The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya

Abstract

BackgroundDisrespect and abuse (D & A) during labor and delivery are important issues correlated with human rights, equity, and public health that also affect women’s decisions to deliver in facilities, which provide appropriate management of maternal and neonatal complications. Little is known about interventions aimed at lowering the frequency of disrespectful and abusive behaviors.MethodsBetween 2011 and 2014, a pre-and-post study measured D & A levels in a three-tiered intervention at 13 facilities in Kenya under the Heshima project. The intervention involved working with policymakers to encourage greater focus on D & A, training providers on respectful maternity care, and strengthening linkages between the facility and community for accountability and governance. At participating facilities, postpartum women were approached at discharge and asked to participate in the study; those who consented were administered a questionnaire on D & A in general as well as six typologies, including physical and verbal abuse, violations of confidentiality and privacy, detainment for non-payment, and abandonment. Observation of provider-patient interaction during labor was also conducted in the same facilities. In both exit interview and observational studies, multivariate analyses of risk factors for D & A controlled for differences in socio-demographic and facility characteristics between baseline and endline surveys.ResultsOverall D & A decreased from 20–13 % (p < 0.004) and among four of the six typologies D & A decreased from 40–50 %. Night shift deliveries were associated with greater verbal and physical abuse. Patient and infant detainment declined dramatically from 8.0–0.8 %, though this was partially attributable to the 2013 national free delivery care policy.ConclusionAlthough a number of contextual factors may have influenced these findings, the magnitude and consistency of the observed decreases suggest that the multi-component intervention may have the potential to reduce the frequency of D & A. Greater efforts are needed to develop stronger evaluation methods for assessing D & A in other settings.

Quality of facility-based family planning services for adolescents in Malawi: Findings from a national census of health facilities

“…In other similar settings it has been possible to obtain detailed and indeed highly critical feedback from clients; for example, the work on disrespect and abuse during clinical care using very specific questions. 13 These reports confirm that approaches that include specific questions and allow for probing in more depth are the most informative. In planning future largescale facility surveys, it might be a better use of resources to reduce the number of exit interviews but make them more in-depth.…”

Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions

“…There was not one ‘silver bullet’ intervention to address all drivers – more a multi component intervention based on a human rights approach to address the multiplicity of causes of D&A. This multi component intervention is described in detail elsewhere [16, 21, 22], but includes strengthening quality improvement teams, values clarification and attitudes transformation workshops for managers and health providers to critically self-evaluate and modify their values, attitudes and beliefs; stress management counseling for providers; awareness raising around rights and obligations at community level and strengthening linkages between facilities and communities through maternity open days [22]. …”

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.…”