Disrespectful Care Research Articles

Give the community the tools and they will help finish the job: key population-led health services for ending AIDS in Thailand.

Give the community the tools and they will help finish the job: key population-led health services for ending AIDS in Thailand.

Factors influencing women\u2019s access to the maternity waiting home in rural Southwest Ethiopia: a qualitative exploration

BackgroundMaternity Waiting Homes (MWHs) have been advocated to improve the utilization of skilled birth attendants. Nevertheless, delivery attended by skilled personnel is low in Ethiopia and may indicate that the utilization of MWH is also low. The aim of this study is to explore the factors influencing women’s access to the MWHs in rural Southwest Ethiopia.MethodsQualitative data were collected through focus group discussions with MWHs users and in-depth interviews with MWHs non-users, health extension workers and the clinicians. Four focus group discussions and 18 in-depth interviews were conducted between May 1 and June 1, 2017. Furthermore, observations were made to assess the availability of basic facilities at selected MWHs. Data were thematically analyzed using NVivo version 7. The concept of access defined by Thiede et al was applied to guide the analysis.ResultsWomen had interest on MWHs and are aware of the existence of MWHs in their immediate vicinity. Health information disseminations and referral linkages by frontline health workers enabled women to timely access the MWHs. However, Women didn’t understand the aims and benefits of MWHs. At the facility level, there were attempts to improve the acceptability of MWHs by allowing women to choose their delivery positions. But, participants claimed lack of privacy and presence of disrespectful care. Physical barriers (long distance, unavailability of transport options & unfavorable roads) were considered as potential problems for women residing in remote areas. MWH users mentioned absences of sufficient basic facilities, poor quality and varieties of food. Because of insufficient facilities, the cost of living was high for most users. The communities try to overcome the indirect costs through contributions in-kind and in-cash.ConclusionsThe factors influencing women’s access to the MWHs were structural and individual and resonate with Thiede et al. dimensions of access. A better understanding of which factors are most influential in preventing women’s access to the MWHs in rural Southwest Ethiopia is needed to appropriately target interventions.

\u201cThe midwife helped me ... otherwise I could have died\u201d: women\u2019s experience of professional midwifery services in rural Afghanistan - a qualitative study in the provinces Kunar and Laghman

BackgroundAfghanistan has one of the world’s highest maternal mortality ratios, with more than 60% of women having no access to a skilled birth attendant in some areas. The main challenges for childbearing Afghan women are access to skilled birth attendance, emergency obstetric care and reliable contraception. The NGO-based project Advancing Maternal and Newborn Health in Afghanistan has supported education of midwives since 2002, in accordance with the national plan for midwifery education.The aim of this study is to explore women’s experiences of professional midwifery care in four villages in Afghanistan covered by the project, so as to reveal challenges and improve services in rural and conflict-affected areas of the country.MethodsAn exploratory case-study approach was adopted. Fourteen in-depth interviews and four focus-group discussions were conducted. A total of 39 women participated – 25 who had given birth during the last six months, 11 mothers-in-law and three community midwives in the provinces of Kunar and Laghman. Data generated by the interviews and observations was analysed using thematic content analysis.FindingsMany of the women greatly valued the trained midwives’ life-saving experience, skills and care, and the latter were important reasons for choosing to give birth in a clinic. Women further appreciated midwives’ promotion of immediate skin-to-skin contact and breastfeeding. However, some women experienced rudeness, discrimination and negligence on the part of the midwives. Moreover, relatives’ disapproval, shame and problems with transport and security were important obstacles to women giving birth in the clinics.ConclusionsLocal recruitment and professional education of midwives as promoted by Afghan authorities and applied in the project seem successful in promoting utilisation and satisfaction with maternal and neonatal health services in rural Afghanistan. Nevertheless, the quality of the services is still lacking, with some women complaining of disrespectful care. There seems to be a need to focus more on communication issues during the education of midwives. An increased focus on in-service training and factors promoting quality care and respectful communication is necessary and should be prioritised.

