Abstract
BackgroundIn recent years Rwanda has achieved remarkable improvement in quality of maternity care services but there is evidence of deficiencies in care quality in terms of disrespectful care. Women’s overall childbirth experience is an important outcome of childbirth and a factor in assessing quality of care. The aim of this study was to investigate how women’s overall childbirth experience in Rwanda was related to their perceptions of childbirth care.MethodsA cross-sectional household study of women who had given birth 1–13 months earlier (n = 921) was performed in the Northern Province and in the capital city. Data was collected via structured interviews following a questionnaire. Significant variables measuring perceptions of care were included in a stepwise forward selection logistic regression model with overall childbirth experience as a dichotomised target variable to find independent predictors of a good childbirth experience.ResultsThe majority of women (77.5%) reported a good overall childbirth experience. In a logistic regression model five factors of perceived care were significant independent predictors of a good experience: confidence in staff (Adjusted OR 1.73, 95% CI 1.20–2.49), receiving enough information (AOR 1.44, 95% CI 1.03–2.00), being treated with respect (AOR 1.69, 95% CI 1.18–2.43), getting support from staff (AOR 1.75, 95% CI 1.20–2.56), and having the baby skin-to-skin after birth (AOR 2.21, 95% CI 1.52–3.19).ConclusionsTo further improve childbirth care in Rwanda and care for women according to their preferences, it is important to make sure that the childbirth care includes the following quality aspects in national and clinical guidelines: build confidence, provide good information, treat women and families with respect, provide good professional support during childbirth and put the newborn baby skin-to-skin with its mother early after birth.
Highlights
In recent years Rwanda has achieved remarkable improvement in quality of maternity care services but there is evidence of deficiencies in care quality in terms of disrespectful care
After informed consent 921 of 922 (99.9% response rate) invited women answered the questionnaire in an interview
The majority of women who had given birth the last 1 to 13 months (77.5%) reported a good overall childbirth experience defined as a rating of 8–10 on a numeric rating scale from 0 (Very bad) to 10 (Very good) in response to the question: What was your overall experience of childbirth? Seven statements of perceptions of care were significantly related to a good overall experience in univariate analyses and five of them remained significant as independent predictors in a multivariable logistic regression model: having confidence in staff, receiving enough information during childbirth, being treated with respect, getting support from staff, and having the baby skin-toskin after birth
Summary
In recent years Rwanda has achieved remarkable improvement in quality of maternity care services but there is evidence of deficiencies in care quality in terms of disrespectful care. In recent years Rwanda has achieved remarkable improvement in quality of maternity care services [1, 2]. The quality progress might be attributed to the introduction of health insurance and Community Health Workers (CHW) who are sufficiently available and motivated. In each village in Rwanda, volunteers are elected to act as CHWs. There are two general CHWs – one male and one female (called a binome) who are responsible for Mukamurigo et al BMC Pregnancy and Childbirth (2017) 17:181 community health, nutrition, and HIV/AIDS prevention – and a maternal health worker (referred to as an Animateur de Santé Maternelle), who manages infants, and pre- and postnatal maternity care. Each village has a CHW in charge of social affairs who is dedicated to addressing the wellbeing of individuals and the community [4, 5]
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