Women’s experiences of mistreatment during childbirth and their satisfaction with care: findings from a multicountry community-based study in four countries

Abstract

IntroductionExperiences of care and satisfaction are intrinsically linked, as user’s experiences of care may directly impact satisfaction, or indirectly impact user’s expectations and values. Both experiences of care and satisfaction are important to measure so that quality can be monitored and improved. Globally, women experience mistreatment during childbirth at facilities; however, there is limited evidence exploring the mistreatment and women’s satisfaction with care during childbirth.MethodsThis is a secondary analysis of a cross-sectional survey within the WHO study ‘How women are treated during facility-based childbirth’ exploring the mistreatment of women during childbirth in Ghana, Guinea, Myanmar and Nigeria. Women’s experiences of mistreatment and satisfaction with care during childbirth was explored. Multivariable logistic regression modelling was conducted to evaluate the association between mistreatment, women’s overall satisfaction with the care they received, and whether they would recommend the facility to others.Results2672 women were included in this analysis. Despite over one-third of women reporting experience of mistreatment (35.4%), overall satisfaction for services received and recommendation of the facility to others was high, 88.4% and 90%, respectively. Women who reported experiences of mistreatment were more likely to report lower satisfaction with care: women were more likely to be satisfied if they did not experience verbal abuse (adjusted OR (AOR) 4.52, 95% CI 3.50 to 5.85), or had short waiting times (AOR 5.12, 95% CI 3.94 to 6.65). Women who did not experience any physical or verbal abuse or discrimination were more likely to recommend the facility to others (AOR 3.89, 95% CI 2.98 to 5.06).ConclusionMeasuring both women’s experiences and their satisfaction with care are critical to assess quality and provide actionable evidence for quality improvement. These measures can enable health systems to identify and respond to root causes contributing to measures of satisfaction.

Development of measures for assessing mistreatment of women during facility-based childbirth based on labour observations

“…However, caution should be used when interpreting these findings, as it is difficult to determine whether the inconsistent findings are due to the actual validity of the measures or due to the criterion against 35 and personcentred maternity care. 41 42 However, the extent to which women's reports of satisfaction are consistently related to mistreatment, particularly third-party labour observations 84 These results highlight the complexity of comprehensively measuring quality of care given this duality of high satisfaction as an outcome measure-informed by expectations of care, empowerment, and knowledge of rights to high quality and respectful care-in the presence of mistreatment as a discrete process measure of women's experiences with health systems. 9 84 Taken together, our confidence in relying on these criteria to help firmly establish validity of these measures is limited.…”

Women’s report of mistreatment during facility-based childbirth: validity and reliability of community survey measures

“…A secondary analysis using data from this study found that women who reported mistreatment were more likely to report lower satisfaction with care. 29 Use of alternative measures of mistreatment would provide further validation in future studies.…”

Galvanizing Collective Action to Accelerate Reductions in Maternal and Newborn Mortality and Prevention of Stillbirths

“…In recent years, some evidence has suggested that fragmentation, volatility, and transaction costs associated with donor funding have limited the impact of development assistance on health outcomes and sustainability of progress in LMICs, 33 while other research has not shown any clear relationship between donor proliferation or fragmentation in health sector aid and measures of health service delivery or health outcomes. 34 The Global Financing Facility (GFF), launched in 2015, was created in an effort to ensure prioritization and financing of health and nutrition for women, children, and adolescents, and provides an opportunity to align domestic and international investments for reproductive, maternal, newborn, child, and adolescent health in several high-burden countries. Increasing linkages between the GFF and country-led processes to monitor progress toward the SDGs may be one path toward better coordination and increased impact of financing and programs, particularly in the setting of narrowing fiscal space for MNH and the damage brought on by the pandemic.…”