Abstract
BackgroundRecent evidence suggests that mistreatment of women during childbirth is a global challenge facing health care systems. This study seeks to explore the prevalence of mistreatment of women in public health facilities of Ethiopia, and identify associated factors.MethodsA two-stage cross sectional sampling design was used to select institutions and women. The study was conducted in hospitals and health centers across four Ethiopian regions. Quantitative data were collected from postpartum women. Mistreatment was measured using four domains: (1) physical abuse, (2) verbal abuse, (3) failure to meet professional standards of care, and (4) poor rapport between women and providers. Percentages of mistreatment and odds ratios for the association between its presence and institutional and socio demographic characteristics of women were calculated using bivariate and multivariable logistic regression modeling.ResultsA total of 379 women were interviewed, of whom 281 (74%) reported any mistreatment. Physical and verbal abuse were reported by 7 (2%) and 31 (8%) women interviewed respectively. Failure to meet professional standards of care and poor rapport between women and providers were reported by 111 (29%) and 274 (72%) women interviewed respectively.Multivariable logistic regression analysis revealed that the odds of reporting mistreatment were higher among women with four or more previous births (aOR = 3.36 95%CI 1.22,9.23, p = 0.019) compared to women with no previous childbirth, Muslim women (aOR = 3.30 95%CI 1.4,7.77, p = 0.006) and women interviewed in facilities with less than 17 births per MNH staff in a month (aOR = 3.63 95%CI 1.9,6.93, p < 0.001). However, the odds of reporting mistreatment were lower among women aged 35 and older (aOR = 0.22 95%CI 0.06, 0.73, p = 0.014) and among women interviewed between 8 and 42 days after childbirth (aOR = 0.37 95%CI 0.15, 0.9, p = 0.028).ConclusionMistreatment during childbirth in Ethiopia is commonly reported. Health workers need to consider provision of individualized care for women and monitor their experiences in order to adjust quality of their services.
Highlights
The third Sustainable Development Goal aims to reduce the maternal mortality ratio (MMR) to below 70 per 100,000 live births in all countries by 2030 [1]
A majority, 73 of the 107 (68%) participants interviewed in hospitals were urban residents compared to only 121 of the 272 (44%) participants interviewed in health centers
In a multivariable logistic regression analysis, the odds of reporting mistreatment were higher among women with four or more previous births compared to women with no previous childbirth, among Muslim women compared to Orthodox Christians and among women interviewed in facilities with less than 17 births per Maternal and Newborn Health (MNH) staff in a month
Summary
The third Sustainable Development Goal aims to reduce the maternal mortality ratio (MMR) to below 70 per 100,000 live births in all countries by 2030 [1]. Recent studies in lowand middle-income countries on experiences of women during childbirth in health facilities have revealed unacceptable practices including disrespectful, abusive or neglectful treatment [3,4,5,6]. These experiences of mistreatment are identified as reasons for low institutional birth rates [7,8,9,10]. Ensuring access to maternity care by skilled providers working in a functional health facility forms the basis of the strategy formulated by the Federal Ministry of Health of Ethiopia to reduce maternal mortality. This study seeks to explore the prevalence of mistreatment of women in public health facilities of Ethiopia, and identify associated factors
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