Disrespectful Maternity Care Experiences Negatively Influence Future Intention to Use Institutional Delivery in Northern Ethiopia

Background Ethiopia has successfully increased antenatal care coverage substantially, but deliveries attended by skilled providers are still low. Disrespectful and abusive maternity care practices are believed to be among the factors deterring institutional delivery services. However, information on the relationship between women’s experience of disrespect and abuse (D&A) and their future intention to give birth at health facilities is lacking in our context. Therefore, the aim of this study was to examine the association between experiencing disrespectful care and future intention of women to utilize health facilities for delivery. Methods A cross-sectional study was conducted in Tigray, Ethiopia. Data were collected using a structured questionnaire. Women who had given birth in the health facilities in the twelve months preceding the study were interviewed. D&A was self reported by the women. Bivariable and multivariable logistic regression models were employed to examine the relationship between future intention of women to use institutional delivery services and their past experience of D and A while receiving maternity care services. Results A total of 1,031 women who delivered in health facilities in the last 12 months participated in the study. Of which, 156 (15.1%) reported having experienced two or more types of D&A while receiving labour and delivery care services. Experiences of D&A were strongly associated with the intention to use the health facility in future deliveries. The odds of having no intention to use health facilities for future deliveries was extremely high among women who reported they had experienced D&A (aOR= 59.42; 95% CI: 30.082, 117.359). Conclusion Disrespectful and abusive experiences strongly deterred future use of maternal health services. In order to achieve the desired level of institutional delivery coverage in low- and middle-income countries, attention must be given to improve the manner in which services are offered. Keywords: Intention to deliver at a health facility, Respectful maternity care, Disrespect and abuse, Tigray, Ethiopia DOI: 10.7176/JHMN/72-01 Publication date: March 31 st 2020

Naming Obstetric Violence as a Social Problem

Abstract Naming social problems is a critical step toward addressing them. Researchers have searched for a term that encompasses the violation of the rights of pregnant women by medical personnel. I argue that instead of more euphemistic terms such as “mistreatment,” “forced compliance,” or “disrespectful care,” we should name these violations more directly. The most popular emerging term is obstetric violence. In the tradition of C. Wright Mills, I argue that obstetric violence is a social problem, too widespread to be merely a personal trouble but rather an issue of public concern. I also address detractors that view using the term obstetric violence as damaging through examples of real women whose experiences cannot and should not be underplayed.

How respectfully women are treated during difficult phase like childbirth? A primary survey of differently-managed health facilities in Odisha, India

ObjectiveThe study was explorative in nature, implemented at hospital level to investigate how respectfully women are treated while accessing delivery care in the health facilities. MethodsA total of 115 differently-managed i.e. public, private and public-private partnerships (PPP) health facilities in Ganjam and Kandhamal districts of Odisha were selected to undertake this study. Three women each having given childbirth in the last six months preceding the survey in the sampled 115 health facilities were selected randomly to participate in the study. ResultsThe result presented a distinct picture wherein provision of respectful maternity care is not uniform for all the respondents included in the study. Management of the health facility remained as the major transpiring factor to providing respectful maternity care. Public health facility (ATT: 5.503) - which happened to be the largest service provider in the study population, affects respectful maternity care adversely. Contrary to this, women having accessed delivery care from the PPP facilities received more respectful maternity care. The private facilities whose number is mushrooming alarmingly at the present time also fails to provide the needed respectful maternity care to women during their difficult phase like childbirth. ConclusionWomen's memory of birth experience including any disrespectful and abusive care stays with her lifetime and affects her physical and emotional health. It may also discourage her to have institutional delivery – by which, opportunities may be lost to diagnose morbidities early that are associated with pregnancy and childbirth.

