Non-confidential Care Research Articles

Addressing obstetric violence: a scoping review of interventions in healthcare and their impact on maternal care quality.

The mistreatment and abuse of women during childbirth have been recognized as a major global health challenge, impeding facility-based delivery and contributing to the high maternal mortalities globally. The World Health Organization has specifically called for interventions to deal with obstetric violence. This scoping review consolidates the existing literature on interventions aimed at reducing obstetric violence and synthesizes existing knowledge on their impact in promoting respectful maternity care. Thirteen electronic databases were searched for relevant articles from January 2001 to March 2023. A total of 863 records were identified, and 72 full-text articles were retrieved for further screening. The review includes 16 studies, particularly from low- and middle-income countries, with interventions implemented at medical facilities and involving both women and healthcare providers. Eight of the studies were quantitative, three were qualitative and five used a mixed-methods approach. The results reveal a promising trend in reducing obstetric violence through various interventions. Ten different types of interventions were identified, highlighting strategies to improve the quality of maternity care and enhance patient-centered care. Improved patient-provider communication skills, increased privacy measures, and reduced abuse and mistreatment emerged as common themes. Enhanced communication skills, including open discussions and the right to be informed, were crucial in reducing obstetric violence. Privacy measures, such as separate rooms, curtains, and birth companions effectively decreased incidents of non-confidential care. General abuse and mistreatment, including physical abuse and neglect, were also reduced, leading to improved perceptions of respectful care during childbirth. Overall, the interventions had a favorable impact on obstetric violence reduction and women's childbirth experiences. However, despite promising results, obstetric violence remains prevalent worldwide, necessitating more efforts to implement effective interventions. To the best of our knowledge, this is the first scoping review on obstetric violence interventions, providing a comprehensive overview of the state of the art. We suggest that further research is needed to explore new interventions, particularly gender-sensitive interventions, to contribute to a growing body of knowledge on the prevention of obstetric violence.

The prevalence of obstetric violence experienced by women during childbirth care and its associated factors in Türkiye: A cross-sectional study

Objective This study determined the prevalence of obstetric violence experienced by women during childbirth and related factors in Türkiye.Design Cross-sectional studySetting This study was conducted in the mother-child health and gynecology outpatient clinics of the training and research hospital in Türkiye.Participants The study was completed with 513 women who gave birth in the last two years between January and May 2022.Methods Data were collected using a questionnaire prepared by the researchers. Bivariate and multivariate logistic regression analyzed the relationship between obstetric violence and socio-demographic and obstetric characteristics.Findings Obstetric violence was reported by 76.4% of the women: 44.4% physical abuse, 44.4% abandonment of care, 26.5% non-consented care, 25.1% non-dignified care, 3.3% non-confidential care, and 0.4% discrimination. Low income (OR=1.98), physician-attended birth (OR=2.91), vaginal birth (OR=6.04), and newborn admission to the neonatal care unit (OR=2.99) were associated with higher reporting of obstetric violence. Primiparous women (OR=0.51), whose pain was controlled by non-pharmacological methods (OR=0.34) and who received companion support (OR=0.24) were less likely to report experiencing obstetric violence (p < 0.05).Key conclusions Approximately three out of four Turkish women report that they have been exposed to obstetric violence during childbirth. In Türkiye, vaginal birth is the type of childbirth with the highest rate of obstetric violence reporting. Women who are low-income and multiparous, who are deprived of midwife, companion, and pain control support during childbirth, are more likely to experience obstetric violence.Implications for practice Supporting low-income women, protecting women from traumatic acts and unnecessary interventions in a vaginal birth, increasing births under the attendance of midwives, and providing pain control with non-pharmacological methods, and companion support during labor may be protective factors against obstetric violence.

Abuse and humiliation in the delivery room: Prevalence and associated factors of obstetric violence in Ghana.

