Disrespect and Abuse During Childbirth in Tanzania

Sando, David; Kendall, Tamil; Lyatuu, Goodluck; Ratcliffe, Hannah L.; McDonald, Kathleen; Mwanyika‐Sando, Mary; Emil, Faida; Chalamilla, Guerino; Langer, Ana

doi:10.1097/qai.0000000000000378

Cited by 78 publications

(106 citation statements)

References 9 publications

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“…This was a little higher than an observational study in a hospital in Tanzania, where providers used non-dignified language with 5.6% and shouted at 6.6% of HIV-negative women while taking their medical history [45]. An exit interview study conducted in Ethiopia and Kenya showed 14% women in Addis Ababa hospitals [43] and 18% of women in Kenya were verbally abused [42].…”

Section: Discussionmentioning

confidence: 99%

Respectful maternity care in Ethiopian public health facilities

Bazant²,

et al. 2017

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BackgroundDisrespect and abuse of women during institutional childbirth services is one of the deterrents to utilization of maternity care services in Ethiopia and other low- and middle-income countries. This paper describes the prevalence of respectful maternity care (RMC) and mistreatment of women in hospitals and health centers, and identifies factors associated with occurrence of RMC and mistreatment of women during institutional labor and childbirth services.MethodsThis study had a cross sectional study design. Trained external observers assessed care provided to 240 women in 28 health centers and hospitals during labor and childbirth using structured observation checklists. The outcome variable, providers’ RMC performance, was measured by nine behavioral descriptors. The outcome, any mistreatment, was measured by four items related to mistreatment of women: physical abuse, verbal abuse, absence of privacy during examination and abandonment.We present percentages of the nine RMC indicators, mean score of providers’ RMC performance and the adjusted multilevel model regression coefficients to determine the association with a quality improvement program and other facility and provider characteristics.ResultsWomen on average received 5.9 (66%) of the nine recommended RMC practices. Health centers demonstrated higher RMC performance than hospitals. At least one form of mistreatment of women was committed in 36% of the observations (38% in health centers and 32% in hospitals).Higher likelihood of performing high level of RMC was found among male vs. female providers (, p = 0.012), midwives vs. other cadres (, p = 0.002), facilities implementing a quality improvement approach, Standards-based Management and Recognition (SBM-R©) (, p = 0.003), and among laboring women accompanied by a companion , p = 0.003). No factor was associated with observed mistreatment of women.ConclusionQuality improvement using SBM-R© and having a companion during labor and delivery were associated with RMC. Policy makers need to consider the role of quality improvement approaches and accommodating companions in promoting RMC. More research is needed to identify the reason for superior RMC performance of male providers over female providers and midwives compared to other professional cadre, as are longitudinal studies of quality improvement on RMC and mistreatment of women during labor and childbirth services in public health facilities.

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Section: Discussionmentioning

confidence: 99%

Respectful maternity care in Ethiopian public health facilities

Bazant²,

et al. 2017

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“…In the Dar es Salaam region, over 90 % of the population delivers in a healthcare facility [19]. The study facility is located in the poorest district in Dar es Salaam and serves as a regional referral hospital for complicated pregnancy and maternity cases to over 70 health facilities in the district.…”

Section: Methodsmentioning

confidence: 99%

“…This is part of the larger study that aimed to test interventions to reduce occurrence of D&A during childbirth, of which some of the findings have already been published [19]. …”