Experiences of LGBT Patients and Family Members with Hospice and Palliative Care (TH352)

•Describe institutional and provider policies regarding LGBT patients and family members in hospice and palliative care.•Describe the extent to which LGBT patients and their close family members and friends receive inadequate, disrespectful or abusive care due to their sexual minority status.•Discuss data-based recommendations for: provider education and practices; institutional and public policy; and future research. The lesbian, gay, bisexual, and transgender (LGBT) community experiences discrimination and stigma in accessing health care and social services – including palliative, hospice, and long-term care. Health care providers may fail to recognize or address disparities in care. Providers and institutions may be uncomfortable with sexual orientation and gender identity and expression issues, and often don't inquire about these. Research shows that LGBT patients fear being open about their identities, not receiving equal or safe treatment, and having their family of choice and designated surrogates disrespected or ignored by health care staff. There are approximately 2.7 million LGBT adults in the U.S. age 50+, with approximately 1.1 million age 65+. With the projected increased number of older adults and improved treatments that extend the life of seriously ill individuals, even more LGBT older adults, and their families, will require palliative and end-of-life care in coming years. This study examines inadequate, disrespectful, and abusive care to patients and family members due to their sexual orientation or gender identity. A cross-sectional study using an online survey was completed by 865 providers, including social workers, physicians, nurses, and chaplains. Among respondents, 55% reported that LGB patients were more likely to experience discrimination at their institution than non-LGB patients; 24% observed discriminatory care; 65% reported that transgender patients were more likely than non-transgender patients to experience discrimination; 20% observed discrimination to transgender patients; 14% observed the spouse/partner of LGBT patients having their treatment decisions disregarded or minimized; and 13% observed the spouse/partner or surrogate being treated disrespectfully. Findings reported also include: institutional non-discrimination policy, staff training, intake procedures, and comfort in assessing LGBT status. Implications for future research, institutional and public policy, and practice will be presented, including current policy barriers to respectful and non-discriminatory care, and the importance of staff training to address inadequate knowledge and discriminatory behaviors.

Magnitude of disrespectful and abusive care among women during facility-based childbirth in Shambu town, Horro Guduru Wollega zone, Ethiopia

BackgroundDisrespectful care during childbirth causes suffering and discourages women from seeking facility-based care. It is one of the silent causes of maternal mortality and morbidity worldwide, but not yet well recorded especially in developing countries. The aim of this study was to measure the magnitude of disrespect and abusive behaviors of health professionals during childbirth and associated factors. MethodCommunity based cross-sectional study design was employed among 321 women who gave birth in public health facilities of Shambu town, Ethiopia, between January 01 and December 31, 2018. Simple random sampling was used to select the study participants. Data were collected using a semi-structured interviewer administered questionnaire. Prevalence of disrespect and abuse was measured by using seven categories of disrespect and abuse with their respective verification criteria. The data were entered into Epi-data 3.1 and then transported to SPSS version 23.0. Logistic regression models were fitted to determine the presence of statistically significant associations between the dependent and independent variables at p-value <0.05 and AOR values with 95% confidence interval. ResultsOut of 321 sampled respondents, 316 participated in this study with response rate of 98.4%. The overall prevalence of disrespect and abuse was 78.2% (95% CI: 73.5–83.2). The most common forms disrespect and abuse encountered by the mothers were: unconsented care (86.1%), non-dignified care (37.3%), lack of privacy (33.9%), physical abuse (21.5%) and neglectful care (13.3%). Mother's occupational status, increasing number of antenatal care visits and giving birth in a hospital setting were significantly associated with disrespect and abuse during facility-based childbirth. ConclusionThough government interventions are in place, excessive levels of disrespect and abusive practices during facility-based childbirth persisted to be important problems in the study area. To address the unnecessary suffering, health policy makers and program designers should develop strategies to enhance respectful maternity care approaches. Health managers and health professionals should do their best to provide high quality, client-centered care in health facilities so that women are not discouraged from using them. We also recommend knowledge exchange with development partners to determine which practices will be adaptable and helpful to address the problem of mistreatment of women in health care facilities.

