Provision Of Respectful Maternity Care Research Articles

Determinants of respectful maternity care among women who gave childbirth in Southern Ethiopia.

Having a good provision of respectful maternity care (RMC) to a woman who gives childbirth is a crucial component of maternal health care to result in positive maternal and neonatal outcomes. Disrespect and lack of women-centered care in birth discourage a woman from seeking healthcare during childbirth contributing to poor healthcare-seeking behaviour and dissatisfaction with the maternity service. The current study aimed to assess key determinants of RMC during childbirth at selected public health facilities of the Gofa zone, Southern Ethiopia. A cross-sectional study design was conducted from March to April 2021 among 390 women who gave birth in eight randomly selected public health facilities of Gofa zone, Southern Ethiopia. The level of RMC was measured using structured exit interview items. A structured-interviewer-administered questionnaire was used to collect data and then entered into Epi-data version 4.6 and exported to SPSS version 25 for further analysis. Bivariate and multivariate logistic regression analyses were used to identify determinants of RMC among women. A total of 390 women responded to the exit interview making a response rate of 100%. The mean (± SD) age of the 390 women was 27.9 (± 4.85) years. The overall prevalence of women who received RMC was 40.5%, 95% CI (36-45%). Two hundred and ninety-seven (76.2%; n = 297/390) women had antenatal care (ANC) attendance in the index pregnancy. A woman who had planned pregnancy (AOR = 1.72, CI: 1.04, 2.85), planned to deliver in a health facility (AOR = 1.68, CI: 1.00, 2.81), presence of familial support (AOR = 2.04, CI: 1.20, 3.48), and had information about service availability (AOR = 4.44, CI: 2.09, 9.42) were associated with RMC among women. The provision of respectful maternity care in the study area was low when compared with local studies. Planned pregnancy, plan to deliver in a health facility, family support, and presence of information about service availability were factors associated with RMC among women. More attention should be given to training and supportive supervision of health care professionals on respectful maternity care and its standards to increase service uptake and make service more women-centred.

Modeling Pathways to Describe How Maternal Health Care Providers' Mental Health Influences the Provision of Respectful Maternity Care in Malawi.

Maternal health (MH) providers may experience traumatic events, such as maternal or fetal death, that can contribute to stress and burnout. Past trauma, poor working relationships, and under-resourced environments not only affect providers' own emotional well-being but also reduce their ability to provide respectful maternity care (RMC). Data were collected in mid-2021 as a cross-sectional survey with 302 MH providers working in 25 maternities in 3 districts in Malawi to measure burnout, depression, and post-traumatic stress disorder (PTSD). We present a pathway model describing how these factors interact and influence RMC. We used the provider-reported person-centered maternity care scale to measure RMC; the Maslach Burnout Inventory, which examines emotional exhaustion, depersonalization, and professional accomplishment; and standard validated screening tools to measure the prevalence of depression and PTSD. Although levels of burnout varied, 30% of MH providers reported high levels of exhaustion, feelings of cynicism manifesting as depersonalization toward their clients (17%), and low levels of professional accomplishment (42%). Moderate to severe depression (9%) and suicidal ideation within the past 2 weeks (10%) were also recorded. Many (70%) reported experiencing an event that could trigger PTSD, and 12% reported at least 4 of 5 symptoms in the PTSD scale. Path analysis suggests that depression and emotional exhaustion negatively influence RMC, and depersonalization is mediated through depression. PTSD has no direct effect on RMC, but increased PTSD scores were associated with increased burnout and depression scores. Positive relationships with facility managers were significantly associated with increased RMC and decreased emotional exhaustion and depersonalization. Burnout will continue to be a challenge among MH providers. However, pragmatic approaches for improving teamwork, psychosocial, and managerial support for MH providers working in challenging environments may help mitigate burnout, improve MH provider well-being, and, in turn, RMC for women seeking MH services.

Respectful maternity care and associated factors among mothers who gave birth in three hospitals of Southwest Ethiopia: A cross-sectional study.

