Midwives’ and patients’ perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study

BMC Pregnancy and Childbirth

Research Article

Sarah Jane Holcombe¹  Dube Jara²  Sahai Burrowes³  Katheryn Smith⁴  Danielle Carter⁴ 

[1] Bixby Center for Population, Health, and Sustainability, University of California, Berkeley 17 University Hall, 94720-7360, Berkeley, CA, USA;Department of Public Health College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia;Public Health Program, College of Education and Health Sciences, Touro University California, 1310 Club Dr. Mare Island, 94592, Vallejo, CA, USA;Touro University California, 1310 Club Dr. Mare Island, 94592, Vallejo, CA, USA;

关键词: Midwives;    Respectful maternity care;    Disrespect and abuse;    Maternity care;    Quality;    Patients’ rights;    Woman-centred care;   

DOI  :  10.1186/s12884-017-1442-1

 received in 2016-10-03, accepted in 2017-08-02,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIt is increasingly recognized that disrespect and abuse of women during labor and delivery is a violation of a woman’s rights and a deterrent to the use of life-saving, facility-based labor and delivery services. In Ethiopia, rates of skilled birth attendance are still only 28% despite a recent dramatic national scale up in the numbers of trained providers and facilities. Concerns have been raised that womens’ perceptions of poor quality of care and fear of mistreatment might contribute to this low utilization. This study examines the experiences of disrespect and abuse in maternal care from the perspectives of both providers and patients.MethodsWe conducted 45 in-depth interviews at four health facilities in Debre Markos, Ethiopia with midwives, midwifery students, and women who had given birth within the past year. Students and providers also took a brief quantitative survey on patients’ rights during labor and delivery and responded to clinical scenarios regarding the provision of stigmatized reproductive health services.ResultsWe find that both health care providers and patients report frequent physical and verbal abuse as well as non-consented care during labor and delivery. Providers report that most abuse is unintended and results from weaknesses in the health system or from medical necessity. We uncovered no evidence of more systematic types of abuse involving detention of patients, bribery, abandonment or ongoing discrimination against particular ethnic groups. Although health care providers showed good basic knowledge of confidentiality, privacy, and consent, training on the principles of responsive and respectful care, and on counseling, is largely absent. Providers indicated that they would welcome related practical instruction. Patient responses suggest that women are aware that their rights are being violated and avoid facilities with reputations for poor care.ConclusionsOur results suggest that training on respectful care, offered in the professional ethics modules of the national midwifery curriculum, should be strengthened to include greater focus on counseling skills and rapport-building. Our findings also indicate that addressing structural issues around provider workload should complement all interventions to improve midwives’ interpersonal interactions with women if Ethiopia is to increase provision of respectful, patient-centered maternity care.

【 授权许可】

CC BY   
© The Author(s). 2017