Abuse and mistreatment of women during childbirth is a major barrier to facility-based delivery, putting women at risk of avoidable complications, trauma and negative health outcomes including death. We study the prevalence of obstetric violence (OV) and its associated factors in the Ashanti and Western Regions of Ghana. A facility-based cross-sectional survey was conducted in eight public health facilities from September to December 2021. Specifically, close-ended questionnaires were administered to 1,854 women, aged 15-45 who gave birth in the health facilities. The data collected include the sociodemographic attributes of women, their obstetric history and experiences of OV based on the seven typologies according to the categorization by Bowser and Hills. We find that about two in every three women (65.3%) experience OV. The most common form of OV is non-confidential care (35.8%), followed by abandoned care (33.4%), non-dignified care (28.5%) and physical abuse (27.4%). Furthermore, 7.7% of women were detained in health facilities for their inability to pay their bills, 7.5% received non-consented care while 11.0% reported discriminated care. A test for associated factors of OV yielded few results. Single women (OR 1.6, 95% CI 1.2-2.2) and women who reported birth complications (OR 3.2, 95% CI 2.4-4.3) were more likely to experience OV compared with married women and women who had no birth complications. In addition, teenage mothers (OR 2.6, 95% CI 1.5-4.5) were more likely to experience physical abuse compared to older mothers. Rural vs. urban location, employment status, gender of birth attendant, type of delivery, time of delivery, the ethnicity of the mothers and their social class were all not statistically significant. The prevalence of OV in the Ashanti and Western Regions was high and only few variables were strongly associated with OV, suggesting that all women are at risk of abuse. Interventions should aim at promoting alternative birth strategies devoid of violence and changing the organizational culture of violence embedded in the obstetric care in Ghana.

Components of obstetric violence: A descriptive study on physical abuse, non-consented care and non-confidential care

Objective: This study aimed at assessing the components of obstetric violence of women in receiving care during labor and postnatal period. Material and methods: This research was designed as a web-based descriptive study. The study was conducted with 556 women who had a vaginal delivery were within the first 6 weeks after delivery. The data of the research were collected between November-December 2021. Results: The mean age of women was 27.33±5.75, and the mean gestational week was 38.96±1.42. It was determined that while 95% of the women who underwent the intervention had a vaginal examination for less than 4 hours, 86.9% of them had no freedom of positioning at birth, and information was not provided to 41.2% of them before shaving, 22.2% of them before the amniotomy, 6.3% of them before oxytocin administration, 7.8% of them before episiotomy administration, 23.6% of them before fundal pressure, and 88.9% of them before vacuum support. It was found that 69.8% of the women did not have a companion during the delivery process, 67.1% of them were not involved in the decisions during the delivery process, and 93.9% of them asked for getting permission and providing information in the interventions during the delivery process. Additionally, the difference between the distributions of exposure to obstetric violence according to some sociodemographic and obstetric characteristics of the women was not statistically significant (p<0.05). Conclusion: According to the result of the study, it was determined that women were subjected to some types of obstetric violence during labor and the delivery process.

Status of Respectful Maternity Care Among Women Availing Delivery Services at a Tertiary Care Center in Central India: A Cross-Sectional Study.

IntroductionThere are numerous reports of disrespectful, abusive, or neglectful treatment during childbirth from health facilities worldwide. Although India has substantially increased the number of hospital deliveries and reduced the maternal mortality ratio, the quality of intrapartum and immediate postpartum care for delivering mothers has not been given much importance. Therefore, assessing mistreatment and quality of care during childbirth is vital for promoting respectful maternity care. MethodsA descriptive hospital-based cross-sectional study was carried out in a tertiary care center in central India. A convenience sampling method was used, and a total of 150 consecutive consenting women aged 18-49 years who delivered in the study setting were included. Data was collected using a predesigned and pretested questionnaire based on seven major categories per the Respectful Maternity Care (RMC) Charter.ResultsAll the 150 women in the present study, i.e., 100%, experienced at least one form of disrespect during their labor, childbirth, or postnatal period at the hospital. The mean scores for domains of non-confidential care (0.59), non-consented care (0.95), abandonment or denial of care (1.21), and physical abuse (1.26) are low.ConclusionThe findings of the present study shed important light on the current state of respectful maternity care in the study area. Though mothers are noticing and reporting positive changes in maternity care practices, respectful maternity care still has a long way to go.

Magnitude and pattern of facility-based disrespect and abusive treatment of women during childbirth in Abia State, Nigeria.