One of the primary barriers to reducing maternal morbidity and mortality is disrespect and abuse during childbirth in biomedical facilities. Despite the serious consequences of disrespect and abuse during childbirth, there is no evidence of the prevalence of respectful maternity care in Southwest Ethiopia. This study aimed to assess the prevalence of respectful maternity care and associated factors among mothers who gave birth in three hospitals in Southwest Ethiopia. An institution-based cross-sectional study was conducted among 348 mothers who gave birth in three hospitals in Southwest Ethiopia. Bivariable and multivariable binary logistic regression were used to identify the factors of respectful maternity care. In this study, 348 mothers with their newborns were included, making a response rate of 100%. The overall prevalence of respectful maternity care was 81.2%. Maternal age [AOR = 2.54; 95% CI (1.01-6.43)]; maternal occupation [AOR = 5.23; 95% CI (1.15-23.72)]; antenatal care follows-up [AOR = 2.86; 95% CI (1.01-8.20)]; and discussions with the provider about the place of delivery during antenatal care follow up [AOR = 5.58; 95% CI: (2.12-14.70)] were found to be the most significant components of respectful maternity care. The provision of respectful maternity care was high, but there are complaints of disrespect and abuse still present in three hospitals in Southwest Ethiopia. Maternal age, maternal occupation, antenatal follow up, and discussion with the provider about the place of delivery during antenatal follow-up were associated with respectful maternity care. Thus, improving antenatal care service utilization and discussions with health care providers about the place of delivery during antenatal care follow-up should be focused on.

Perspectives of doctors and nurses about the implementation of respectful maternity care in a teaching hospital in India

Background: An important component of the mother-and-baby-friendly birthing facility is respectful maternity care (RMC) during delivery. Aims and Objectives: The objectives of this study were to identify resident doctors' and staff nurses' opinions on the provision of RMC at their workplace, to explore the association between opinion on RMC and respondent's characteristics, and to explore the perceived barriers. Materials and Methods: A facility-based observational, descriptive study of the cross-sectional design was thus conducted among 78 resident doctors and staff nurses posted in the labour room of the study hospital. Data were collected by a predesigned, self-administered questionnaire. Variables included were demographic, service related and opinion on prevalent RMC practice at the respondents' workplace. SPSS version 17 was used for data analysis. Results: Providers' mean age was 30.5 years, and the mean work experience of 3.1 years. About two-thirds of the respondents were resident doctors and 83.3% were female. More than 60% of providers were trained on RMC. Providers reported desirable practices on most items related to RMC except in providers introducing themselves to women, allowing birthing companions and allowing women to assume the position of choice. Opinion about RMC was significantly associated with training status. Uncooperative women were considered the most important barrier to providing optimum RMC. Conclusion: It can be concluded from this study that training providers can reinforce good practices related to RMC and improve the quality of care at birth.

S3 - Nepalese nursing students’ experiences of witnessing disrespectful and abusive care towards women during labour and childbirth

There are increasing reports of disrespectful and abusive care towards women in health facilities during labour and birth which contributes to low uptake of facility-based childbirth in low- and middle-income countries. To investigate undergraduate nursing students’ witnessing of disrespect and abuse towards women during their midwifery clinical practicum. A cross-sectional study was conducted with nursing students (n = 268) in two medical colleges in Nepal. The survey instrument consisted of sociodemographic variables, clinical placement variables, students’ perceptions of respectful maternity care, and nine forms of disrespectful and abusive care practices that may have been observed during their clinical practicum. A total of 171 students (63.8%) students participated. Students’ mean age was 23.68 (SD = 2.44, range = 20-34). Almost half (48%) were in the third year of their program. A total of 138 (80.7%) students had witnessed at least one form of disrespectful and abusive care. Students observed other people not involved in a woman’s care to being present at the birth (43.9%), treating women in an unfriendly manner (42.7%), verbal abuse such as shouting, scolding, insulting, or threatening (33.9%), talking about a woman’s health information with others not directly involved in her care (33.9%), discrimination (24.6%), leaving women exposed (23.4%), and physical abuse such as pushing, slapping, or pinching women if they did not co-operate (23.4%). Witnessing disrespectful and abusive care may adversely impact students’ provision of respectful maternity care (RMC). Educating students about the status of women; midwifery philosophy of care; and strategies to navigate and change a medically-dominated model of care are required. Identification of organisational and personal factors associated with disrespect and abuse is necessary to develop and implement tailored interventions to enhance RMC.