Experiences of Lesbian, Gay, Bisexual, and Transgender Patients and Families in Hospice and Palliative Care: Perspectives of the Palliative Care Team

Background: Lesbian, gay, bisexual, and transgender (LGBT) patients fear being open about their identities, not receiving equal or safe treatment, and having their family and surrogates disrespected or ignored by providers. Objective: To examine inadequate, disrespectful, and abusive care to patients and family due to sexual orientation or gender identity. Design: A cross-sectional study using an online survey. Setting/Subjects: Home and residential hospice, inpatient palliative care service, and other inpatient and outpatient settings. Subjects were 865 hospice and palliative care providers, including physicians, social workers, nurses, and chaplains. Measurements: Inadequate, disrespectful, or abusive care to LGBT patients and discriminatory treatment of family and surrogates were measured. Results: Among respondents, 53.6% thought that lesbian, gay, or bisexual (LGB) patients were more likely than non-LGB patients to experience discrimination at their institution; 23.7% observed discriminatory care; 64.3% reported that transgender patients were more likely than nontransgender patients to experience discrimination; 21.3% observed discrimination to transgender patients; 15% observed the spouse/partner of LGBT patients having their treatment decisions disregarded or minimized; and 14.3% observed the spouse/partner or surrogate being treated disrespectfully. Conclusions: These findings provide strong evidence that LGBT patients and their families are more likely to receive discriminatory care as compared with those who are not LGBT. Disrespectful care can negatively impact the trust patients have in providers and institutions, and lead to delaying or avoiding care, or not disclosing relevant information. Partners/spouses and surrogates may be treated disrespectfully, have their treatment decisions ignored or minimized, be denied or have limited access to the patient, and be denied private time. Advocacy and staff training should address barriers to delivering respectful and nondiscriminatory care.

Barriers to provision of respectful maternity care in Zambia: results from a qualitative study through the lens of behavioral science

BackgroundRecently, a growing body of literature has established that disrespect and abuse during delivery is prevalent around the world. This complex issue has not been well studied through the lens of behavioral science, which could shed light on the psychological dimensions of health worker behavior and how their micro-level context may be triggering abuse. Our research focuses on the behavioral drivers of disrespect and abuse in Zambia to develop solutions with health workers and women that improve the experience of care during delivery.MethodsA qualitative study based on the behavioral design methodology was conducted in Chipata District, Eastern Province. Study participants included postpartum women, providers (staff who attend deliveries), supervisors and mentors, health volunteers, and birth companions. Observations were conducted of client-provider interactions on labor wards at two urban health centers and a district hospital. In-depth interviews were audio recorded and English interpretation from these recordings was transcribed verbatim. Data was analyzed using thematic analysis and findings were synthesized following the behavioral design methodology.ResultsFive key behavioral barriers were identified: 1) providers do not consider the decision to provide respectful care because they believe they are doing what they are expected to do, 2) providers do not consider the decision to provide respectful care explicitly since abuse and violence are normalized and therefore the default, 3) providers may decide that the costs of providing respectful care outweigh the gains, 4) providers believe they do not need to provide respectful care, and 5) providers may change their mind about the quality of care they will provide when they believe that disrespectful care will assist their clinical objectives. We identified features of providers’ context – the environment in which they live and work, and their past experiences – which contribute to each barrier, including supervisory systems, visual cues, social constructs, clinical processes, and other features.ConclusionsClient experience of disrespectful care during labor and delivery in Chipata, Zambia is prevalent. Providers experience several behavioral barriers to providing respectful maternity care. Each of these barriers is triggered by one or more addressable features in a provider’s environment. By applying the behavioral design methodology to the challenge of respectful maternity care, we have identified specific and concrete contextual cues that targeted solutions could address in order to facilitate respectful maternity care.

Deliver on Your Own: Disrespectful Maternity Care in rural Kenya.