Section: Introductionmentioning

confidence: 99%

The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania

Sando

Ratcliffe

McDonald

et al. 2016

BMC Pregnancy Childbirth

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168

192

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BackgroundIn many countries, rates of facility-based childbirth have increased substantially in recent years. However, insufficient attention has been paid to the acceptability and quality of maternal health services provided at facilities and, consequently, maternal health outcomes have not improved as expected. Disrespect and abuse during childbirth is increasingly being recognized as an indicator of overall poor quality of care and as a key barrier to achieving improved maternal health outcomes, but little evidence exists to describe the scope and magnitude of this problem, particularly in urban areas in low-income countries.MethodsThis paper presents findings from an assessment of the prevalence of disrespectful and abusive behaviors during facility-based childbirth in one large referral hospital in Dar es Salaam, Tanzania. Client reports of disrespect and abuse (D&A) were obtained through postpartum interviews immediately before discharge from the facility with 1914 systematically sampled women and from community follow-up interviews with 64 women four to six weeks post-delivery. Additionally, 197 direct observations of the labor, delivery, and postpartum period were conducted to document specific incidences of disrespect and abuse during labor and delivery, which we compared with women’s reports.ResultsDuring postpartum interviews, 15 % of women reported experiencing at least one instance of D&A. This number was dramatically higher during community follow-up interviews, in which 70 % of women reported any experience of D&A. During postpartum interviews, the most common forms of D&A reported were abandonment (8 %), non-dignified care (6 %), and physical abuse (5 %), while reporting for all categories of D&A, excluding detention and non consented care, was above 50 % during community follow-up interviews. Evidence from direct observations of client-provider interactions during labor and delivery confirmed high rates of some disrespectful and abusive behaviors.ConclusionsThis study is one of the first to quantify the prevalence of disrespect and abuse during facility-based childbirth in a large public hospital in an urban setting. The difference in respondent reports between the two time periods is striking, and more research is needed to determine the most appropriate methodologies for measuring this phenomenon. The levels and types of disrespect and abuse reported here represent fundamental violations of women’s human rights and are symptomatic of failing health systems. Action is urgently needed to ensure acceptable, quality, and dignified care for all women.

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“…At least four recent studies have examined PMTCT adherence and engagement in Tanzania (10, 20, 27, 28). A cohort study with 120 mother-child pairs, conducted in 2011 before Option A implementation, found only 10 pairs (8.3%) achieved at least 80% adherence rates in all PMTCT phases (before, during, and after delivery); one mother-child pair (0.8%) achieved a 95% adherence level for the entire PMTCT intervention (27).…”

Section: Introductionmentioning

confidence: 99%

“…A 2014 qualitative study in northern Tanzania highlighted the importance of patient-provider relationships in PMTCT engagement and noted that imbalances of power, unclear communication, disrespectful statements, discriminatory treatment, and inadequate counseling by providers undermined PMTCT clients’ trust in the health care system (10). However, a more recent mixed-methods study based in an urban referral facility in Dar es Salaam found no statistically significant difference in the experience of disrespect or abuse by HIV serostatus; the authors underscored that the overall prevalence of disrespect and abuse is high, indicating “a serious problem” in the maternal health sector generally (28). …”

Section: Introductionmentioning

confidence: 99%

Stigma, Facility Constraints, and Personal Disbelief: Why Women Disengage from HIV Care During and After Pregnancy in Morogoro Region, Tanzania

et al. 2016

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Millions of children are living with HIV in sub-Saharan Africa, and the primary mode of these childhood infections is mother-to-child transmission. While existing interventions can virtually eliminate such transmission, in low- and middle-income settings, only 63% of pregnant women living with HIV accessed medicines necessary to prevent transmission. In Tanzania, HIV prevalence among pregnant women is 3.2%. Understanding why HIV-positive women disengage from care during and after pregnancy can inform efforts to reduce the impact of HIV on mothers and young children. Informed by the tenets of Grounded Theory, we conducted qualitative interviews with 40 seropositive postpartum women who had disengaged from care to prevent mother-to-child transmission (PMTCT). Nearly all women described antiretroviral treatment (ART) as ultimately beneficial but effectively inaccessible given concerns related to stigma. Many women also described how their feelings of health and vitality coupled with concerns about side effects underscored a desire to forgo ART until they deemed it immediately necessary. Relatively fewer women described not knowing or forgetting that they needed to continue their treatment regimens. We present a theory of PMTCT disengagement outlining primary and ancillary barriers. This study is among the first to examine disengagement by interviewing women who had actually discontinued care. We urge that a combination of intervention approaches such as mother-to-mother support groups, electronic medical records with same-day tracing, task shifting, and mobile technology be adapted, implemented, and evaluated within the Tanzanian setting.

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Disrespect and Abuse During Childbirth in Tanzania

Cited by 78 publications

References 9 publications

Respectful maternity care in Ethiopian public health facilities

Respectful maternity care in Ethiopian public health facilities

The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania

Stigma, Facility Constraints, and Personal Disbelief: Why Women Disengage from HIV Care During and After Pregnancy in Morogoro Region, Tanzania

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