Jeopardizing quality at the frontline of healthcare: prevalence and risk factors for disrespect and abuse during facility-based childbirth in Ethiopia

Abstract

Disrespect and abuse (D&A) experienced by women during facility-based childbirth has gained global recognition as a threat to eliminating preventable maternal mortality and morbidity. This study explored the frequency and associated factors of D&A in four rural health centres in Ethiopia. Experiences of women who delivered in these facilities were captured by direct observation of client-provider interaction (N = 193) and exit interview at time of discharge (N = 204). Incidence of D&A was observed in each facility, with failure to ask woman for preferred birth position most commonly observed [n = 162, 83.9%, 95% confidence interval (95% CI) 78.0–88.5%]. During exit interviews, 21.1% (n = 43, 95% CI 15.4–26.7%) of respondents reported at least one occurrence of D&A. Bivariate models using client characteristics and index birth experience showed that women’s reporting of D&A was significantly associated with childbirth complications [odds ratio (OR) = 7.98, 95% CI 3.70, 17.22], weekend delivery (OR = 0.17, 95% CI 0.05, 0.63) and no previous delivery at the facility (OR = 3.20, 95% CI 1.27, 8.05). Facility-level fixed-effect models found that experience of complications (OR = 15.51, 95% CI 4.38, 54.94) and weekend delivery (OR = 0.05, 95% CI 0.01–0.32) remained significantly and most strongly associated with self-reported D&A. These data suggest that addressing D&A in health centres in Ethiopia will require a sustained effort to improve infrastructure, support the health workforce in rural settings, enforce professional standards and target interventions to improve women’s experiences as part of quality of care initiatives.

Factors affecting Disrespect and Abuse during facility-based care in rural and urban setting in Kano, northwest Nigeria; A mixed-method study

“…There was significant association found between D&A and the time of delivery (daytime or night) in this study as women who delivered at night reported less D&A than those who delivered in the day time. This is similar to the findings of Banks et al [ Banks et al, 2018] that women who delivered at night were less likely to report D&A than those who delivered during day, but the difference was not significant and Nawab et al report no variation with time of delivery [Nawab et al, 2019]. D&A was highest when delivery was at hospital (46.4%) and lowest when it was at a health center (25%).…”

“…As in previous study, the present study also showed that mothers who stayed in a health facility longer than 2 days after delivery were likely to experience D&A [17,18]. The present study findings also corroborate with previous studies that childbirth complications were associated with reporting D&A [Banks et al, 2018;Abuya, 2015]. The present study has shown that D&A was commoner among women with high monthly family income.…”

“…This may be because of higher patient load and unfavorable patient-provider ratio in public hospitals. The present study noted that D&A is associated with the cadre of health worker, but a previous study reported that the cadre of health worker was not significantly associated with reporting of D&A [Banks et al, 2018] As reported in a previous study, the present study showed that D & A were reported more by women who experienced longer labour duration, and also by women who did not have support…”

An Innovative Intervention to Improve Respectful Maternity Care in Three Districts in Ethiopia

“…Mistreatment ranges from subtle negligence and abandonment to overt verbal or physical abuse. The Bowser and Hill framework is commonly cited to describe aspects of mistreatment during childbirth (4,6,(8)(9)(10)(11)(12). These categories include physical abuse, non-consented care (including denial of birth companionship), non-con dential care, non-digni ed care (including verbal abuse), discrimination based on speci c attributes, abandonment or denial of care and detention in facilities.…”

‘I would have stayed home if I could manage it alone’; testimony of an Ethiopian mother abandoned by care providers during facility based childbirth: a case report

“…Respectful care is a fundamental right for every woman and baby (10). However, many women in Ethiopia are mistreated by their attendants during facility based childbirth (14)(15)(16)(17)(18)(19)(20)(21). This mistreatment is manifested by any form of uncaring behavior or inhumane treatment (22).…”