Abstract
Mistreatment during childbirth occurs across the globe and endangers the well-being of pregnant women and their newborns. A gender-sensitive approach to mistreatment during childbirth seems relevant in Ethiopia, given previous research among Ethiopian midwives and patients suggesting that male midwives provide more respectful maternity care, which is possibly mediated by self-esteem and stress. This study aimed a) to develop a tool that assesses mistreatment appraisal from a provider’s perspective and b) to assess gender differences in mistreatment appraisal among Ethiopian final-year midwifery students and to analyze possible mediating roles of self-esteem and stress. First, we developed a research tool (i.e. a quantitative scale) to assess mistreatment appraisal from a provider’s perspective, on the basis of scientific literature and the review of seven experts regarding its relevance and comprehensiveness. Second, we utilized this scale, the so-called Mistreatment Appraisal Scale, among 390 Ethiopian final-year midwifery students to assess their mistreatment appraisal, self-esteem (using the Rosenberg Self-Esteem Scale), stress (using the Perceived Stress Scale) and various background characteristics. The scale’s internal consistency was acceptable (α = .75), corrected item-total correlations were acceptable (.24 - .56) and inter-item correlations were mostly acceptable (.07 - .63). Univariable (B = 3.084, 95% CI [-.005, 6.173]) and multivariable (B = 1.867, 95% CI [-1.472, 5.205]) regression analyses did not show significant gender differences regarding mistreatment appraisal. Mediation analyses showed that self-esteem (a1b1 = -.030, p = .677) and stress (a2b2 = -.443, p = .186) did not mediate the effect of gender on mistreatment appraisal. The scale to assess mistreatment appraisal appears to be feasible and reliable. No significant association between gender and mistreatment appraisal was observed and self-esteem and stress were not found to be mediators. Future research is needed to evaluate the scale’s criterion validity and to assess determinants and consequences of mistreatment during childbirth from various perspectives.
Highlights
Every day, about 800 women and 7,300 newborns die from causes related to pregnancy and childbirth [1,2]
047 .009 p-value .267 .380 .404 gender differences were detected for four variables: females were more often enrolled at Gondar University (35% versus 31%), Hawassa Health Science College (HSC) (12% versus 9%) and Menelik HSC (29% versus 9%), they originated more frequently from urban areas (65% versus 34%), attended a HSC (35% versus 25%) and/or followed an extension program (46% versus 33%)
Our study showed that we succeeded in developing a quantitative research scale, the MISAP Scale, that measures mistreatment appraisal from a provider perspective with acceptable psychometric properties, and that female Ethiopian midwifery students did not have more positive mistreatment appraisal scores than their male counterparts
Summary
About 800 women and 7,300 newborns die from causes related to pregnancy and childbirth [1,2]. Most of these deaths are preventable and occur in low-income countries, especially in Sub-Saharan Africa [3]. Skilled birth attendants play an essential role in reducing maternal and newborn mortality [6]. A factor that may account for the underuse of maternal healthcare services in low-income settings is care providers’ mistreatment of women during childbirth, which creates fear and hesitancy in women when approaching health facilities for delivery care [9,10,11]
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