Abstract
BackgroundImproving respectful maternity care (RMC) is a recommended practice during childbirth as a strategy to eliminate the mistreatment of women and improve maternal health. There is limited evidence on the effectiveness of RMC interventions and implementation challenges, especially in low-resource settings. This study describes lessons learned in RMC training and its implementation from the perspectives of service providers’ perceptions and experiences.MethodsOur mixed methods study employed a pre- and post-intervention quantitative survey of training participants to assess their perceptions of RMC and focus group discussions, two months following the intervention, investigated the experiences of implementing RMC within birthing facilities. The intervention was a three-day RMC training offered to 64 service providers from three hospitals in southern Ethiopia. We performed McNemar’s test to analyse differences in participants’ perceptions of RMC before and after the training. The qualitative data were analysed using hybrid thematic analysis. Integration of the quantitative and qualitative methods was done throughout the design, analysis and reporting of the study.ResultsMistreatment of women during childbirth was widely reported by participants, including witnessing examinations without privacy (39.1%), and use of physical force (21.9%) within the previous 30 days. Additionally, 29.7% of participants reported they had mistreated a woman. The training improved the participants’ awareness of the rights of women during childbirth and their perceptions and attitudes about RMC were positively influenced. However, participants believed that the RMC training did not address providers’ rights. Structural and systemic issues were the main challenges providers reported when trying to implement RMC in their contexts.ConclusionTraining alone is insufficient to improve the provision of RMC unless RMC is addressed through a lens of health systems strengthening that addresses the bottlenecks, including the rights of providers of childbirth care.
Highlights
In 2017, almost all (99%) of the 295,000 global maternal deaths occurred in developing regions, 66.3% in subSaharan Africa [1]
This paper presents the analysis of one component (RMC training) of a multi-component intervention
The study complements a growing interest in the promotion of respectful maternity care (RMC) globally and revealed that training of service providers alone is limited in promoting RMC unless it is approached from a health system strengthening perspective
Summary
In 2017, almost all (99%) of the 295,000 global maternal deaths occurred in developing regions, 66.3% in subSaharan Africa [1]. Evidence shows that improving access to quality and woman-centred care during pregnancy and childbirth substantially reduces preventable maternal and newborn deaths [2, 3]. Effective communication, and emotional support are key domains of the World Health Organization’s (WHO) vision for quality of care for pregnant women and newborns [4]. These domains are integral parts of respectful maternity care (RMC) and make a sizable contribution to positive childbirth experience [5]. This study describes lessons learned in RMC training and its implementation from the perspectives of service providers’ perceptions and experiences
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