Development and use of a scale to assess gender differences in appraisal of mistreatment during childbirth among Ethiopian midwifery students

Abstract

Mistreatment during childbirth occurs across the globe and endangers the well-being of pregnant women and their newborns. A gender-sensitive approach to mistreatment during childbirth seems relevant in Ethiopia, given previous research among Ethiopian midwives and patients suggesting that male midwives provide more respectful maternity care, which is possibly mediated by self-esteem and stress. This study aimed a) to develop a tool that assesses mistreatment appraisal from a provider's perspective and b) to assess gender differences in mistreatment appraisal among Ethiopian final-year midwifery students and to analyze possible mediating roles of self-esteem and stress. First, we developed a research tool (i.e. a quantitative scale) to assess mistreatment appraisal from a provider's perspective, on the basis of scientific literature and the review of seven experts regarding its relevance and comprehensiveness. Second, we utilized this scale, the so-called Mistreatment Appraisal Scale, among 390 Ethiopian final-year midwifery students to assess their mistreatment appraisal, self-esteem (using the Rosenberg Self-Esteem Scale), stress (using the Perceived Stress Scale) and various background characteristics. The scale's internal consistency was acceptable (α = .75), corrected item-total correlations were acceptable (.24 -.56) and inter-item correlations were mostly acceptable (.07 -.63). Univariable (B = 3.084, 95% CI [-.005, 6.173]) and multivariable (B = 1.867, 95% CI [-1.472, 5.205]) regression analyses did not show significant gender differences regarding mistreatment appraisal. Mediation analyses showed that self-esteem (a 1 b 1 = -.030, p = .677) and stress (a 2 b 2 = -.443, p = .186) did not mediate the effect of gender on mistreatment appraisal. The scale to assess mistreatment appraisal appears to be feasible and reliable. No significant association between gender and mistreatment appraisal was observed and self-esteem and stress were not found to be mediators. Future research is needed to evaluate the scale's criterion validity and to assess determinants and consequences of mistreatment during childbirth from various perspectives.

Risk Factors for Positive Appraisal of Mistreatment during Childbirth among Ethiopian Midwifery Students

“…One study has for example pointed toward more RMC among male Ethiopian healthcare providers. However, in our earlier published study, gender did not predict positive appraisal of mistreatment during childbirth among Ethiopian midwifery students [24]. The lack and inconclusiveness of previous research led to the aim of the current study, which was to analyze and identify risk factors for mistreatment during childbirth among Ethiopian midwifery students.…”

“…The outcome variable was appraisal of mistreatment during childbirth (α = 0.75), and it was assessed with the 10-item Mistreatment Appraisal (MISAP) Scale [24]. The items of the MISAP scale are based on the typology of mistreatment by Bohren et al [4] and encompass the following mistreatment themes: physical abuse, verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers, and health system conditions and constraints.…”

Improving Respectful Maternity Care in Ethiopia

“…being a good mother and wife, managing the household), this might not yet hold for most female midwifery students. Thus, fewer responsibilities and adequate fulfillment of social obligations among female midwifery students, as compared to female midwives, may imply higher self-esteem and reduced stress levels [47,48]. In turn, this offers an explanation for the finding that associations between gender and self-esteem, gender and stress, as well as gender and mistreatment appraisal were insignificant.…”

“…Part of the reason could be rationalization of physical abuse by health providers, with the belief to ensure safety of newborn. In a qualitative study conducted among midwifery students in Ghana and health workers in Nigeria, some students and health workers mentioned it was necessary to hit women to gain compliance [47,48].…”

“…Reasons for health providers verbally abusing laboring women were not explored in this study but qualitative study in Tanzania suggested coming too early or too late for delivery, wearing old dirty dresses and not pushing strongly were some of the reasons why women were verbally abused by providers [32]. A study in Ghana with midwifery students revealed that both students and their preceptors do not know how to encourage women to push or to open their legs [48].…”