Perspectives from Providers and Mothers on the Benefits of and Barriers to Respectful Maternity Care in a Refugee Camp Setting in Thailand

Abstract

IntroductionRecent evidence suggests the lack of respectful maternity care (RMC) may indirectly contribute to maternal morbidity and mortality. Compared to more stable settings, provision of RMC in emergency, conflict‐affected, and transitional contexts poses a greater challenge, though few studies have focused on RMC in these settings. This study aimed to describe providers’ and women's perspectives on benefits of and barriers to RMC in a conflict‐affected setting. An additional aim was to better understand the extent to which Burmese refugee women are experiencing disrespect and abuse during their maternity care, including care processes and interactions with providers.MethodsIn‐depth interviews and focus group discussions with maternity care providers and women giving birth in the previous 4 months were conducted at clinics in 2 refugee camps in Thailand and in a nearby Thai government referral hospital in August 2014. Participant observation occurred in the labor and postpartum wards and delivery rooms of these facilities. Recorded sessions were translated, transcribed, coded, and analyzed for common themes.ResultsEleven mothers and 14 providers, including midwives, traditional birth attendants, nurses, and physician interns, participated in either a focus group discussion or in‐depth interview exploring experiences receiving or delivering maternity care. Major themes emerging from the data included patient‐centered care, care equity, and trust. Both providers and women shared numerous experiences of disrespectful or abusive care. Subthemes related to these experiences were lack of patient privacy or consent, verbal and physical abuse by providers, ethnic and religious discrimination, and lack of mutual trust between patient and provider. High caseloads, language barriers, and patient‐provider educational disparities were also identified by providers as major barriers to providing RMC.DiscussionRefugee women are experiencing disrespectful and abusive care in both camp settings and a government referral facility. Challenges to RMC delivery in conflict‐affected settings include language and cultural barriers, provider stress, and lack of mutual trust. More research is needed among displaced women and their providers to fully characterize barriers to RMC and develop effective interventions to overcome them in emergency contexts around the world.