Search and read at least one article on Respectful Maternity Care and share readings by replying in this discussion forum.
Globally, there exists growing evidence on the experience of mistreatment of women during pregnancy and childbirth. In response to this, the World Health Organization (WHO) released a statement on prevention and elimination of disrespect and abuse during facility-based childbirth. This statement advocates for the initiation, support, and sustenance of programs designed to address the quality of Maternal and Newborn Health (MNH) services with a strong emphasis on the provision of respectful maternity care (RMC) as an essential component of the quality of care. RMC is a universal human right that is due to every childbearing woman in every health system. It is an approach that emphasizes the positive interpersonal interactions of women with health care providers and staff during the course of their pregnancies (Sheferaw, 2017).
To reiterate, RMC encompasses the prevention and elimination of disrespect and abuse during facility-based childbirth. In a study by Bulto et al. (2020), the disrespect and abuse encountered by pregnant women were categorized into 7 categories: physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination based on patient’s attributes, abandonment of care, and detention in facilities. In countries where skilled birth attendance is very low despite the high maternal mortality rate, such as in Ethiopia, disrespect and abuse during labor and childbirth is an important concern. Disrespect and abuse during childbirth on skilled delivery attendance is an important barrier in increasing services utilization and enhancing maternal well-being. While skilled assistance is one of the key interventions in reducing maternal morbidity and mortality, the experience of disrespect and abuse during labor and childbirth in institutions hinders skilled care utilization, thereby worsening maternal health outcomes.
In fact, in the study conducted by Bulto et al. (2020), it was found that only one-third of women received RMC during labor and childbirth at public health institutions in the West Shewa Zone. Furthermore, the study also outlined some factors that affect the provision of RMC during childbirth.
First is the type of health facility in the health care system. It was discovered that giving birth at health centers entailed higher chances of receiving respectful care as compared to those who gave birth in the general hospital. This indicates that there is a significant difference between the maternal care received in health centers and hospitals. This may be attributed to the higher number of caseloads compared to the available number of human resources at hospitals than in health centers.
Another factor would be maternal stay at the health facility. Mothers who stayed more than 13 hours at health institutions were almost 2 times more likely to receive RMC than those who stayed for less than 12 hours. This might be attributed to the familiarity of women who stay longer in health facilities with the health workers, thereby making them more likely to receive customary services.
It was also discovered that women who gave birth during the day were 5.56 times more likely to receive respectful care than during a nighttime shift. This might be due to the availability of more resources, infrastructures, and manpower during the day in comparison to that of the night. Furthermore, weaker supervision from senior health workers and managers might also occur during nighttime, further impacting the quality of care given.
Apart from this, it was also reported that women whose current pregnancy was unwanted were 5.56 times more likely to get RMC than those of a wanted pregnancy. This may be attributable to the fact that women with unwanted pregnancies were less likely to be worried about the outcomes and were multiparous in the current study.
Further, the study also showed that women who had discussed a place of delivery with health workers during antenatal care (ANC) were 4.42 times more likely to receive RMC than those who did not. A possible reason for this is that the women who had ANC and discussed on a place of delivery were more likely to be familiar with the health care providers since a majority of them in the current study gave birth at the same facility.
Another finding was that the number of attending health care providers was found to be significantly associated with RMC during labor and childbirth. Mothers who were attended to by 2 or fewer providers were 2.23 times more likely to receive RMC than those who were attended by 3 or more. This may be attributed to mothers not wanting to show their private bodies to a high number of providers.
Taking consent before doing a procedure was found to affect RMC. Women who provided their consent before the procedure were 3.45 times more likely to get respectful care than those who did not consent. Furthermore, those who are involved in the decision-making about their care were found to be 8.24 times more likely to receive respectful care than those who were not involved. This is a consequence of the presence of a wrong perception among some health care providers that mothers might feel more pain if informed before performing healthcare procedures. Hence, these are performed without informing the clients and even sometimes performed without providing analgesia. This finding highlights the need for involving mothers in all types of care they receive from health facilities.
Lastly, it was also discovered that women who were satisfied with their waiting time to be seen by health workers were 2 times more likely to get RMC than those who were not. This may be due to the possibility that women who were not satisfied were likely to feel as they were neglected or left without care if not seen by health workers after admission.
All in all, the study showed that the proportion of RMC during labor and childbirth at health institutions in the West Shewa Zone was low. The factors attributed to this finding are the type of institution, discussion during ANC, time of delivery, duration of stay, involvement in decision-making, the number of health workers, waiting time, and consent. Therefore, emphasis should be given to creating awareness of healthcare providers on the standards and categories of RMC. Furthermore, consideration must also be provided to the identified factors for intervention (Bulto et al., 2020).
In addition to this, monitoring and reinforcing accountability mechanisms must also be employed. Governments, facilities, and individual providers are increasingly acknowledging the prevalence of mistreatment in the provision of maternal care. However, there seems to be a lack of accountability. Hence, beyond assessing the prevalence of mistreatment, the utilization of validated tools that have been developed to drive efforts at increasing accountability and tracking change must also be explored in dealing with this concern (Afulani & Moyer, 2019).
References:
Afulani, P. A., & Moyer, C. A. (2019). Accountability for respectful maternity care. The Lancet, 394(10210), 1692-1693.
Bulto, G. A., Demissie, D. B., & Tulu, A. S. (2020). Respectful maternity care during labor and childbirth and associated factors among women who gave birth at health institutions in the West Shewa zone, Oromia region, Central Ethiopia. BMC Pregnancy and Childbirth, 20(1), 1-12.
Sheferaw, E. D., Bazant, E., Gibson, H., Fenta, H. B., Ayalew, F., Belay, T. B., ... & Stekelenburg, J. (2017). Respectful maternity care in Ethiopian public health facilities. Reproductive health, 14(1), 1-12.