Barriers to the provision of respectful maternity care during childbirth by midwives in South-West, Nigeria: Findings from semi-structured interviews with midwives

BackgroundDisrespect and Abusive Care (DA&C) of women in health facilities during childbirth is a topic of growing concern globally. Given that DA&C is a violation of women’s basic rights and a deterrent to facility-based maternity services for women. In Nigeria, limited evidence exists on barriers to the provision of Respectful Maternity Care (RMC), especially in South-West, Nigeria. AimThis study aimed to explore the barriers to the provision of Respectful Maternity Care (RMC) during childbirth by midwives in selected health facilities in Lagos State, Nigeria. MethodologyThe research used an Exploratory Descriptive Research Design. Data was collected through semi-structured individual interviews. Data analysis was done following Burns and Clarke’s thematic method. Twenty midwives were purposively selected from two public secondary health facilities. FindingsThe findings of this study revealed the barriers to the provision of RMC are diverse and interwoven. The study highlighted health system factors, health provider factors and client factors as barriers challenging the provision of RMC. Health system factors include physical structure of the labour ward, shortage of staff, shortage of resources, lack of motivation, hospital policy and poor working conditions. Health provider factors identified were midwives’ personal beliefs, individual personalities, the poor orientation of professional staff, and poor collaborations among professionals. The client factors were women’s/relations attitudes and unmet expectations. ConclusionTraining midwives and others on RMC without addressing deficiencies in the health care system will not achieve the desired goals of RMC. Encouraging teamwork, trust-building, collaboration, accountability and effective communication among health workers, policymakers, stakeholders and women will further promote RMC.

Utilization of Immediate Postpartum Long Acting Reversible Contraceptives among Women Who Gave Birth in Public Health Facilities in Eastern Ethiopia: A Cross-Sectional Study.

Objective Although importance of postpartum family planning is essential and immediate postpartum insertion of long acting and reversible contraceptives (LARC) is recommended, evidence on its uptake and associated factors is limited in Ethiopia. This study was conducted to assess utilization of immediate postpartum LARC among women who gave birth in selected public health facilities in eastern Ethiopia. Method An institution-based cross-sectional study was conducted among randomly selected women who gave birth in selected public health facilities in eastern Ethiopia from 10 March to 09 April 2020. At discharge, all eligible women who gave birth in the facilities were interviewed using a pretested structured questionnaire. Data were entered using EpiData 3.1 and analyzed using SPSS 24. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with utilization of immediate postpartum LARC. Adjusted odds ratio (aOR) with 95% confidence interval was used to report association, and significance was declared at p value < 0.05. Results From a total of 546 women invited to the study, 530 (97.1%) participated in the study and 98 (18.5%; 95% CI: 15.1%, 22.0%) reported starting long acting reversible contraceptives. Women who reported discussing about contraceptives with partners (aOR = 6.69, 95% CI: 3.54, 12.61) and receiving postpartum counselling on contraceptives (aOR = 5.37, 95% CI: 3.00, 9.63) were more likely to using contraception. However, women who live >30-minute walking distance from the nearest health facility (aOR = 0.47, 95% CI: 0.26, 0.85) and reported disrespect and abuse during childbirth (aOR = 0.22, 95% CI: 0.12, 0.40) were less likely to start LARC. Conclusions Almost one in five women delivering in public health facilities in eastern Ethiopia started using LARC. Provision of respectful maternity care including counselling on the importance of immediate postpartum family planning is essential for increasing its uptake.

The impact of COVID-19 on the provision of respectful maternity care: Findings from a global survey of health workers

BackgroundSignificant adjustments to maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care. AimTo explore how the COVID-19 pandemic negatively affected frontline health workers’ ability to provide respectful maternity care globally. MethodsWe conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected qualitative data between July and December 2020 among a subset of respondents and conducted a qualitative content analysis to explore open-ended responses. FindingsHealth workers (n = 1127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers’ fear of getting infected and measures taken to minimise COVID-19 transmission. DiscussionMultidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term. ConclusionsThe measures taken during the COVID-19 pandemic had the capacity to disrupt the provision of respectful maternity care and therefore the quality of maternity care.

