Promoting respectful maternity care in rural Tanzania: nurses\u2019 experiences of the \u201cHealth Workers for Change\u201d program

Gail Webber,Nyamusi Magatti,Bwire Chirangi

doi:10.1186/s12913-018-3463-5

Abstract

BackgroundDisrespectful and abusive care of women during their pregnancies has been shown to be a barrier for women accessing health care services for antenatal care and delivery. As part of an implementation research study to improve women’s access to health care services in Rorya District, Mara, Tanzania, we conducted a pilot study training reproductive health care nurses to be more sensitive to women’s needs based on the “Health Workers for Change” curriculum.MethodsSix series of workshops were held with a total of 60 reproductive health care nurses working at the hospitals, health centres and dispensaries in the district. The participants provided comments on a survey and participated in focus groups at the conclusion of the workshop series. These qualitative data were analyzed for common themes.ResultsThe participants appreciated the training and reflected on the poor quality of health care services they were providing, recognizing their attitudes towards their women patients were problematic. They emphasized the need for future training to include more staff and to sustain positive changes. Finally, they made several suggestions for improving women’s experiences in the future.ConclusionsThe qualitative findings demonstrate the success of the workshops in assisting the health care providers to become aware of their negative attitudes towards women. Future research should examine the impact of the workshops both on sustaining attitudinal changes of the providers and on the experiences of pregnant women receiving health care services.

Highlights

Disrespectful and abusive care of women during their pregnancies has been shown to be a barrier for women accessing health care services for antenatal care and delivery
This paper reports on the experiences of nurses in a series of workshops based on the “Health Workers for Change” curriculum [9] in Rorya District, Mara Region, Tanzania
“This [workshop] has really changed my behaviour, I thought we were doing the right thing, seriously we were very wrong.” (Focus Group Participant, Kogaja Dispensary). In addition to their attitudes being a barrier for women attending health facilities, the health care providers noted the quality of care for women who did attend the health facility was lacking due to insufficient supplies and sometimes limitations of the health care provider’s service: “Sometimes we have a shortage of supplies so we don’t give satisfactory care.” (Focus Group Participant, Kowak Hospital)

Summary

Introduction

Disrespectful and abusive care of women during their pregnancies has been shown to be a barrier for women accessing health care services for antenatal care and delivery. In understanding why a significant proportion of women continue to avoid facility care, it has become evident that one of the important barriers for women to access maternity care is the disrespectful and abusive attitudes of some health care providers towards women [1]. There is considerable evidence of disrespectful and abusive health care provider attitudes towards women in a number of African settings. Webber et al BMC Health Services Research (2018) 18:658 and reproductive health care services, Jonas and colleagues [4] examined 35 studies over a 15 year period They concluded that health care providers’ negative attitudes - in addition to lack of knowledge, limited access to medical equipment and sometimes conservative religious beliefs - limit access of women and adolescents to family planning and antenatal care services

Methods

Results

Discussion

Conclusion