To ascertain the prevalence and pattern of reported facility-based disrespect and abuse of women during labour in Abia State, South-East, Nigeria. A cross-sectional questionnaire-based study. One urban and one rural healthcare facility in Abia State- Federal Medical Centre, Umuahia and Nigerian Christian Hospital (NCH) Nlagu, respectively. A total of 312 women who were recently delivered of their babies in the two facilities in Abia State and attending postnatal clinics were sampled for the survey. Disrespect and abuse D&A) during labour among women who give birth in healthcare facilities in Abia State. In all, over half (54.5%) of the women experienced disrespect and abuse in Abia State (50% urban and 63.5% in rural areas). The commonest form of disrespect and abuse was non-confidential care (22.9%). The commonest disrespectful and abusive care received was lack of privacy in the labour ward (18.3%). The study recorded a high prevalence of reported facility-based disrespect and abuse of women during delivery in Abia State. Training and re-training healthcare providers to promote respectful care, advocacy to policy makers and healthcare stakeholders on the development of respectful maternal care policies and further research in the area are needed. No funding was obtained for this study.

Neglected and non-consented care during childbirth in public health facilities in Central Tigray, Ethiopia

BackgroundThe present study aimed to assess the magnitude and factors associated with neglected and non-consented care during childbirth in public health facilities in Central Tigray, Ethiopia.MethodsA health facility-based cross-sectional survey supplemented by a qualitative study was conducted from April to May 2020 among women giving birth. We included 415 participants and recruited via a systematic random sampling technique. To collect the data, a pre-tested, face-to-face exit interview using an interviewer-administered structured questionnaire was used. Neglected and non-consented care and its outcomes (yes and no) were the dependent variables, and Socio-demographic data such as (age, educational level, region, and income), and other variables associated with compassionate and respective maternity care were the independent variables. We applied bivariate and multivariate logistic regression to determine predictors for non-consented and non-confidential care components of disrespect or abuse. The in-depth interviews were analyzed using content analysis.ResultsAmong the participants, 82.4% and 78.6% had neglected care and non-consented care among women giving birth respectively. No formal education level (AOR: 0.37, 95%, CI (0.18–0.78)) and primary education level (AOR: 0.18, 95%, CI (0.05–0.57))., mode of delivery (AOR 3.79, 95% CI 1.42–10.09), sex of skilled healthcare providers (AOR: 0.56, 95%, CI (0.34–0.93)), number of deliveries in a health Centre (AOR: 1.89, 95% CI (1.03–3.47)) predicted non-consented care, and history ANC (AOR: 8.10, 95% CI (1.33–49.51)), and federal government employee (AOR: 0.24, 95% CI (0.07–0.78)) predicted neglected care during childbirth. In-depth interview result shows the mode of delivery and sex of healthcare providers were factor associated with non-consented care and women's stay at health facilities were factor associated with neglected care.ConclusionThe level of neglected and non-consented care during delivery was high reflecting substantial mistreatment. Educational level, mode of delivery, sex of skilled healthcare providers, and the number of deliveries in a health Centre were associated with non-consented care, and history ANC and Federal Government employees were associated with neglected care during childbirth. These findings imply the urgent needs or intervention including strengthening of awareness of both patients and healthcare providers on patients' rights and responsibilities and training service providers in patient-centered care and interpersonal communication and relationships to minimize mistreatment.

Disrespectful Maternity Care and Abuse During Childbirth: Exploring Perceptions and Experiences of Women Delivered at a Tertiary Hospital in Abakaliki, Nigeria.

An important but little understood component of poor care that women receive during antenatal care and childbirth is disrespect and abuse perpetuated by health workers. Fear of experiencing disrespect and abuse has a negative influence on women's decision to seek care at health facility during pregnancy, labour and delivery. The objective of this study is to determine the prevalence, pattern and predictors of disrespect and abuse during labour and delivery. This is a questionnaire-based cross-sectional study conducted from February 1, 2019, to July 31, 2019 among postnatal women delivered at Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Data were analyzed using SPSS version 22. The prevalence of disrespectful maternity care and abuse was 47.6%. The forms of disrespect and abuse experienced by the participants were detention in the health facility (40.2%), physical abuse (34.1%), non-dignified care (37.2%), non-consented care (20.1%), abandonment of care (18.9%), non-confidential care (25%) and discriminatory care (15.2%). Lack of companionship during delivery (AOR: 7.01, 95%CI: 1.27-4.49; p = 0.007), unbooked status (AOR: 2.37, 95%Cl: 0.31 - 0.92; p = 0.01) and rural residence (AOR = 4.52 95% CI: 2.33-8.75, P<0.0001) were factors associated with disrespect and abuse during childbirth. Disrespectful maternity care and abuse during childbirth among women seeking maternity care is still prevalent (47.6%) in our hospital. Educating health workers on the importance of respectful maternity care would ensure acceptable, quality and dignified care for all women seeking maternity care in our facility.

