Does disrespect and abuse during childbirth differ between public and private hospitals in Southeast Nigeria

Ijeoma Nkem Okedo-Alex,Chika Nwamma Onwasigwe,Irene Ifeyinwa Eze,Ifeyinwa Chizoba Akamike

doi:10.1186/s12884-021-04298-z

Ijeoma Nkem Okedo-Alex, Chika Nwamma Onwasigwe + Show 2 more

Open Access

https://doi.org/10.1186/s12884-021-04298-z

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Abstract

BackgroundDisrespect and Abuse (D&A) during childbirth represents an important barrier to skilled birth utilization, indicating a problem with quality of care and a violation of women‘s human rights. This study compared prevalence of D&A during childbirth in a public and a private hospital in Southeast Nigeria.MethodsThis study was a cross-sectional study among women who gave birth in two specialized health facilities: a public teaching and a private-for-profit faith-based hospital in Southeast Nigeria. In each facility, systematic random sampling was used to select 310 mothers who had given birth in the facility and were between 0-14 weeks after birth. Study participants were recruited through the immunization clinics. Semi-structured, interviewer-administered questionnaires using the Bowser and Hills classification of D&A during childbirth were used for data collection. Data were analyzed using SPSS version 20 at 95% significance level.ResultsMean age of the participants in the public hospital was 30.41 ± 4.4 and 29.31 ± 4.4 in the private hospital. Over three-fifths (191; 61.6%) in the public and 156 women (50.3%) in the private hospital had experienced at least one form of D&A during childbirth [cOR1.58; 95% CI 1.15, 2.18]. Abandonment and neglect [Public153 (49.4%) vs. Private: 91 (29.4%); cOR2.35; 95% CI. 1.69, 3.26] and non-consented care [Public 45 (14.5%) vs. Private 67(21.6%): cOR0.62; 95% CI. 0.41, 0.93] were the major types of D&A during childbirth. Denial of companionship was the most reported subtype of D&A during childbirth in both facilities [Public 135 (43.5%) vs. Private66 (21.3%); cOR2.85; 95% CI. 2.00, 4.06]. Rural residents were less likely to report at least one form of D&A during childbirth (aOR 0.53; CI 0.35-0.79).ConclusionAlthough prevalence was high in both facilities, overall prevalence of D&A during childbirth and most subtypes were higher in the public health facility. There is a need to identify contextual factors enabling D&A during childbirth in public and private health care settings.

Highlights

Disrespect and Abuse (D&A) during childbirth represents an important barrier to skilled birth utiliza‐ tion, indicating a problem with quality of care and a violation of women‘s human rights
Okedo‐Alex et al BMC Pregnancy and Childbirth (2021) 21:852 from violence and discrimination [1, 2].The World Health Organization’s (WHO’s) quality of care framework for maternal and newborn health (MNH) care contains eight domains, three of which relate to women’s experience of care and include effective and responsive communication, care provided with respect and dignity and social and emotional support of the woman’s choice [3, 4]
Study Area The study was conducted in two hospitals offering specialized care: a private-for-profit specialist hospital located in Afikpo North Local Government Area and a public tertiary hospital located in Abakaliki Local Government Area, both in Ebonyi State, Nigeria

Summary

Introduction

Disrespect and Abuse (D&A) during childbirth represents an important barrier to skilled birth utiliza‐ tion, indicating a problem with quality of care and a violation of women‘s human rights. While disrespect and abuse (D&A) of women may occur throughout pregnancy, childbirth and the postpartum period, women are vulnerable during childbirth Such practices may have direct adverse consequences for both mother and newborn [2]. Women who have previously been treated disrespectfully during childbirth and those hearing from their experiences may avoid facility childbirth, even if they have complications This may contribute to increased maternal and perinatal mortality and morbidity. According to the 2018 Nigerian Demographic and Health Survey (NDHS), only 39% of births by Nigerian women occurred in health facilities and 43%were assisted by skilled birth attendants Unskilled providers such as traditional birth attendants and relatives/friends assisted in 42% of births, while 11% had no external assistance during childbirth [9]. This national data did not explore D&A during childbirth, studies have found that D&A undermined utilization of health facilities for births and encouraged traditional birth attendance [10, 11]

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