Abstract
BackgroundMistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from attending skilled birth. In Ethiopia, mistreatment occurs in up to 49.4% of mothers giving birth in health facilities. This study describes the development, implementation and results of interventions to improve respectful maternity care.As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed respectful maternity care training module with three core components: testimonial videos developed from key themes identified by staff as experiences of mothers, skills-building sessions on communication and onsite coaching. Respectful maternity care training was conducted in February 2017 in three districts within three regions.MethodsFacility level solutions applied to enhance the experience of care were documented. Safe Childbirth Checklist data measuring privacy and birth companion offered during labor and childbirth were collected over 27 months from 17 health centers and three hospitals. Interrupted time series and regression analysis were conducted to assess significance of improvement using secondary routinely collected programmatic data.ResultsSignificant improvement in the percentage of births with two elements of respectful maternal care—privacy and birth companionship offered— was noted in one district (with short and long-term regression coefficient of 18 and 27% respectively), while in the other two districts, results were mixed. The short-term regression coefficient in one of the districts was 26% which was not sustained in the long-term while in the other district the long-term coefficient was 77%. Testimonial videos helped providers to see their care from their clients’ perspectives, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions. This includes organizing tour to the birthing ward and allowing cultural celebrations.ConclusionThis study demonstrated effective way of improving respectful maternity care. Use of a multipronged approach, where the respectful maternity care intervention was embedded in quality improvement approach helped in enhancing respectful maternity care in a comprehensive manner.
Highlights
Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from attending skilled birth
Our study revealed that respectful maternity care (RMC)-focused interventions embedded into a district-wide quality improvement (QI) approach led to significant improvements of the two measures of RMC in Tigray and SNNP
This study suggests that integrating RMC training into a QI program is effective in improving RMC
Summary
Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from attending skilled birth. The Bowser and Hill framework is commonly cited to describe seven categories of mistreatment during childbirth [4, 6, 8,9,10,11,12] These include physical abuse, nonconsented care (including denial of birth companionship), non-confidential care, non-dignified care (including verbal abuse), discrimination based on specific attributes, abandonment or denial of care and detention in facilities. These forms of mistreatment are major human rights violations and discourage women from seeking care during birth [3, 4, 8, 9, 13,14,15,16,17,18,19]. Mistreatment can occur at the level of interaction between women and health care providers (HCP) or may result from health system failures, including supply constraints or non-enabling facilities [3, 12, 21]
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