Person-Centred Maternity Care in a Poor-Resource Setting: Evidence from a Cross-Sectional Study in Enugu State, Nigeria

Abstract

Background Women are not getting adequate person-centred maternity care (PCMC) in low-income and middle-income countries despite being important in reducing maternal morbidity and mortality. This study assessed perceptions and predictors of PCMC among childbearing women in Enugu State, South-east Nigeria.Methods The study was conducted in two health districts in Enugu State using a descriptive, cross-sectional survey design. We conveniently selected 450 childbearing women, within 9 weeks post-partum, from 11 health facilities purposively selected based on high maternal and child health attendance. Data was collected from women using an interviewer administered 30-item PCMC scale (scores 0–90) consisting of: dignity and respect (6 items, scores 0–18), communication and autonomy (9 items, scores 0–27), and supportive care (15 items, scores 0–45). We categorized full PCMC and each sub-scale into “low, medium and high” using 25th and 75th percentile of the summative scores. The questionnaire also collected data on women characteristics, facility characteristics and service type. Data were analysed using descriptive statistics, t- tests, analysis of variance and Generalized Linear Models.Results Women had medium scores on full PCMC scale and sub-scales. The lowest score was in communication and autonomy. A quarter of women perceived PCMC as high. Marrying at age 20–29 years (β = 5.83, ρ = 0.002), self-employed women (β = -10.23, ρ = 0.004), starting antenatal care in the third trimester (β = -7.93, ρ = 0.008), high participation in household decisions (β = -4.98, ρ = 0.011), domestic violence experience (β = 5.41, ρ = 0.002), delivery at health centre (β = 7.09, ρ = 0.000), delivery at private/mission hospital (β = 17.47, ρ = 0.000), delivery by non-skilled attendant (β = -9.61, ρ = 0.001); delivery by community health workers (β = -7.65, ρ = 0.001), and experience of pregnancy complication (β = 6.20, ρ = 0.028) predicted PCMC.Conclusions Person-centred maternity care was generally inadequate. Improving PCMC would entail sustaining dignified care, enhancing provider-patient communication, addressing facility-level drivers, increasing women’s personal empowerment and self-employment, timely initiation of antenatal care, and paying attention to women with pregnancy complication.

Person-centered care during childbirth and associated factors among mothers who gave birth at health facilities in Hawassa city administration Sidama Region, Southern Ethiopia

“…The least score was on the communication and autonomy sub-scale, while the highest was on the respect and dignity dimension. This result is consistent with studies done in India, and Nigeria which showed that the mean score of person-centered care during childbirth was 55.8, and 55.13 respectively [ 17 , 18 ]. The current finding showed that person-centered care during childbirth was low compared with the recommended scale value to say high person-centered care, which is above 75 percentile by the measurement tool validates and compared to other studies done in low- and middle-income countries [ 2 , 12 ].…”

“…Person-centered care during childbirth is measured using the PCC during childbirth scale, which has three domains: dignity and respect, communication and autonomy, supportive care, and 30 items with a four-point response scale. i.e., 0 “(“no, never””), 1 “(“yes, a few times””), 2 “(“yes, most of the time””),and 3 “(“yes all the time””) [ 5 , 6 , 16 ], and with negative items reverse coded so that high numbers represent good care). Therefore, the scale score ranges from zero to 90.…”

“…Full PCMC and each sub-scale are categorized into “low, medium, and high”. Low was defined as scores in the approximate lower 25th percentile and scores in the top 75th percentile were defined as high by Dr. Patience A Afulani and colleague [ 16 ].…”