Comparison of disrespect maternity care among immediate postnatal women in health centre and hospital of Siltie Zone Southern region, Ethiopia 2020.

disrespect and abuse during childbirth are interactions or facility conditions that local consensus seems to be humiliating or undignified. Physical abuse, non-consented clinical care, non-confidential care, non-dignified care, discrimination, abandonment, and detention in health facilities are the recent building blocks of maternal health. The objective was to compare the magnitude of disrespect for maternity care and associated factors among mothers during the immediate postpartum period at Siltie Zone health centre and hospital. institutional based cross-sectional study design using an interview-administered questionnaire used to measure the magnitude of disrespect and abuse during childbirth in a health facility. One randomly selected hospital and six health centres from three woredas were considered. A total sample of 420 was allocated to the health facilities according to the average number of delivery services provided per month. Proportion test, percentage and frequencies were used to show the relationship between the numbers of mistreatment between hospitals and health centres. the overall mistreatment during childbirth and after birth is about 99%. Mistreatment in health centres is 98% and 100% in hospitals. The two categories of disrespect and abusive care namely deny the right to information 69% in hospitals and 42% in health centres. Secondly, Non-confidential care 51% in hospitals and 31% in the health centre are frequently shared categories of mistreatment during childbirth. mistreatment in hospitals and health centres is the same and very high. Abandonment of care, denial of right to information and non-confidential care has a significant difference in hospital and health centre.

Intrapartum respectful maternity care practices and its barriers in Eastern India.

Respectful maternal care (RMC) is increasingly recognized globally as critical to improving the quality of maternity care as women deserve respectful and dignified care. Numerous women face disrespectful maternal care during labor and delivery, especially in low- and middle-income countries, which dissuades them from seeking institutional care. Women, the consumers of care, are better positioned to report on the level of respectful care they receive. Health care workers' perspectives on barriers to delivering respective maternity care are seldom explored. Thus, this study aims to assess the levels of respectful maternity care and its barriers. This cross-sectional study assesses the level of RMC and its barriers in the labor room of tertiary care hospital in Odisha among 246 women selected by consecutive sampling technique by a questionnaire. More than one-third of women reported good RMC. Although women rated high in domains of environment, resources, dignified care, and non-discrimination, non-consented care and non-confidential care were poorly rated. Barriers that adversely affect the delivery of RMC perceived by health care workers were lack of resources, staffing, uncooperative mother, communication issues, privacy issues, lack of policies, workload, and language problems. There was a significant association of RMC with age, education, occupation, and income. In contrast, residence, marital status, number of children, antenatal visit, type of institute of antenatal care, mode of delivery, and gender of health care provider were not associated with RMC. Given the above findings, we recommend vigorous efforts to improve the institutional policies, resources, training, and supervision of health care professionals on women's rights during childbirth to strengthen the quality of care for positive birth experiences.

Determinants of respectful maternity care in India: A cross-sectional study.

Respectful maternity care (RMC) is a basic right of all pregnant women. The study identifies the sociodemographic and economic factors influencing disrespect and abuse (D&A) faced by women during pregnancy, childbirth, and immediate postpartum period in India. A cross-sectional study was conducted across six health facilities in three states of India from June 2019 to June 2020 among 401 women aged 18 years or more who had a live birth within the past 2 months of data collection. A validated structured interview schedule was used to capture data on sociodemographic and economic characteristics; antenatal, intranatal, and postnatal history; and incidences of D&A based on Bowser's seven domains of RMC. Ordered logistic regression was done to identify the determinant of high D&A. The composite score of D&A ranged from 0 to 48 with a median interquartile range of 13 (9-17). All women faced one or the other kind of D&A. Women with the lowest food security (odds ratio [OR] = 3.3; 95% confidence interval: 1.6-6.7), who did not avail any antenatal care from the facility (OR = 1.9 [1.1-3.2]), and in the lowest wealth index (OR = 2.2 [1.3-3.7]) faced more D&A than those with high food security, more than two ANC services from same health facility, and in the high wealth index, respectively. Women who had low mobility score experienced lower D&A (OR = 0.5 [0.3-0.8]) as compared to the women with a high mobility score. Nonconsented care, nonconfidential care, and physical discomfort were the most common types of D&A. RMC is directly associated with socioeconomic status of women. Policy and program interventions are needed to address the inequity in health service care provision and expanding the social security net for women.

