Exploring the Prevalence of Disrespect and Abuse during Childbirth in Kenya

Abstract

BackgroundPoor quality of care including fear of disrespect and abuse (D&A) perpetuated by health workers influences women’s decisions to seek maternity care. Key manifestations of D&A include: physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination, abandonment, and detention in facilities. This paper describes manifestations of D&A experienced in Kenya and measures their prevalence.MethodsThis paper is based on baseline data collected during a before-and-after study designed to measure the effect of a package of interventions to reduce the prevalence of D&A experienced by women during labor and delivery in thirteen Kenyan health facilities. Data were collected through an exit survey of 641 women discharged from postnatal wards. We present percentages of D&A manifestations and odds ratios of its relationship with demographic characteristics using a multivariate fixed effects logistic regression model.ResultsTwenty percent of women reported any form of D&A. Manifestations of D&A includes: non-confidential care (8.5%), non-dignified care (18%), neglect or abandonment (14.3%), Non-consensual care (4.3%) physical abuse (4.2%) and, detainment for non-payment of fees (8.1). Women aged 20-29 years were less likely to experience non-confidential care compared to those under 19; OR: [0.6 95% CI (0.36, 0.90); p=0.017]. Clients with no companion during delivery were less likely to experience inappropriate demands for payment; OR: [0.49 (0.26, 0.95); p=0.037]; while women with higher parities were three times more likely to be detained for lack of payment and five times more likely to be bribed compared to those experiencing there first birth.ConclusionOne out of five women experienced feeling humiliated during labor and delivery. Six categories of D&A during childbirth in Kenya were reported. Understanding the prevalence of D&A is critical in developing interventions at national, health facility and community levels to address the factors and drivers that influence D&A in facilities and to encourage clients’ future facility utilization.

Mothers’ experience of disrespect and abuse during maternity care in northern Ethiopia

“…In this study, the proportion of women (22%) who reported D and A during labour and delivery is similar to studies conducted in Kenya and Ethiopia [12,16], although lower than that reported in a study conducted in Nigeria (98%) [17]. The commonly reported incidents of D and A in this study were similar to those reported in many from sub-Saharan African countries [13].…”

“…The proportion of women left unattended during labour (6%) was low in this study compared to that reported in other studies [12,14]. This could well be due to routine performance evaluations that were implemented in health services at the time of this study.…”

“…On the other hand, women referred to a health facility as a result of life-threatening complications may feel gratitude and therefore downplay their reporting of incidents of D and A [9,12,27]. However, we cannot say whether this is true or not from these data.…”

“…Educated women are more knowledgeable about their rights and have higher expectations regarding their healthcare experiences than uneducated women [12,24]. Higher incidents of disrespectful and abusive care were reported from women who had longer labour durations.…”

“…Disrespectful and abusive care includes impoliteness of care providers, inappropriate reprimands, shouting at the client, lack of empathy, refusal to assist, threatening clients for their non-compliance, and denying clients opportunities to choose or give an opinion on the care they are receiving [9–11]. In recent years, the issue has received greater attention due to improved methods to operationally define and measure the phenomena [12–14]. However, community-based information on disrespectful and abusive care in sub-Saharan Africa is still lacking.…”