Provision of respectful maternal care by midwives during childbirth in health facilities in Lagos State, Nigeria: A qualitative exploratory inquiry

BackgroundQuality midwifery care through respectful maternity care is the key to reducing maternal mortality rate. Several literatures implicated midwives as meting out disrespectful maternity care to women during childbirth, thus discouraging women from accessing facility-based childbirth. Hence, this study’s aim was to explore provision of respectful maternity care by midwives during childbirth in selected health facilities in Lagos State, Nigeria. MethodologyThis study adopted an exploratory descriptive research design. As a result, the collection of data was through semi-structured individual interviews. The purposive selection of 20 midwives was from two health facilities. FindingsThe study showed the adequate provision of confidentiality, availability of showers and water, availability of meals and drinks to women, and pain relief in labour and delivery. Findings further revealed other aspects of respectful maternity care poorly provided by midwives, included physical abuse, privacy, use of dignified tone/language/threat/neglect, obtaining consent for procedures during labour and delivery, discrimination, allowing birth companion, detention, mobility, positioning and availability of commodities. All the midwives claimed to be providing respectful maternity care and showed willingness to support provision of respectful maternity care. ConclusionTo foster provision, RMC requires an enabling environment where staff are highly motivated, there is adequate staff strength, reduced workload, continuous in-service training on evidence-based practices, training and support of midwives on RMC, adequate provision of supplies, commodities and modern equipment, and restructuring the ward to private delivery suites to accommodate birth companions and provide privacy.

Lessons learned through respectful maternity care training and its implementation in Ethiopia: an interventional mixed methods study

BackgroundImproving respectful maternity care (RMC) is a recommended practice during childbirth as a strategy to eliminate the mistreatment of women and improve maternal health. There is limited evidence on the effectiveness of RMC interventions and implementation challenges, especially in low-resource settings. This study describes lessons learned in RMC training and its implementation from the perspectives of service providers’ perceptions and experiences.MethodsOur mixed methods study employed a pre- and post-intervention quantitative survey of training participants to assess their perceptions of RMC and focus group discussions, two months following the intervention, investigated the experiences of implementing RMC within birthing facilities. The intervention was a three-day RMC training offered to 64 service providers from three hospitals in southern Ethiopia. We performed McNemar’s test to analyse differences in participants’ perceptions of RMC before and after the training. The qualitative data were analysed using hybrid thematic analysis. Integration of the quantitative and qualitative methods was done throughout the design, analysis and reporting of the study.ResultsMistreatment of women during childbirth was widely reported by participants, including witnessing examinations without privacy (39.1%), and use of physical force (21.9%) within the previous 30 days. Additionally, 29.7% of participants reported they had mistreated a woman. The training improved the participants’ awareness of the rights of women during childbirth and their perceptions and attitudes about RMC were positively influenced. However, participants believed that the RMC training did not address providers’ rights. Structural and systemic issues were the main challenges providers reported when trying to implement RMC in their contexts.ConclusionTraining alone is insufficient to improve the provision of RMC unless RMC is addressed through a lens of health systems strengthening that addresses the bottlenecks, including the rights of providers of childbirth care.

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.

Exploring women and traditional birth attendants\u2019 perceptions and experiences of stillbirths in district Thatta, Sindh, Pakistan: a qualitative study

