The roles of multi-component interventions in reducing mistreatment of women and enhancing respectful maternity care: a systematic review

Abstract

Background Despite recognition of the adverse impacts of the mistreatment of women during pregnancy, labour and birth, there remains limited evidence on interventions that could reduce mistreatment and build a culture of respectful maternity care (RMC) in health facilities. The sustainability of effective individual interventions and their adaptability to various global contexts remain uncertain. In this systematic review, we aimed to synthesise the best available evidence that has been shown to be effective in reducing the mistreatment of women and/or enhancing RMC during women’s maternity care in health facilities. Methods We searched the online databases PubMed, CINAHL, EBSCO Nursing/Academic Edition, Embase, African Journals Online (AJOL), Scopus, Web of Science, and grey literature using predetermined search strategies. We included cluster randomized controlled trials (RCTs) and pre-and-post observational studies and appraised them using JBI critical appraisal checklists. The findings were synthesised narratively without conducting a meta-analysis. The certainty of evidence was assessed using GRADE criteria. Results From the 1493 identified records, 11 studies from six sub-Sahara African countries and one study from India were included: three cluster RCTs and nine pre- and post-studies. We identified diverse interventions implemented via various approaches including individual health care providers, health systems, and policy amendments. Moderate certainty evidence from two cluster RCTs and four pre- and post-studies suggests that multi-component interventions can reduce the odds of mistreatment that women may experience in health facilities, with odds of reduction ranging from 18 per cent to 66 per cent. Similarly, women’s perceptions of maternity care as respectful increased in moderate certainty evidence from two cluster RCTs and five pre- and post-studies with reported increases ranging from 5 per cent to 50 per cent. Conclusions Multi-component interventions that address attitudes and behaviors of health care providers, motivate staff, engage the local community, and alleviate health facility and system constraints have been found to effectively reduce mistreatment of women and/or increase respectful maternity care. Such interventions which go beyond a single focus like staff training appear to be more likely to bring about change. Therefore, future interventions should consider diverse approaches that incorporate these components to improve maternal care.

The mistreatment of women during maternity care and its association with the maternal continuum of care in health facilities

“…However, the findings from this study reveals a substantial proportion of women experienced care that failed to meet these standards, along with experiencing nuanced interpersonal abuses, poor rapport with healthcare providers and health system related constrains. Identification of these varied categories of mistreatment in current study signifies the need to understand mistreatment of women as a product of complex personal, structural and system issues that need system-wide solutions [ 42 – 44 ].…”

L’expérience de l’accouchement en milieu surveillé dans la province d’Essaouira au Maroc: Quelle réalité?

“…Les interventions à composantes multiples qui s’attaquent aux attitudes et aux comportements des prestataires de soins de santé, motivent le personnel, engagent la communauté locale et atténuent les contraintes des établissements et des systèmes de santé se sont avérées efficaces pour réduire la maltraitance des femmes et accroître les soins de maternité respectueux. 57 …”

“…Multicomponent interventions that address the attitudes and behaviours of healthcare providers, motivate staff, engage the local community, and alleviate the constraints of health institutions and systems, have proven effective in reducing the mistreatment of women and increasing respectful maternity care. 57 …”

What is the Status of Respectful Maternity Care for Childbearing Women Globally?

“…Systematic reviews reporting studies conducted in Sub Saharan Africa, Pakistan, India, Ethiopia, Iran, and other countries have been published (Dhakal et al, 2022;Jiru & Sendo, 2021;Kasaye et al, 2023). One review recommends multiple interventions rather than single focused approaches which are less successful (Kasaye et al, 2023). Avan et al (2023) have developed a model health system cluster of interventions which is being used in Pakistan.…”

“…In recent years, studies have been conducted summarizing perspectives of midwives, women who recently gave birth in public facilities and their families, health care administrators, and community members (Moridi et al, 2020). Systematic reviews reporting studies conducted in Sub Saharan Africa, Pakistan, India, Ethiopia, Iran, and other countries have been published (Dhakal et al, 2022;Jiru & Sendo, 2021;Kasaye et al, 2023). One review recommends multiple interventions rather than single focused approaches which are less successful (Kasaye et al, 2023).…”