Applying the COM-B Model to Understand the Drivers of Mistreatment During Childbirth: A Qualitative Enquiry Among Maternity Care Staff

Abstract

One of the major drivers of mistreatment during childbirth includes the lack of staff training on interpersonal skills and psychosocial support, which resulted in providers lacking the understanding that patients' rights also include equity, respect, and satisfaction-and not only the right to high-quality clinical care.n Providers restricted the presence of birth companions, particularly males, based on providers' own cultural preferences and comfort, thus denying women a source of support during childbirth. n Provider's physical and verbal abuse, neglect, and abandonment of patients, particularly of those from lower castes and minority ethnic groups, in response to patients' lack of cooperation and compliance was common and justified. Stronger performance monitoring systems and patient feedback mechanisms would help hold staff accountable for mistreatment and contribute to improving respectful maternity care.

Promoting Supportive and Respectful Maternity Care in Public Health Facilities in Sindh, Pakistan: A Theory-Informed Health System Intervention

“… 29 – 33 Within the health system, labor rooms and wards are the contact point for pregnant women, yet maternity teams are not technically equipped to support their clients’ perinatal mental health, especially their psychological and social needs. 9 , 10 Moreover, maternity staff can suffer from stress and burnout due to their workload and need mental health support themselves. 34 We believe our study is the first to use mhGAP in the maternity care setting.…”

“…We used the COM-B (capability, opportunity, motivation, and behavior) framework to develop the S-RMC intervention. 10 The COM-B is a well-studied model used to develop an in-depth understanding of the behavior change of health care staff. 11 , 12 Its premise, a particular behavior, is a function of both psychological and physical abilities, along with the social and physical opportunity to perform that behavior more than other competing behavior possibilities.…”

Promoting Maternity Care: Knowledge, Perception and Challenges of Midwives in Selected Government Hospitals in Federal Capital Territory (FCT), Abuja

“…The COM-B model states that in order for a behavior to be carried out, it must be more desirable or necessary than alternative competing behaviors, feel psychologically and physically capable of being carried out, and have access to social and physical opportunities (Asim et al, 2023).…”

Understanding the Mechanisms of Change in the Supportive and Respectful Maternity Care Intervention in Sindh, Pakistan: Provider Perspectives

“…Our intervention involved a participatory, consensus-driven process of working closely with maternity teams, theoretically underpinned by the COM-B framework (capability, opportunity, and motivation drivers for respectful maternity behavior). 12 , 14 , 15 The intervention components included capacity-building of maternity teams and systemic changes for improvements in governance and accountability within public health facilities ( Table 1 ). The integration of psychosocial support in routine maternity care to address the needs of birthing women and their companions was a unique feature.…”