Abstract
Disrespect and abuse (D&A) experienced by women during facility-based childbirth has gained global recognition as a threat to eliminating preventable maternal mortality and morbidity. This study explored the frequency and associated factors of D&A in four rural health centres in Ethiopia. Experiences of women who delivered in these facilities were captured by direct observation of client-provider interaction (N = 193) and exit interview at time of discharge (N = 204). Incidence of D&A was observed in each facility, with failure to ask woman for preferred birth position most commonly observed [n = 162, 83.9%, 95% confidence interval (95% CI) 78.0–88.5%]. During exit interviews, 21.1% (n = 43, 95% CI 15.4–26.7%) of respondents reported at least one occurrence of D&A. Bivariate models using client characteristics and index birth experience showed that women’s reporting of D&A was significantly associated with childbirth complications [odds ratio (OR) = 7.98, 95% CI 3.70, 17.22], weekend delivery (OR = 0.17, 95% CI 0.05, 0.63) and no previous delivery at the facility (OR = 3.20, 95% CI 1.27, 8.05). Facility-level fixed-effect models found that experience of complications (OR = 15.51, 95% CI 4.38, 54.94) and weekend delivery (OR = 0.05, 95% CI 0.01–0.32) remained significantly and most strongly associated with self-reported D&A. These data suggest that addressing D&A in health centres in Ethiopia will require a sustained effort to improve infrastructure, support the health workforce in rural settings, enforce professional standards and target interventions to improve women’s experiences as part of quality of care initiatives.
Highlights
Complications from pregnancy and childbirth are the leading causes of maternal mortality and morbidity for women of reproductive age in developing countries (Kassebaum et al 2014)
Evidence has shown that access to maternal health services alone is insufficient to prevent maternal deaths, and that the quality of care received is integral to ensuring good maternal health outcomes (Souza et al 2013)
Client-provider interactions during labour and delivery were observed for 193 births, and 204 women who gave birth at these health centres were interviewed at their time of discharge from the facility (n 1⁄4 204)
Summary
Complications from pregnancy and childbirth are the leading causes of maternal mortality and morbidity for women of reproductive age in developing countries (Kassebaum et al 2014). Evidence has shown that access to maternal health services alone is insufficient to prevent maternal deaths, and that the quality of care received is integral to ensuring good maternal health outcomes (Souza et al 2013) This is reflected in the post-2015 development agenda, which underlines the growing recognition of the importance of quality in health service delivery (Koblinsky et al 2016). D&A has been acknowledged as a deficiency in the delivery of high quality maternal health services, threatening the ability of health systems to achieve good maternal health outcomes (Bowser and Hill 2010; Kruk et al 2014; Abuya et al 2015a; Bohren et al 2015; Vogel et al 2015a,b; Sando et al 2016). Women who experience D&A are more likely to report lower satisfaction with their birth experience and are less likely to seek facility-based delivery for future pregnancies (Kujawski et al 2015)
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