Women’s Experience of Disrespect and Abuse during Institutional Delivery in Biratnagar, Nepal

Worldwide, a large number of women experience disrespectful and abusive behavior from care providers during childbirth. This violates the rights of women to attain respectful care. This study aimed to find out the women’s experience of disrespect and abuse during institutional delivery. A cross-sectional study was conducted in two hospitals of Morang district situated in eastern Nepal. Two hundred eighteen women from a public hospital and 109 women from a private hospital (N = 327) with normal vaginal delivery were selected purposively for this study. Data were collected through face-to-face interviews using a structured questionnaire based on the Disrespectful and Abusive Scale by Bowser and Hill. All women had experienced at least one type of disrespect and/or abuse during labor and delivery, most common being non-consented care (100%), non-dignified care (72%), and non-confidential care (66.6%), respectively. Discriminatory care and physical abuse were experienced by 32.33% and 13.23%, respectively. Ethnicity, religion, place of delivery, and numbers of living children were the main predictors of reporting disrespect and abuse. Overall, the occurrence of disrespect and abuse during institutional delivery was found to be very high.

Patient and Provider Perspectives of Disrespect and Abuse during Childbirth in Tanzania: A Literature Review

Objective: Disrespectful and abusive (D&A) maternity care is a deterrent to facility childbirth and can thus contribute to child and maternal mortality. This study will review existing literature on D&A in Tanzania to better understand and contextualize the issue. Methods: A comprehensive literature search was conducted to find relevant publications on D&A during childbirth in Tanzania. The search was conducted on the National Center for Biotechnology Information (NCBI) and PubMed (U.S. National Library of Medicine at the National Institutes of Health). The inclusion criteria were as follows: qualitative, quantitative, and ethnographic studies conducted in Tanzania on obstetrical violence; published in English; focused on prevalence, incidence, root causes, historical trends, interventions, and policy recommendations for obstetrical violence in Tanzania. Results: Twenty-one studies were selected for this literature review. Up to 73.1% of women reported experiencing at least one form of D&A during labor. Commonly reported D&A events include non-dignified care, non-confidential care, and physical abuse. Other forms of D&A, including detention in facilities and asking for unofficial payments, are also reported. Ninety-six percent of nurses, midwives, and nursing assistants in Tanzania self-reported engaging in at least one form of D&A. Lack of training and provider support, long work hours, fear of blame, and limited infrastructure were reported as factors leading to D&A by providers. Conclusions: In Tanzania, D&A during childbirth is prevalent in healthcare systems. The direct relationship between D&A and poor maternal and fetal health is well-documented. Individual and systemic factors influence both provider and patient perspectives of D&A, providing a window into a complex and sensitive phenomenon. It is important that D&A in Tanzania be viewed holistically, and that interventions target the multifaceted nature of the issue.