BackgroundPakistan reports the highest stillbirth rate in the world at 43 per thousand births with more than three-quarters occurring in rural areas. The Global Network for Women’s and Children’s Health maintains a Maternal and Newborn Health Registry (MNHR) in 14 study clusters of district Thatta, Sindh Pakistan. For the last 10 years, the MNHR has recorded a high stillbirths rate with a slow decline. This exploratory study was designed to understand the perspectives of women and traditional birth attendants regarding the high occurrence of stillbirth in Thatta district.MethodsWe used an exploratory qualitative study design by conducting in-depth interviews (IDIs) and focus group discussions (FGDs) using semi-structured interview guide with rural women (FGDs = 4; n = 29) and traditional birth attendants (FGDs = 4; n = 14) who were permanent residents of Thatta. In addition, in-depth interviews were conducted with women who had experienced a stillbirth (IDIs = 4). This study presents perceptions and experiences of women and TBAs regarding high rate of stillbirth in Thatta district, Karachi.ResultsWomen showed reluctance to receive skilled/ standard care when in need due to apprehensions towards operative delivery, poor attitude of skilled health care providers, and poor quality of care as service delivery factors. High cost of care, far distance to facility, lack of transport and need of an escort from the family or village to visit a health facility were additional important factors for not seeking care resulting in stillbirth. The easy availability of unskilled provider in the form of traditional birth attendant is then preferred over a skilled health care provider. TBAs shared their husband or family members restrict them to visit or consult a doctor during pregnancy. According to TBAs after delivering a macerated fetus, women are given herbs to remove infection from woman‘s body and uterus. Further women are advised to conceive soon so that they get rid of infections.ConclusionWomen of this rural community carry lots of apprehension against skilled medical care and as a result follow traditional practices. Conscious efforts are required to increase the awareness of women to develop positive health seeking behavior during pregnancy, delivery and the post-partum period. Alongside, provision of respectful maternity care needs to be emphasized especially at public health facilities.

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.

Can an integrated obstetric emergency simulation training improve respectful maternity care? Results from a pilot study in Ghana.

Few evidence-based interventions exist on how to improve respectful maternity care (RMC) in low-resource settings. We sought to evaluate the effect of an integrated simulation-based training on provision of RMC. The pilot project was in East Mamprusi District in northern Ghana. We integrated specific components of RMC, emphasizing dignity and respect, communication and autonomy, and supportive care, into a simulation training to improve identification and management of obstetric and neonatal emergencies. Forty-three providers were trained. For evaluation, we conducted surveys at baseline (N=215) and endline (N=318) 6 months later, with recently delivered women to assess their experiences of care using the person-centered maternity care scale. Higher scores on the scale represent more respectful care. Compared to the baseline, women in the endline reported more respectful care. The average person-centered maternity care score increased from 50 at baseline to 72 at endline, a relative increase of 43%. Scores on the subscales also increased between baseline and endline: 15% increase for dignity and respect, 87% increase for communication and autonomy, and 55% increase for supportive care. These differences remained significant in multivariate analysis controlling for several potential confounders. The findings suggest that integrated provider trainings that give providers the opportunity to learn, practice, and reflect on their provision of RMC in the context of stressful emergency obstetric simulations have the potential to improve women's childbirth experiences in low-resource settings. Incorporating such trainings into preservice and in-service training of providers will help advance global efforts to promote RMC.

Perspectives from Providers and Mothers on the Benefits of and Barriers to Respectful Maternity Care in a Refugee Camp Setting in Thailand

IntroductionRecent evidence suggests the lack of respectful maternity care (RMC) may indirectly contribute to maternal morbidity and mortality. Compared to more stable settings, provision of RMC in emergency, conflict‐affected, and transitional contexts poses a greater challenge, though few studies have focused on RMC in these settings. This study aimed to describe providers’ and women's perspectives on benefits of and barriers to RMC in a conflict‐affected setting. An additional aim was to better understand the extent to which Burmese refugee women are experiencing disrespect and abuse during their maternity care, including care processes and interactions with providers.MethodsIn‐depth interviews and focus group discussions with maternity care providers and women giving birth in the previous 4 months were conducted at clinics in 2 refugee camps in Thailand and in a nearby Thai government referral hospital in August 2014. Participant observation occurred in the labor and postpartum wards and delivery rooms of these facilities. Recorded sessions were translated, transcribed, coded, and analyzed for common themes.ResultsEleven mothers and 14 providers, including midwives, traditional birth attendants, nurses, and physician interns, participated in either a focus group discussion or in‐depth interview exploring experiences receiving or delivering maternity care. Major themes emerging from the data included patient‐centered care, care equity, and trust. Both providers and women shared numerous experiences of disrespectful or abusive care. Subthemes related to these experiences were lack of patient privacy or consent, verbal and physical abuse by providers, ethnic and religious discrimination, and lack of mutual trust between patient and provider. High caseloads, language barriers, and patient‐provider educational disparities were also identified by providers as major barriers to providing RMC.DiscussionRefugee women are experiencing disrespectful and abusive care in both camp settings and a government referral facility. Challenges to RMC delivery in conflict‐affected settings include language and cultural barriers, provider stress, and lack of mutual trust. More research is needed among displaced women and their providers to fully characterize barriers to RMC and develop effective interventions to overcome them in emergency contexts around the world.

