Respectful maternity care in Ethiopian public health facilities

Abstract

BackgroundDisrespect and abuse of women during institutional childbirth services is one of the deterrents to utilization of maternity care services in Ethiopia and other low- and middle-income countries. This paper describes the prevalence of respectful maternity care (RMC) and mistreatment of women in hospitals and health centers, and identifies factors associated with occurrence of RMC and mistreatment of women during institutional labor and childbirth services.MethodsThis study had a cross sectional study design. Trained external observers assessed care provided to 240 women in 28 health centers and hospitals during labor and childbirth using structured observation checklists. The outcome variable, providers’ RMC performance, was measured by nine behavioral descriptors. The outcome, any mistreatment, was measured by four items related to mistreatment of women: physical abuse, verbal abuse, absence of privacy during examination and abandonment.We present percentages of the nine RMC indicators, mean score of providers’ RMC performance and the adjusted multilevel model regression coefficients to determine the association with a quality improvement program and other facility and provider characteristics.ResultsWomen on average received 5.9 (66%) of the nine recommended RMC practices. Health centers demonstrated higher RMC performance than hospitals. At least one form of mistreatment of women was committed in 36% of the observations (38% in health centers and 32% in hospitals).Higher likelihood of performing high level of RMC was found among male vs. female providers (, p = 0.012), midwives vs. other cadres (, p = 0.002), facilities implementing a quality improvement approach, Standards-based Management and Recognition (SBM-R©) (, p = 0.003), and among laboring women accompanied by a companion , p = 0.003). No factor was associated with observed mistreatment of women.ConclusionQuality improvement using SBM-R© and having a companion during labor and delivery were associated with RMC. Policy makers need to consider the role of quality improvement approaches and accommodating companions in promoting RMC. More research is needed to identify the reason for superior RMC performance of male providers over female providers and midwives compared to other professional cadre, as are longitudinal studies of quality improvement on RMC and mistreatment of women during labor and childbirth services in public health facilities.

Respectful maternity care and associated factors among women who delivered at Harar hospitals, eastern Ethiopia: a cross-sectional study

“…The odds of RMC were two times higher among women whose labor attended by male providers. This finding is in line with the study conducted at public hospitals of Ethiopia in which, male HCPs were more likely to engage in the implementation of RMC [25]. This is challenging to explain but it might be due to the natural inclination to opposite-sex rather than the quality of care provided.…”

“…In this study, merely 38.4% of women received RMC. This finding is higher than the study conducted in Addis Ababa (21%) [7] and lower than the studies conducted in public hospitals of Ethiopia (66%), Bahir Dar, Ethiopia (57%), Uttar Pradesh, India (43%), Tanzania (85%), and Kenya (80%) [22,24,25,33,34]. This incongruity may be due to study period variation, participant's level of understanding about the service, educational and socio-economic status of the participants, service quality, and the ability of participants to report D&A.…”

“…Evidence from India, Tanzania, Kenya, and Ethiopia showed that the status of RMC ranges from 21 to 80%. Delivering at night time, private health facilities, cesarean delivery, continuous emotional support during labor, intention to use the facility, assurance of privacy and high economic status were some of the factors associated with RMC [7,[22][23][24][25].…”

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

“…This could well be due to routine performance evaluations that were implemented in health services at the time of this study. Another reason was that the majority of the health institutions in the study also allowed women, but not men, to accompany women in the labour ward [21,23]. …”

Status of Respectful Maternal Care in Ndola and Kitwe Districts of Zambia

“…The most frequently mentioned form of disrespect and abuse in the open-ended comments was abandonment and neglect". Another study by Sheferaw et al [4] found that women on average received 5.9 (66%) of the nine recommended RMC practices. Health centres demonstrated higher RMC performance than hospitals.…”