Abstract

BackgroundDisrespect and abuse (D & A) during labor and delivery are important issues correlated with human rights, equity, and public health that also affect women’s decisions to deliver in facilities, which provide appropriate management of maternal and neonatal complications. Little is known about interventions aimed at lowering the frequency of disrespectful and abusive behaviors.MethodsBetween 2011 and 2014, a pre-and-post study measured D & A levels in a three-tiered intervention at 13 facilities in Kenya under the Heshima project. The intervention involved working with policymakers to encourage greater focus on D & A, training providers on respectful maternity care, and strengthening linkages between the facility and community for accountability and governance. At participating facilities, postpartum women were approached at discharge and asked to participate in the study; those who consented were administered a questionnaire on D & A in general as well as six typologies, including physical and verbal abuse, violations of confidentiality and privacy, detainment for non-payment, and abandonment. Observation of provider-patient interaction during labor was also conducted in the same facilities. In both exit interview and observational studies, multivariate analyses of risk factors for D & A controlled for differences in socio-demographic and facility characteristics between baseline and endline surveys.ResultsOverall D & A decreased from 20–13 % (p < 0.004) and among four of the six typologies D & A decreased from 40–50 %. Night shift deliveries were associated with greater verbal and physical abuse. Patient and infant detainment declined dramatically from 8.0–0.8 %, though this was partially attributable to the 2013 national free delivery care policy.ConclusionAlthough a number of contextual factors may have influenced these findings, the magnitude and consistency of the observed decreases suggest that the multi-component intervention may have the potential to reduce the frequency of D & A. Greater efforts are needed to develop stronger evaluation methods for assessing D & A in other settings.

Highlights

  • Disrespect and abuse (D & A) during labor and delivery are important issues correlated with human rights, equity, and public health that affect women’s decisions to deliver in facilities, which provide appropriate management of maternal and neonatal complications

  • The emphasis on the rights of both patients and health workers has its foundation in the Universal Declaration of Human Rights

  • The Human Rights Council has, for example, called upon States to scale up efforts to achieve the integrated management of quality maternal, newborn and child health services, at the community and family levels, and technical guidance documents on a human rights based

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Summary

Introduction

Disrespect and abuse (D & A) during labor and delivery are important issues correlated with human rights, equity, and public health that affect women’s decisions to deliver in facilities, which provide appropriate management of maternal and neonatal complications. Most international efforts for strengthening maternal health care focus largely on preventing morbidity and mortality, but recent emphasis on the universal right of quality maternal health care has illuminated the need for examining interpersonal relationships between patients and providers and, The emphasis on the rights of both patients and health workers has its foundation in the Universal Declaration of Human Rights. Other international covenants such as the economic, social and cultural rights focuses on the right to everyone enjoying the highest attainable standard of physical and mental health [1]. Treating women with dignity and respect is central to improvements of quality of care

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