Will You Like to Return to This Facility for Your Next Delivery? Measuring Respectful Maternity Care Delivered within Health Facilities in Bangladesh, Ghana and Tanzania

Abstract

Background: In 2015, a WHO statement called for global actions to prevent and eliminate disrespect and abuse during facility-based childbirth. UNICEF and health ministries in Bangladesh, Ghana and Tanzania tested the feasibility of implementing WHO's eight standards for improving quality of health facility care for mothers and newborns. This manuscript presents findings from measuring respectful maternity care (RMC) in facilities at baseline. Methods: Uniform methods and tools were used for data collection in the three countries: Assessment involved interviews with 43 managers, 325 providers, 849 recently-delivered women exiting post-discharge and 641 client-provider observations in the 43 facilities across the three countries. Trained clinicians and social scientists/anthropologists spent 2 weeks in facilities between May-July 2016. Data were analysed in Stata 14·1 and NVIVO 12. Responses to open-ended questions were coded into themes and triangulated with close-ended questions to facilitate their contextual interpretations. Findings: Facilities in Ghana (81%) were the most likely to have policies and processes for identifying client abuses compared to Tanzania (73%) and Bangladesh(50). Between 30%-60% of providers had no training in providing RMC but up to 80% could not cite two measures to prevent abuses and 80%-90% did not know how facilities respond to abuses, though 96%-100% claim they provide RMC. Women's account on the experience of RMC were not always consistent; up to 97% were happy with care received but up to 36% were sometimes concerned that providers were not doing enough for them and up to 7% were abused. Majority will recommend these facilities to relatives/friends, but based on their experiences, they would not return to these same facilities for future care. In Bangladesh, 97.4% expressed satisfaction with care received but only 43% will return to the same facilities for the next delivery (p<0·001). These were similar in Ghana and Tanzania. Interpretation: Measuring care satisfaction with questions that merely ask whether women or providers were satisfied with care received or provided are unreliable. A better index of satisfaction with care may be the significant proportion of women who reported that, based on the maternity care experienced, they will not return to the same facilities for birth in the future. This needs exploration in other settings. Funding: The study was funded by the Bill and Melinda Gates Foundation through UNICEF headquarters, New York. Declaration of Interests: All the authors declare no conflict of or competing interests. Ethics Approval Statement: The study protocol was approved by institutional ethics review boards (IRBs) in all three countries: ICDDR,B in Bangladesh, Ghana Health Service (GHS) in Ghana and NIMR in Tanzania. Clearance was sought from the facility managers for the study in the respective facilities.