BackgroundUnder the Free Maternity Policy (FMP), Kenya has witnessed an increase in health facility deliveries rather than home deliveries with Traditional Birth Attendants (TBA) resulting in improved maternal and neonatal outcomes. Despite these gains, maternal and infant mortality and morbidity rates in Kenya remain unacceptably high indicating that more needs to be done.AimUsing data from the Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project’s qualitative gender assessment, this paper examines women’s experience of disrespectful care during pregnancy, labour, and delivery. The goal is to promote an improved understanding of the actual care conditions to inform the development of interventions that can lift the standard of care, increase maternity facility use, and improve health outcomes for both women and newborns.MethodologyWe conducted sixteen focus group discussions (FGDs), two each for adolescent females, adult females, adult males, and community health committee members. As well, twenty-four key Informants interviews (KII) were also conducted including religious leaders, and persons from local government representatives, Ministry of Health (MOH), and local women’s organizations. Data were captured through audio recordings and reflective field notes.Research siteKisii and Kilifi Counties in Kenya.FindingsFindings show nursing and medical care during labour and delivery were at times disrespectful, humiliating, uncompassionate, neglectful, or abusive. In both counties, male health workers were preferred by women giving birth, as they were perceived as more friendly and sensitive. Adolescent females were more likely to report abuse during maternity care while women with disabled children reported being stigmatized. Structural barriers related to transportation and available resources at facilities associated with disrespectful care were identified.ConclusionsA focus on quality and compassionate care as well as more facility resources will lead to increased, successful, and sustainable use of facility care. Interpreting these results within a systems perspective, Kenya needs to implement, enforce, and monitor quality of care guidelines for pregnancy and delivery including respectful maternity care of pregnant women. To ensure these procedures are enforced, measurable benchmarks for maternity care need to be established, and hospitals need to be regularly monitored to ensure these benchmarks are achieved.

Respectful maternity care during childbirth in India: A systematic review and meta-analysis.

Background:Respectful maternity care is a rightful expectation of women. However, disrespectful maternity care is prevalent in various settings. Therefore, a systematic review and meta-analysis were conducted to identify various forms of ill-treatment, determinants, and pooled prevalence of disrespectful maternity care in India.Methods:A systematic review was performed in various databases. After quality assessment, seven studies were included. Pooled prevalence was estimated using the inverse variance method and the random-effects model using Review Manager Software.Results:Individual study prevalence ranged from 20.9% to 100%. The overall pooled prevalence of disrespectful maternity care was 71.31% (95% CI 39.84–102.78). Pooled prevalence in community-based studies was 77.32% (95% CI 56.71–97.93), which was higher as compared to studies conducted in health facilities, this being 65.38% (95% CI 15.76–115.01). The highest reported form of ill-treatment was non-consent (49.84%), verbal abuse (25.75%) followed by threats (23.25%), physical abuse (16.96%), and discrimination (14.79%). Besides, other factors identified included lack of dignity, delivery by unqualified personnel, lack of privacy, demand for informal payments, and lack of basic infrastructure, hygiene, and sanitation. The determinants identified for disrespect and abuse were sociocultural factors including age, socioeconomic status, caste, parity, women autonomy, empowerment, comorbidities, and environmental factors including infrastructural issues, overcrowding, ill-equipped health facilities, supply constraints, and healthcare access.Results:Individual study prevalence ranged from 20.9% to 100%. The overall pooled prevalence of disrespectful maternity care was 71.31% (95% CI 39.84–102.78). Pooled prevalence in community-based studies was 77.32% (95% CI 56.71–97.93), which was higher as compared to studies conducted in health facilities, this being 65.38% (95% CI 15.76–115.01). The highest reported form of ill-treatment was non-consent (49.84%), verbal abuse (25.75%) followed by threats (23.25%), physical abuse (16.96%), and discrimination (14.79%). Besides, other factors identified included lack of dignity, delivery by unqualified personnel, lack of privacy, demand for informal payments, and lack of basic infrastructure, hygiene, and sanitation. The determinants identified for disrespect and abuse were sociocultural factors including age, socioeconomic status, caste, parity, women autonomy, empowerment, comorbidities, and environmental factors including infrastructural issues, overcrowding, ill-equipped health facilities, supply constraints, and healthcare access.Conclusion:The high prevalence of disrespectful maternity care indicates an urgent need to improve maternity care in India by making it more respectful, dignified, and women-centered. Interventions, policies, and programs should be implemented that will protect the fundamental rights of women.

Lessons from the Holocaust for perinatal care today.

Lessons from the Holocaust for perinatal care today.