Women\u2019s experiences of disrespect and abuse in maternity care facilities in Benue\xa0State, Nigeria

BackgroundDisrespect and abuse (D&A) of women in health facilities continues to be a prevailing public health issue in many countries. Studies have reported significantly high prevalence of D&A among women during pregnancy and childbirth in Nigeria, but little is known about women’s perceptions and experiences of D&A during maternity care in the country. The aim of this study was to explore: 1) how women perceived their experiences of D&A during pregnancy, childbirth, and in the postnatal period in Benue State, Nigeria; and 2) how women viewed the impact of D&A on the future use of health facilities for maternity care.MethodFive focus group discussions with a sample of 32 women were conducted as part of a qualitative phenomenological study. All the women received maternity care in health facilities in Benue State, Nigeria and had experienced at least one incident of disrespect and abuse. Audio-recorded discussions were transcribed and analysed using a six-stage thematic analysis using NVivo11.ResultsThe participants perceived incidents such as being shouted at and the use of abusive language as a common practice. Women described these incidents as devaluing and dehumanising to their sense of dignity. Some women perceived that professionals did not intend to cause harm by such behaviours. Emerged themes included: (1) ‘normative’ practice; (2) dehumanisation of women; (3) 'no harm intended' and (4) intentions about the use of maternity services in future. The women highlighted the importance of accessing health facilities for safe childbirth and expressed that the experiences of D&A may not impact their intended use of health facilities. However, the accounts reflected their perceptions about the inherent lack of choice and an underlying sense of helplessness.ConclusionIncidents of D&A that were perceived as commonplace carry substantial implications for the provision of respectful maternity care in Nigeria and other similar settings. As a country with one of the highest rates of maternal deaths, the findings point to the need for policy and practice to address the issue urgently through implementing preventive measures, including empowering women to reinforce their right to be treated with dignity and respect, and sensitising health care professionals.

Perceptions of quality across the maternal care continuum in the context of a health financing intervention: Evidence from a mixed methods study in rural Malawi

BackgroundIn 2013, Malawi with its development partners introduced a Results-Based Financing for Maternal and Newborn Health (RBF4MNH) intervention to improve the quality of maternal and newborn health-care services. Financial incentives are awarded to health facilities conditional on their performance and to women for delivering in the health facility. We assessed the effect of the RBF4MNH on quality of care from women’s perspectives.MethodsWe used a mixed-method prospective sequential controlled pre- and post-test design. We conducted 3060 structured client exit interviews, 36 in-depth interviews and 29 focus group discussions (FGDs) with women and 24 in-depth interviews with health service providers between 2013 and 2015. We used difference-in-differences regression models to measure the effect of the RBF4MNH on experiences and perceived quality of care. We used qualitative data to explore the matter more in depth.ResultsWe did not observe a statistically significant effect of the intervention on women’s perceptions of technical care, quality of amenities and interpersonal relations. However, in the qualitative interviews, most women reported improved health service provision as a result of the intervention. RBF4MNH increased the proportion of women reporting to have received medications/treatment during childbirth. Participants in interviews expressed that drugs, equipment and supplies were readily available due to the RBF4MNH. However, women also reported instances of neglect, disrespect and verbal abuse during the process of care. Providers attributed these negative instances to an increased workload resulting from an increased number of women seeking services at RBF4MNH facilities.ConclusionOur qualitative findings suggest improvements in the availability of drugs and supplies due to RBF4MNH. Despite the intervention, challenges in the provision of quality care persisted, especially with regard to interpersonal relations. RBF interventions may need to consider including indicators that specifically target the provision of respectful maternity care as a means to foster providers’ positive attitudes towards women in labour. In parallel, governments should consider enhancing staff and infrastructural capacity before implementing RBF.