Disrespect and abuse during facility‐based childbirth in central Ethiopia

ABSTRACT Background Respectful maternity care is a fundamental human right, and an important component of quality maternity care. Objective The aim of this study was to quantify the frequency and categories of D&A and identify factors associated with reporting D&A among women in north Showa zone of Ethiopia. Method A cross-sectional study was conducted with 435 randomly selected women who had given birth at public health facility within the previous 12 months in North Showa zone of Ethiopia. A digital (tablet-based) structured and researcher administered tool was used for data collection. Frequencies of D&A items organised around the Bowser and Hill categories of D&A and presented in the White Ribbon Alliance’s Universal Rights of Childbearing Women Framework were calculated. Multivariable logistic regression was used to identify the association between experience of disrespect and abuse and interpersonal and structural factors at p-value <0.05 and odds ratio values with 95% confidence interval. Results All participants reported at least one form of disrespect and abuse during childbirth. Types of disrespect and abuse experienced by participants were physical abuse 435 (100%), non-consented care 423 (97.2%), non-confidential care 288 (66.2%), abandonment/neglect (34.7%), non-dignified care 126 (29%), discriminatory care 99 (22.8%) and detention 24 (5.5%). Hospital birth [AOR: 3.04, 95% CI: 1.75, 5.27], rural residence [AOR: 1.44, 95% CI: 0.76, 2.71], monthly household income less than 1,644 Birr (USD 57) [AOR: 2.26, 95% CI: 1.20, 4.26], being attended by female providers [AOR: 1.74, 95% CI: 1.06, 2.86] and midwifery nurses [AOR: 2.23, 95% CI: 1.13, 4.39] showed positive association with experience of disrespect and abuse. Conclusion Hospital birth showed consistent association with all forms of disrespect and abuse. Expanding the size and skill mix of professionals in the hospitals, sensitizing providers consequences of disrespect and abuse could promote dignified and respectful care.

Reducing Disrespect and Abuse of Women During Antenatal Care and Delivery Services at Injibara General Hospital, Northwest Ethiopia: A Pre-Post Interventional Study.

IntroductionDisrespect and abuse during pregnancy and childbirth continue to be a barrier for the utilization and quality of care in maternal health services. This study was therefore aimed at reducing the disrespect and abuse of mothers during antenatal care and delivery services at Injibara general hospital, northwest Ethiopia.Materials and MethodsA pre–post interventional mixed method design was conducted among a total of 738 randomly selected mothers who attended antenatal care and delivery services from November 1, 2018 to May 20, 2019. To collect the data, exit interview using an interviewer-administered structured questionnaire was used. Provision of training, preparation of standard written guidelines and protocols, waiting room construction, availing screening or curtain, equipment, essential drugs and supplies, supportive supervision and mentoring, and staff motivation were the lists of interventions applied to decrease disrespect and abuse. Descriptive statistics and independent t-test were computed. The independanet t-test is used because the study populations at the baseline and endline were different. A p-value of <0.05 and a mean difference with 95% CI was used to test the significance of the interventions.ResultsThe study revealed that disrespect and abuse during pregnancy and childbirth decreased from 71.8% at baseline to 15.9% at the end-line with a 55.9% change (mean difference: 0.56, 95% CI: 0.55–0.57). Alongside, the magnitude on the subscales of disrespect and abuse (physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination and neglected care) was decreased at post-intervention, compared with the baseline.ConclusionRespectful maternal healthcare after the intervention was significantly improved. The finding suggests that provision of training to healthcare providers, written policies and procedures that describe the responsibilities of healthcare providers in the respectful maternal care process, improving facility infrastructure, availing supplies, regular supportive supervision and mentoring and motivation of high-performance employees have the potential to enhance respectful maternal care. Therefore, incorporating such training into pre-service curricula and in‐service training of healthcare workers may indorse the practice of respectful maternal care.

Disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa: a systematic review and meta-analysis

BackgroundDisrespectful and abusive treatment of women by health care providers during the process of childbirth at health facility is an international problem. There is a lack of data on disrespect and abuse of women during the process of childbirth at health facilities in Sub-Saharan Africa. The purpose of this study was to determine the prevalence of disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa.MethodsThe PRISMA guideline protocol was followed to write the systematic review and meta-analysis. Published studies were searched from Medline, PubMed, CINAHL, EMBASE, Maternal and infant care, science direct, and PsycINFO. Articles were accessed by three reviewers (ZY, BT and AA) using the following key terms, “attitude of health personnel” AND “delivery obstetrics*/nursing” OR “maternity care” AND “disrespect” OR “abuse” OR “professional misconduct” AND “parturition” AND “prevalence” AND “professional-patient relations” AND “Sub-Saharan Africa”. Additional articles were retrieved by cross referencing of reference. The heterogeneity of studies were weighed using Cochran’s Q test and I2 test statistics. Publication bias was assessed by Egger’s test.ResultsThirty three studies met the inclusion and included in this systematic review and meta–analysis of disrespect and abuse of women during the process of childbirth at health facilities. The pooled prevalence of disrespect and abuse women during the process of childbirth at health facilities in Sub-Saharan Africa was 44.09% (95% CI: 29.94–58.24).Particularly physical abuse was 15.77% (95% CI: 13.38–18.15), non-confidential care was 16.87% (95% CI: 14.49–19.24), abandonment was 16.86% (95% CI: 13.88–19.84) and detention was 4.81% (95% CI: 3.96–5.67).ConclusionIn this study disrespect and abuse of women during the process of childbirth at health facilities are high compared with other studies, particularly non-confidential care and abandonment his high compared with other studies. This study points out that the ministry of health, health care providers, maternal health experts shall due attention to women’s right during the process of childbirth at health facilities.