Is there respectful maternity care in Poland? Women\u2019s views about care during labor and birth

BackgroundAbuse against women in labor starts with subtle forms of discrimination that can turn into overt violence. Therefore it is crucial to work towards prevention and elimination of disrespect and ill-treatment in medical facility perinatal care in which staff allows such abuse.The aim of the study was to analyze the experiences of women related to perinatal care. Special emphasis was put on experiences that had traits indicating disrespectful and offensive care during childbirth in medical facilities providing perinatal care.MethodsThis was a cross-sectional survey. A questionnaire was prepared for respondents who gave birth in medical facilities. Information about the study was posted on the website of a non-governmental foundation dealing with projects aimed at improving perinatal care. The respondents gave online consent for processing the submitted data. 8378 questionnaires were submitted. The study was carried out between February 06 and March 20, 2018. The results were analyzed using the Chi-square independence test. The analysis was carried out at the significance level of 0.05 in Excel, R and SPSS.ResultsDuring their hospital stay, 81% of women in the study experienced violence or abuse from medical staff on at least one occasion. The most common abuse was having medical procedures without prior consent. Inappropriate comments made by staff related to their own or a woman’s situation were reported in 25% of situations, whilst 20% of women experienced nonchalant treatment. In the study 19.3% of women reported that the staff did not properly care for their intimacy and 1.7% of the respondents said that the worst treatment was related to feeling anonymous in the hospital.ConclusionsThe study shows that during Polish perinatal care women experience disrespectful and abusive care. Most abuse and disrespect involved violation of the right to privacy, the right to information, the right to equal treatment, and the right to freedom from violence. The low awareness of abuses and complaints reported in the study may result from women’s ignorance about relevant laws related to human rights.

EXPERIENCE OF LGBT PATIENTS AND FAMILY WITH HOSPICE AND PALLIATIVE CARE

This study examines the degree to which hospice and palliative care staff observe or perceive inadequate, disrespectful, or abusive care to LGBT patients and family members. A cross-sectional study using an online survey completed by 865 providers, including social workers, physicians, nurses, and chaplains. Among respondents, 55% reported that LGB patients were more likely to experience discrimination at their institution than non-LGB patients; 24% observed discriminatory care; 65% reported that transgender patients were more likely than non-transgender patients to experience discrimination; 20% observed discrimination to transgender patients; 14% observed the spouse/partner of LGBT patients having their treatment decisions disregarded or minimized; and 13% observed the spouse/partner being treated disrespectfully. Findings reported also include: institutional non-discrimination policy, staff training, intake procedures, and comfort in assessing LGBT status. Implications for future research, policy, and practice will be presented.

PALLIATIVE AND END-OF-LIFE CARE TO THE LGBT COMMUNITY

The lesbian, gay, bisexual, and transgender (LGBT) community experiences discrimination and stigma in accessing health care and social services – including palliative, hospice, and long-term care – across cultures and countries. Health care providers may fail to recognize, acknowledge or address disparities in care. Providers and institutions may be uncomfortable with gender and sexuality issues, and often fail to inquire about sexual orientation and gender identity. It is estimated that there are approximately 2.7 million LGBT adults in the U.S. age 50 and older and approximately 1.1 million age 65 and older. In the UK, an estimated 5-7% of the population identify as LGBT; there are between 600,000 and 840,000 LGBT adults aged 65+. With the projected increased number of older adults and improved treatments that extend the life of seriously ill individuals, even greater numbers of LGBT older adults, and their families, will require palliative and end-of-life in the coming years. Researchers in the US and UK have found that LGBT older adults living in the community and in long-term care facilities experience inadequate, disrespectful, and abusive care due to their sexual orientation and gender identity status. They fear being open about their identities, not receiving equal or safe treatment, and having their family of choice and designated surrogates disrespected or ignored by health care staff. This symposium will describe the experiences of LGBT individuals and their family members, and compare commonalities and differences faced by LGBT communities in the US and UK in accessing palliative and end-of-life care.

Disrespectful treatment in primary care in rural Tanzania: beyond any single health issue.

