Assessing respectful maternity care in a fragile, conflict-affected context: Observations from a 2016 national assessment in Afghanistan

Abstract

evidence on experiences and perceptions of care in pregnancy and childbirth in conflict-affected settings is limited. We interviewed 561 maternity care providers and observed 413 antenatal care consultations, 671 births, and 393 postnatal care consultations at public health facilities across afghanistan. We found that healthcare providers work under stressed conditions with insufficient support, and most women receive mixed quality care. Understanding socio-cultural and contextual factors underpinning acceptance of mistreatment in childbirth, related to conflict, insecurity, gender and power dynamics, is critical for improving the quality of maternity care in afghanistan and similar fragile and conflict affected settings.The number of women and children affected by armed conflict has grown steadily since 2000; during this period, at least 630 million women and children-10% of women and 16% of children worldwide-have either been displaced by conflict or living dangerously close to armed conflict events (Bendavid et al., 2021). With this shifting global landscape, there is growing attention to quality of health services in crisis-affected settings, with efforts to review evidence on health system quality (Jordan et al., 2021), understand context-specific challenges to delivery of quality care (Munyuzangabo et al., 2021), and develop operational guidance for improving quality of care (Syed et al., 2020) in areas affected by conflict and fragility.As authors of the Lancet Maternal Series in 2016 emphasize: Every woman, every newborn, everywhere has the right to appropriate, timely, evidence-based, respectful care (The Lancet, 2016). Mistreatment during childbirth has been highlighted as a significant obstacle in reducing maternal and newborn mortality around the globe -it contributes to negative user experiences and can be a significant deterrent to the uptake of facility-based childbirth (

Knowledge, attitude and practice of healthcare providers on mistreatment during labour and childbirth: a cross-sectional study in Tehran, Iran, 2021

“…The results of our study showed that 60.8% of the providers did not consider the application of fundal pressure during delivery as a form of mistreatment. Based on the available evidence, the use of fundal pressure during vaginal birth is very common in hospitals [43][44][45][46][47][48]. A systematic review showed that the prevalence of fundal pressure ranged from 0.6 to 69.2% globally [45].…”

The Individual and Community Level Women Empowerment and Utilization of Maternity Care Services in Afghanistan: A Multilevel Cross-Validation Study

“…However, there was no signi cant association between age at critical life events and PNC. The limitations in access to PNC aside; the low quality of such services is one of the discouraging factors in the utilization of it in poor-resourced settings such as Afghanistan (35). In addition, older mothers-those with high scores in age at critical life eventsoften have more exposure to such services, and therefore; low quality of PNC could be a stronger disappointing factor for this age group as compared to younger groups abd this could further reduce the utilization of PNC by this age group.…”

Disrespect and Abuse Experienced by Mothers While Accessing Delivery Healthcare Services in Bangladesh

“…Explanatory variables were selected by reviewing the relevant literature in the context of 13,[16][17][18][19][20][21][22]. The selected variables included were mother's age (≤ 19 years, 20-34 years, and ≥ 35 years), mother's education (no formal education, primary education, secondary education, and higher education), mother's formal work engagement (yes, no), number of children ever born (1-2 children and > 2 children), husband's age (≤ 30, 31-40, ≥ 41), husband's education (no formal education, primary education, secondary education, and higher education), wealth quintile (poorest, poorer, middle, richer, richest), mass media exposure (no exposure, moderate exposure, higher exposure), number of antenatal healthcare services visits (no visit, 1-3 visits, ≥ 4 visits), place of residence (urban, rural), and district of residence (Mymensingh, Rajshahi, Rangpur).…”

“…The rate of RMC has been observed to be higher among illiterate mothers, those residing in rural areas, and those from disadvantaged socio-demographic backgrounds [9,10,13,[16][17][18]. These ndings are echoed in the limited available studies in South Asian countries [8, [19][20][21][22]. However, to date, no studies have been conducted in Bangladesh to assess the extent of RMC, D&A, and their determinants.…”