Reducing Missed Opportunities for Human Papillomavirus Vaccination in School-Based Health Centers: Impact of an Intervention.

Human papillomavirus (HPV) immunization rates among US adolescents are low. Missed opportunities (MOs) for HPV vaccination are common. School-based health centers (SBHCs) have potential to boost HPV vaccination, but their role in addressing MOs has not been examined. We implemented a multicomponent intervention, consisting of 3 immunization process workflow modifications combined with provider performance feedback, in 2 Los Angeles area SBHCs and conducted a pre/post evaluation of MOs. Our primary outcome was SBHC-based MOs for HPV vaccination during all visits, including visits for confidential reproductive health care (ie, confidential visits). Secondary outcomes were MOs for meningococcal (MenACWY) and influenza vaccination during visits for nonconfidential care. MOs for HPV vaccination decreased during all visit types from the baseline to the intervention period (82.3% to 46.1%; adjusted risk ratio [RR]=0.558, P < .0001). The rate decrease appeared to be greater during physical examination visits than confidential visits (83.4% to 31.6% vs 98.7% to 70.4%, respectively). MOs for MenACWY (74.5% to 35.0%; adjusted RR=0.47, P < .0001) and influenza (86.7% to 69.3%; adjusted RR=0.792, P < .0001) vaccination also decreased during nonconfidential visits. Vaccine refusal was the most frequently documented reason for HPV vaccine MOs during both physical examination and confidential visits. A pragmatic, multicomponent SBHC intervention reduced MOs for HPV vaccination during all visit types. MOs for MenACWY and influenza vaccination also decreased during nonconfidential visits. Findings suggest that practice-level improvements in SBHCs can improve delivery of HPV and other adolescent vaccines.

Disrespect or Abuse During Facility Based Maternity Care and Associated Factors among Women who Give Birth for the Last 12 Months in Fagetalekoma Woreda, North Western Ethiopia,2018

1. Abstract 1.1. Introduction Globally, more than half million women die every year as a result of complications of pregnancy and childbirth. Providing compassionate and respectful maternity care services to laboring mothers is one of the most important interventions to ensure survival of women. However, compassionate and respectful maternity care has received less attention both in practice and research. Therefore, the main objective of this study was to assess prevalence of disrespect or abuse during facility based maternity care and associated factors among women who give birth in the last 12 month in Fagetalekoma woreda, 2018. 1.2. Method A community based cross-sectional study was conducted to collect data from 374 women who give birth in the last 12 month from February 1, 2018 to 30 March 2018 in Fageta lekoma woreda in each cluster households. Simple random sampling method was used to recruit study participants. Data were collected by face-to-face interview using semi structured questionnaire. The data was entered, cleaned and edited using EPI data and exported to SPSS version for analysis. Both bivariate and multiple logistic regression were fitted and odds ratio and 95% CI were computed to identify associated factors and p-value of <0.05 was considered as statistical significant. 1.3. Result Overall prevalence of disrespect or abuse was 84.4%. The level of some specific types of disrespected and abused were non-consented care 266 (72.9%), non-confidential care 240(65.8%) and followed by physical abuse 230(63%). Age of women (AOR=2.23, (1.07, 4.66), sex of maternal care giver (AOR=2.08, (1.06, 4.08), and women know profession of care giver during antenatal care (AOR=0.50, (0.25, 0.10) were significantly associated factors. 1.4. Conclusion The prevalence of disrespected or abused during maternal care service in health institution is very high which needs urgent intervention. Fageta lekoma woreda and Awi zone health department even regional health bureau dealing with maternal health service during labour and delivery better to take immediately action on programs to lower the unacceptably high prevalence of disrespect or abuse during maternity care.

