An Innovative Intervention to Improve Respectful Maternity Care in Three Districts in Ethiopia

Abstract

BackgroundDisrespect and abuse (D&A) during childbirth are major violations of human rights and often deter women from accessing skilled delivery in health facilities. In Ethiopia, D&A has been documented to occur in up to 49.4% of mothers delivering in health facilities. This study describes the development, implementation and results of a novel intervention to improve respectful maternity care (RMC) and decrease D&A in three districts in Ethiopia.MethodsAs part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed a novel RMC training module with three core components: testimonial videos, didactic sessions on communication, and onsite coaching. As of February 2017, we implemented the RMC training in three districts within the regions of Oromia; Southern Nations, Nationalities, and People’s; and Tigray. Measures of births with privacy and a birth companion from a 27-month data from 17 health centers and three hospitals were analyzed using STATA version 13 for interrupted time series and a regression analysis was conducted to assess the significance of improvement. Facilitated discussions were conducted among health care providers to gauge the effectiveness of the videos. Facility level solutions applied to enhance RMC were documented. ResultsAn analysis of the effectiveness of integrating RMC using available programmatic data showed significant improvement following the RMC training, which was sustained beyond the project intervention (regression coefficients ranging from 0.18 to 0.77). Several local solutions were devised and implemented in the health facilities to improve the experience of care for mothers. Facilitated discussions with health care providers participating in the RMC training showed improved understanding of patients’ perspectives and the psychosocial needs of their clients. ConclusionThis study suggests that integrating the RMC training into the district-wide quality improvement (QI) collaborative is effective in improving RMC. Use of testimonial videos are especially helpful as they remind providers of the need to treat mothers with dignity and helps them reflect on potential root causes for this type of treatment and develop effective solutions.