Respectful maternity care among laboring women in public hospitals of Benishangul Gumuz Region, Ethiopia: A mixed cross-sectional study with direct observations

Abstract

Objectives: Promoting respectful maternity care is a fundamental strategy for enhancing facility birth, which significantly reduces maternal and newborn mortality and morbidity. Despite these effects, disrespect and abusive childbirth care remain a challenge in Ethiopia. Therefore, this study aimed to determine the prevalence of respectful maternity care and its associated factors among laboring women in public hospitals of Benishangul Gumuz region, Ethiopia. Methods: A facility-based cross-sectional study design was employed, and trained external assessors observed the care provided to 404 laboring women in public hospitals using structured observation checklists. A focus group discussion and two key informant interviews were also conducted. A structured pre-tested questionnaire and a semi-structured guide were used to generate quantitative and qualitative data, respectively. Seven verification criteria were employed, and the mean value and above for each criterion were used to measure respectful maternity care. Results: Of the 404 client–provider interaction observations during childbirth, only 12.6% ( n = 51) participants received respectful maternity care. Being from an urban area (adjusted odds ratio = 3.34, 95% confidence interval: 1.39, 8.08), giving childbirth at daytime (adjusted odds ratio = 2.59, 95% confidence interval: 1.26, 5.33), receiving the service from compassionate and respectful care trained provider (adjusted odds ratio = 4.54, 95% confidence interval: 1.63, 12.66), giving childbirth at general hospital (adjusted odds ratio = 3.03, 95% confidence interval: 1.39, 6.65) were positively associated with respectful maternity care. Staff workload, shortage of supply and equipment, partiality in providing timely care, yelling and insulting at clients and birth companions were also barriers to respectful maternity care. Conclusion: The observed respectful maternity care practices were low in the study area. Therefore, the findings of this study suggest that addressing respectful maternity care would require increased compassionate and respectful care trained providers, and sustained efforts to improve access to basic equipment and supply for maternity care with an emphasis on primary hospitals. Tailored interventions aimed at improving respectful maternity care should also target rural residents and nighttime parturients.

Respectful maternity care among women who gave birth at public hospitals in Hadiya Zone, Southern Ethiopia

“…This finding may be a result of companion, which indicates that providers are more likely to be cautious about how they act and speak to a client when a companion of the client is present. This finding is also supported by many other studies ( 17 , 23 , 25 – 27 ).…”

“…The magnitude of RMC in this study is by far higher than the study conducted in Addis Ababa (21%) ( 20 ), Harar (38.4%) ( 21 ), West Shewa, Oromia region (35.8%) ( 22 ), and the study conducted in public Hospitals of Benishangul Gumuz Region, Ethiopia (12.6%) ( 23 ). However, this study finding is lower than the study finding from Tanzania (85%) ( 24 ) and Kenya (80%) ( 25 ).…”

“…Women were considered as experienced disrespect and abuse if they answered no to one or more of those questions assessing RMC or verification criteria used for assessing the seven categories of RMC ( 18 , 23 , 24 ).…”

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

“…There was a very poor performance with the observed RMC scores received in our study, with a mean score of only 38.2% for the 29 items in the observational checklist. A similar RMC observational study conducted in the Benishangul Gumuz region of Ethiopia using all the items on the MCHIP checklist reported that a very low proportion of women (12.6%) received RMC [46]. Their assessment of RMC was based on receiving the mean score or higher for each of the 7-sub-categories assessed, which is quite different to the method of analysis we have presented.…”

“…The best RMC sub-category, received by most women in our study, for both observed and reported RMC, was equitable/non-discriminatory care. Almost all the 404 women observed, (97%) during childbirth at public hospitals in the Benishangul Gumuz region in Ethiopia also received non-discriminatory care [46]. Privacy during childbirth was not guaranteed when delivering at our study health facilities.…”