Study protocol for promoting respectful maternity care initiative to assess, measure and design interventions to reduce disrespect and abuse during childbirth in Kenya

Abstract

BackgroundIncreases in the proportion of facility-based deliveries have been marginal in many low-income countries in the African region. Preliminary clinical and anthropological evidence suggests that one major factor inhibiting pregnant women from delivering at facility is disrespectful and abusive treatment by health care providers in maternity units. Despite acknowledgement of this behavior by policy makers, program staff, civil society groups and community members, the problem appears to be widespread but prevalence is not well documented. Formative research will be undertaken to test the reliability and validity of a disrespect and abuse (D&A) construct and to then measure the prevalence of disrespect and abuse suffered by clinic clients and the general population.Methods/designA quasi-experimental design will be followed with surveys at twelve health facilities in four districts and one large maternity hospital in Nairobi and areas before and after the introduction of disrespect and abuse (D&A) interventions. The design is aimed to control for potential time dependent confounding on observed factors.DiscussionThis study seeks to conduct implementation research aimed at designing, testing, and evaluating an approach to significantly reduce disrespectful and abusive (D&A) care of women during labor and delivery in facilities. Specifically the proposed study aims to: (i) determine the manifestations, types and prevalence of D&A in childbirth (ii) develop and validate tools for assessing D&A (iii) identify and explore the potential drivers of D&A (iv) design, implement, monitor and evaluate the impact of one or more interventions to reduce D&A and (v) document and assess the dynamics of implementing interventions to reduce D&A and generate lessons for replication at scale.

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

“…Lack of information given to women before or during procedures, procedures conducted without their consent, and breach of privacy and confidentiality during childbirth are common practices associated with D and A in sub-Saharan Africa [14,16,20–22]. It is critical that healthcare providers offer women adequate explanation and obtain informed consent from women before administering treatment and performing procedures.…”

“…When women are well informed about the procedures they are required to undergo, their compliance with safety instructions is likely to be higher. They are also more likely to feel respected and come away with positive feelings about their childbirth experiences [9,22]. …”

What price a welcome? Understanding structure agency in the delivery of respectful midwifery care in Uganda

“…Increases in population coverage, antenatal care attendance or rates of deliveries with skilled birth attendants, is not synonymous with care that is respectful or free from abuse. Maternal mortality will only be reduced once essential interventions, structural improvements and access to resources goes hand in hand with maternity care that is respectful and empowering for both women and their families (Warren et al, 2013).…”

Abuse in South African maternity settings is a disgrace: Potential solutions to the problem

“…[28] There are examples of initiatives at global and country level to address abuse of women in labour and promote effective care. These include the Humanising Childbirth Movement (predominantly South America), [29] the Better Births Initiative (SA), [30] and more recently the Respectful Maternity Care Movement (Mozambique, Ethiopia) [31][32][33][34] and the Heshima Project (Kenya). [34] The Patient-Centred Maternity Care Code in the Cape Metro…”