Enablers and Barriers to Respectful Maternity Care in Low and Middle-Income Countries: A Literature Review of Qualitative Research
This article focuses on the enablers and barriers to respectful maternity care (RMC) in low and middle-income countries as well as strategies to enhance RMC, according to findings from various qualitative studies conducted from the year 2000 to June 2020. As I read through this article, I could not help but feel appalled by the experiences of the women who participated in these studies. I began to wonder whether the abuse and disrespect mentioned in these studies are also present here in the Philippines, particularly in marginalized and far-flung areas. It is crucial to be aware of these enablers and barriers in order to promote health-seeking behaviors among patients.
Factors that Enhance Respectful Maternity Care
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Good Reception |
Having a welcoming healthcare staff provides comfort and assurance of supportive and respectful care to women entering the healthcare facility. It also promotes hospital-based delivery for future pregnancies. |
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Information Provision |
Providing information on the progress of labor and involving the patient in the decision-making process for their care provides pain relief and promotes delivery satisfaction. |
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Prompt Care |
Providing speedy intervention is crucial to saving lives. It also leads to respect and satisfaction that promotes facility-based delivery, as women feel that they are being treated well. |
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Dignified Care |
Includes: • Gently-conducted pregnancy examinations • Encouragement and support during delivery • Provision of basic/supportive materials (e.g., sanitary pads) These practices convey respect and satisfaction, which encourage women to seek facility-based care in subsequent pregnancies. Some women even reported having crossed borders in pursuit of respectful maternity care. |
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Psychological Support |
Providing support and companionship to women reduces the stress of labor. |
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Privacy and Confidentiality |
Includes: • Providing physical barriers in the labor room • Limiting the number of individuals in the labor room • Maintaining the secrecy of events that took place during delivery These practices promote comfort, respect, confidence, satisfaction, and security. |
Factors that Inhibit Respectful Maternity Care
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Poor Communication |
Involves: • Non-supportive, disrespectful, humiliating statements, including insults > “…when a patient has called for help, they ignore by saying ‘I was not there when you were having sex with your husband.’” • Unfriendly care > “I messed on the floor, with the blood because I was pushing…she [nurse] told me…’Go and get a mop there and make your mess clean.’” • Lack of information or patient involvement in the decision-making process • Denied chances to speak with healthcare personnel These experiences result in women no longer wanting to receive facility-based delivery. |
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Non-consented Care |
Women expressed concerns over lack of respect, as healthcare providers do not seek permission prior to conducting procedures, with some students not speaking to them at all. Healthcare providers admit that asking for consent for any procedure may not be necessary. |
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Stigma and Discrimination |
Women faced stigma and discrimination over lack of education, poor financial status, country of origin, and diseases like HIV. |
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Physical Abuse |
Women experienced beating which healthcare providers assumed as a form of discipline for non-cooperative women > “When we are doing an episiotomy, the mother may want to stand and try to leave the room, in such cases, we may kick the women by scissor…” |
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Poor Psychological Support |
Women expressed feeling scared, worried, and not respected as their relation was not allowed to accompany them. Some women reported a lack of respect due to repeated virginal examinations that are painful and affect them psychologically. |
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Lack of Privacy and Confidentiality |
Includes: • Lack of partition and protective cover • Secrecy discussed with other individuals |
Strategies to Facilitate Respectful Maternity Care
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Health Education |
Involves: • Antenatal health education on care expected during labor • Health advice to ease suffering during labor • Involvement in healthcare decisions |
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Good Communication |
Involves: • Welcoming women during delivery with good communication • Communicate without shouting • Respecting women’s decision not to have something done during delivery |
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Capacity Building |
Involves: • Staff training (e.g., leadership training for heads) • Psychological training for handling hostile patients |
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Staff Motivation |
Involves: • Good working environment • Financial or other forms of commendation • Good feedback from the community |
Reference
Mgawadere, F., & Shuaibu, U. (2021). Enablers and barriers to respectful maternity care in low and middle-income countries: A literature review of qualitative research. International Journal of Clinical Medicine, 12, 224-249. https://doi.org/10.4236/ijcm.2021.125021