Experiences of Health Facility Childbirth in Sub-Saharan Africa: A Systematic Review of Qualitative Evidence

Abstract

Introduction Access to skilled birth attendance has been prioritised as an intervention to minimise burden of maternal deaths in sub-Saharan Africa (SSA). However, poor experience of care (EoC) is impeding progress. We conducted a systematic review to holistically explore EoC patterns of facility-based childbirth in SSA. Methods PubMed, Embase and Scopus databases were searched to identify SSA EoC studies conducted between January 2000 and December 2019. Studies meeting our pre-defined inclusion criteria were quality assessed and relevant data extracted. We utilised the EoC quality standards (defined by the World Health Organization) to summarise and analyse findings while highlighting patterns. Results Twenty-two studies of varying quality from 11 SSA countries were included for review. Overall, at least one study from all included countries reported negative EoC in one or more domains of the WHO framework. Across SSA, ‘respect and preservation of dignity’ was the most reported domain of EoC. While most women deemed the pervasive disrespect as unacceptable, studies in West Africa suggest a “normalisation” of disrespect, if the intent is to save their lives. Women often experienced sub-optimal communication and emotional support with providers in public facilities compared to non-public ones in the region. These experiences had an influence on future institutional deliveries. Discussion Sub-optimal EoC is widespread in SSA, more so in public facilities. As SSA heath systems explore approaches make progress towards the Sustainable Development Goal 3, emphasis needs to be placed on ensuring women in the region have access to both high-quality provision and experience of care.

Women’s and health providers’ perceptions of companionship during labor and childbirth: a formative study for the implementation of WHO companionship model in Burkina Faso

“…In addition, enabling factors and barriers that hinder implementation of WHO companionship model were identified. Some of these barriers have been well documented in both existing literature [ 19 , 20 ] and in our study, such as limited space in labor and delivery wards, no private rooms or privacy measures (e.g., curtains) for women during labor, and hospital rules preventing companionship. However, an important consideration in Burkina Faso, and likely in other West African settings, includes that a woman may not be able to express her autonomy and choice about who supports her during this intimate time.…”

Travel of pregnant women in emergency situations to hospital and maternal mortality in Lagos, Nigeria: a retrospective cohort study

“…In addition to other points, this discussion should highlight the urgency of travel straight to a hospital for women even if they are only concerned about the health of their unborn child. Furthermore, negative experiences of health facility delivery that cause women to bypass nearer facilities in emergency to travel further need to be minimised 11 38. Efforts also need to be geared to reduce intrafacility delays at referring points of care to minimise maternal deaths among referred women.…”

Midwifery care providers’ childbirth and immediate newborn care competencies: a cross-sectional study in Benin, Malawi, Tanzania and Uganda

“…All these aspects influence lack of teamwork, collaboration, and trust as well as the interaction with women during childbirth [20]. Evidence suggests that it is not uncommon for women to experience sub-optimal care in SSA and the experiences are often less positive in public facilities than in private facilities [21, 22]. It is generally acknowledged that globally pre-service midwifery education competency levels are difficult to compare across programmes due to their differing contents and lengths as well as varying faculty capacity including competence of midwifery educators, teaching and learning materials, in addition to the level of clinical training and supervision [23].…”