Disrespect and abuse during childbirth in Western Ethiopia: Should women continue to tolerate?

BackgroundHealthcare coverage in Ethiopia has improved dramatically in recent decades. However, facility-based delivery remains persistently low, while maternal mortality remains high. This paper presents the prevalence and associated factors of disrespect and abuse (D&A) during childbirth in public health facilities of western Oromia, Ethiopia.MethodA facility-based cross-sectional study was conducted among 612 women from February 2017 to May 2017. Exit interview with the mothers were conducted upon discharge from the maternity ward. We measured D&A during childbirth using seven dimensions. Multivariable logistic regression model was used to assess the association between experience of D&A and client characteristics and institutional factors.ResultThree quarters (74.8%) of women reported experiencing at least one form of D&A during their facility childbirth. The types of D&A experienced by the women were; physical abuse (37.1%), non-dignified care (34.6%), non-consented care (54.1%), non-confidential care (40.4%), neglect (25.2%), detention (2.9%), and discrimination (13.2%). Experiences of D&A were 1.6 times more likely to be reported by women delivering at hospitals than health centers (OR: 1.64, 95% CI: 1.01, 2.66). Women without a companion throughout their delivery were almost 10 times more likely than women who had a companion to encounter D&A (OR: 9.94, 95% CI: 5.72, 17.28). On the other hand, women with more than 1,368-birr (USD 57) monthly income were less likely to experience any type of D&A (OR: 0.36, 95% CI: .21, .65).ConclusionThree in four women reported experiencing at least one form of D&A during labor and delivery. This demonstrates a real disconnect between what the health system intends to achieve and what is practiced and calls for fundamental solutions in terms of both improving quality of facility-based delivery and ensuring women’s right to receive health care with dignity.

RESPECTFUL MATERNITY CARE: A QUALITATIVE STUDY ON THE EXPERIENCE OF HEALTH PROVIDERS IN PUBLIC HEALTH FACILITIES OF NORTH SHEWA ZONE, OROMIA, ETHIOPIA

ABSTRACTBACkGROUND: Emerging evidence indicates that women face humiliating and undignified conditions in health facilities in developing countries like Ethiopia. This negative aspect of maternity care can influence women’s decision not to make use of health facilities. It is, therefore, crucial to examine the experiences of health providers on the provision of respectful maternity care and to identify the forms of disrespect and abuse that exist, and better meet women’s needs as part of broader efforts to provide better quality care. METHODS: A qualitative study employing a phenomenological research design was carried out from August to September 2017 in six woredas/districts of North Shewa Zone, Oromia, Ethiopia. A total of 20 key informant interview was done. The key informants were selected by purposive sampling techniques considering their experience in Maternal, Neonatal and Child Health (MNCH) service delivery in the selected public health facilities. The data were collected using a semi-structured key informant interview guide. All interviews were transcribed and translated verbatim into English. Data analysis was initiated alongside data collection using a thematic approach based on a priori identified themes and those emerged during the analysis. RESULT: The health providers’ experiences indicated the existence of different categories of disrespect and abuse to women in the study area. Non-consented care, physical abuse, non-confidential care, non-dignified care were the areas identified. Furthermore, painful procedures such as episiotomy were performed without anesthesia, women may also stay for a long time without getting the service and they were restricted to have a companion of their choice in the birthing area. The discrimination of women because of personal attributes such as income level, being rural versus urban, and HIV status was also revealed in the present study. However, detention wasn’t reported by any of the respondents.CONCLUSION: To promote quality maternal health service, the government in partnership with other stakeholders should address the challenges faced by women in the health facilities. Providers should also be capacitated with the required knowledge, attitude and skill and further effort should be made to equip health facilities with the necessary material and human resource. Enforcing policies on respectful maternity care is also important. kEY WORDS: Respectful Maternity Care, Health Providers Experience, Qualitative Study, Ethiopia (Ethiopian Journal of Reproductive Health; 2019; 11;1:42-51)