Abstract
BackgroundSub-Saharan Africa accounts for approximately 66% of global maternal deaths. Poor person-centered maternity care, which emphasizes the quality of patient experience, contributes both directly and indirectly to these poor outcomes. Yet, few studies in low resource settings have examined what is important to women during childbirth from their perspective. The aim of this study is to examine women’s facility–based childbirth experiences in a rural county in Kenya, to identify aspects of care that contribute to a positive or negative birth experience.MethodsData are from eight focus group discussions conducted in a rural county in western Kenya in October and November 2016, with 58 mothers aged 15 to 49 years who gave birth in the preceding nine weeks. We recorded and transcribed the discussions and used a thematic approach for data analysis.ResultsThe findings suggest four factors influence women’s perceptions of quality of care: responsiveness, supportive care, dignified care, and effective communication. Women had a positive experience when they were received well at the health facility, treated with kindness and respect, and given sufficient information about their care. The reverse led to a negative experience. These experiences were influenced by the behavior of both clinical and support staff and the facility environment.ConclusionsThis study extends the literature on person-centered maternity care in low resource settings. To improve person-centered maternity care, interventions need to address the responsiveness of health facilities, ensure women receive supportive and dignified care, and promote effective patient-provider communication.
Highlights
Poor person-centered maternity care, which emphasizes the quality of patient experience, contributes both directly and indirectly to the poor outcomes
We examine Kenyan women’s positive and negative facility–based childbirth experiences to identify aspects of care that are important to them
This study extends the literature on Person-centered maternity care (PCMC) by analyzing the range of women’s facility-based childbirth experiences to more holistically assess quality of care from their perspective
Summary
Sub-Saharan Africa accounts for approximately 66% of global maternal deaths. Poor person-centered maternity care, which emphasizes the quality of patient experience, contributes both directly and indirectly to these poor outcomes. Maternal mortality remains high in sub-Saharan Africa (SSA), despite improvements in the last decade [1]. Most efforts to improve maternal health in SSA emphasized increasing the proportion of women delivering in health facilities with skilled attendants. Maternal mortality has remained high in many countries despite increasing facility deliveries [3, 4]. This has highlighted the need to focus on the quality of facility-based delivery care [5]. Documentation of disrespectful, abusive, and neglectful treatment of women during childbirth in facilities has highlighted gaps in person-centered maternity care [6,7,8,9]
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