Knowing how patients are treated in care is foundational for creating patient-centred, high-quality health systems and identifying areas where policies and practices need to adapt to improve patient care. However, little is known about the prevalence of disrespectful treatment of patients in sub-Saharan Africa outside of maternity care. We used data from a household survey of 2002 women living in rural Tanzania to describe the extent of disrespectful care during outpatient visits, who receive disrespectful care, and determine the association with patient satisfaction, rating of quality and recommendation of the facility to others. We asked about women’s most recent outpatient visit to the local clinic, including if they were made to feel disrespected, if a provider shouted at or scolded them, and if providers made negative or disparaging comments about them. Women who answered yes to any of these questions were considered to have experienced disrespectful care. We report risk ratios with standard errors clustered at the facility level. The most common reasons for seeking care were fever or malaria (33.9%), vaccination (33.6%) and non-emergent check-up (13.4%). Disrespectful care was reported by 14.3% of women and was more likely if the visit was for sickness compared to a routine check-up [risk ratio (RR): 1.6, 95% confidence interval (CI): 1.1–2.2]. Women who did not report disrespectful care were 2.1 times as likely to recommend the clinic (95% CI: 1.6–2.7). While there is currently a lot of attention on disrespectful maternity care, our results suggest that this is a problem that goes beyond this single health issue and should be addressed by more horizontal health system interventions and policies.

Women's experiences of disrespectful and abusive maternal health care in a low resource rural setting in eastern Zimbabwe

There has been an increase in recent publications, in high and medium resource settings, documenting women's dissatisfaction with the quality of maternity care they receive. Their discontent is mostly related to their midwives' disrespectful or negative attitudes. To explore women's experiences and perceptions of disrespect and abuse from their maternity care providers in a low resource rural setting in Zimbabwe. A critical, qualitative research methodology, using in-depth interviews and two focus group discussions, was employed to capture rural women's experiences during antenatal care, postpartum care, and the use of maternity waiting homes' services. Three rural health centres in Mutare district, Manicaland Province in eastern Zimbabwe. A total of 20 purposively sampled women, 16-30 years of age, who were accessing various stages of maternal health services, were recruited from three conveniently selected rural health centres. Eight women participated in the in-depth interviews. A further eight women were discussants in the first focus group, and a further four women participated in the second focus group. Multifaceted and interconnected factors contribute to midwives' attitudes and behaviours towards their clients. Midwives' subjective perceptions, women's social status, and health system constraints (i.e., availability of trained midwives and quality of midwifery training) in rural and poorly resourced community, often result in inappropriate services, negative attitudes, abusive treatment, and disrespectful behaviour towards women. Poor treatment in maternity care directly contribute to adverse health outcomes and women's satisfaction with services. Women's social status, level of education and age, were perceived to influence the quality of care or treatment they received. Improving women's experience of maternal care requires targeted interventions at the interpersonal level between a woman and her health care providers, as well as at the level of the health care facility and the health system. The results of this study challenge all tiers of health personnel including policy makers, in low resource settings to reappraise the present situation thereby challenging these established behaviours, to ensure that the continuum of maternity care is respectfully and socio-culturally delivered.

Women who break the rules: Social exclusion and inequities in pregnancy and childbirth experiences in Zambia

Health inequities are a growing concern in low- and middle-income countries, but reducing them requires a better understanding of underlying mechanisms. This study is based on 42 semi-structured interviews conducted in June 2018 with women who gave birth in the previous year, across rural and urban clinic sites in Mansa district, Zambia. Findings show that health facility rules regulating women's behaviour during pregnancy and childbirth create inequities in women's maternity experiences. The rules and their application can be understood as a form of social exclusion, discriminating against women with fewer financial and social resources. This study extends existing frameworks of social exclusion by demonstrating that the rules do not only originate in, but also reinforce, the structural processes that underpin inequitable social institutions. Legitimising the rules supports a moral order where women with fewer resources are constructed as “bad women”, while efforts to follow the rules widen existing power differentials between socially excluded women and others. This study's findings have implications for the literature on reversed accountability and the unintended consequences of global and national safe motherhood targets, and for our understanding of disrespectful maternity care.

Respectful and disrespectful care in the Czech Republic: An online survey

Respectful and disrespectful care in the Czech Republic: An online survey