldom together. In this study, we assessed RMC received by women using two methodologies and evaluated the associated factors of RMC received. This was a cross-sectional study conducted in nine public health facilities in Ibadan, a large metropolis in Nigeria. We selected 269 pregnant women by cluster sampling. External clinical observers observed them during childbirth using the 29-item Maternal and Child Health Integrated Program RMC observational checklist. The same women were interviewed postpartum using the 15-item RMC scale for self-reported RMC. We analysed total RMC scores and RMC sub-category scores for each tool. All scores were converted to a percentage of the maximum possible to facilitate comparison. Correlation and agreement between the observed and reported RMC scores were determined using Pearson’s correlation and Bland-Altman analysis respectively. Multiple linear regression was used to identify factors associated with observed RMC. No woman received 100% of the observed RMC items. Self-reported RMC scores were much higher than those observed. The two measures were weakly positively correlated (rho = 0.164, 95%CI: 0.045–0.278, p = 0.007), but had poor agreement. The lowest scoring sub-categories of observed RMC were information and consent (14.0%), then privacy (28.0%). Twenty-eight percent of women (95%CI: 23.0% -33.0%) were observed to be hit during labour and only 8.2% (95%CI: 4.0%-18.0%) received pain relief. Equitable care was the highest sub-category for both observed and reported RMC. Being employed and having completed post-secondary education were significantly associated with higher observed RMC scores. There were also significant facility differences in observed RMC. In conclusion, the women reported higher levels of RMC than were observed indicating that these two methodologies to evaluate RMC give very different results. More consensus and standardisation are required in determining the cut-offs to quantify the proportion of women receiving RMC. The low levels of RMC observed in the study require attention, and it is important to ensure that women are treated equitably, irrespective of personal characteristics or facility context.

Implementing maternal and newborn health quality of care standards in healthcare facilities to improve the adoption of respectful maternity care in Bangladesh, Ghana and Tanzania: a controlled before and after study

“…Consistent with the literature, women reported more significant improvements in care experience compared with observers 38 39. This may suggest that women may have lower expectations of care experiences than observers or may indicate a possible social desirability bias.…”

Association of workload and practice of respectful maternity care among the healthcare providers, before and during the early phase of COVID-19 pandemic in South Western Nepal: a cross-sectional study

“…It was assessed using a questionnaire adapted from the performance standard for respected maternity care prepared by the Maternal and Child Health Integrated Program [ 38 ]. This tool was chosen for this study because it was used in other similar LMICs [ 39 , 40 ]. Also, it was adapted from Bowser and Hills’s landscape analysis on disrespect and abuse in facility-based birth, which was developed using evidence from multiple countries [ 8 ].…”

Women’s Voices, Women’s Realities; Experiences of Respectful Maternity Care During Childbirth in Jos, Nigeria

“…Verbal abuse, a breach of confidentiality, physical abuse, and nonconsensual care are examples of disrespectful care. The treatment received during pregnancy and childbirth may have an immediate and permanent impact on how people use healthcare in the future (Esan, Maswime, & Blaauw, 2022;Bohren et al, 2017). Women frequently hesitate to seek institutional care once more due to their fear of being disrespected and abused (Mengesha et al, 2020;Ukke, Gurara, & Boynito, 2019;Tekle Bobo et al, 2019;Bohren et al, 2017), and that might act as a stronger impediment to receiving expert birth care than other lesscommonly acknowledged deterrents like distance and cost (Bowser & Hill, 2010).…”

“…Women frequently hesitate to seek institutional care once more due to their fear of being disrespected and abused (Mengesha et al, 2020;Ukke, Gurara, & Boynito, 2019;Tekle Bobo et al, 2019;Bohren et al, 2017), and that might act as a stronger impediment to receiving expert birth care than other lesscommonly acknowledged deterrents like distance and cost (Bowser & Hill, 2010). A woman's fundamental human right is to be treated with respect (Esan, Maswime, & Blaauw, 2022;Mengesha et al, 2020).…”