How women's experiences and perceptions of care influence uptake of postnatal care across sub-Saharan Africa: a qualitative systematic review

Abstract

Background The burden of maternal and neonatal morbidity and mortality is a global health concern with the highest burden documented after childbirth in women and babies living in sub-Saharan Africa. To date, there is limited information on the quality of postnatal care and/or whether evidence-based interventions to improve postnatal care in a way that meets the specific health needs of each mother and her baby have been lacking. There is also limited data related to how quality of care (respectful or disrespectful) influences women's decision to access postnatal care. Objective To systematically review available qualitative evidence for how quality of care (respectful or disrespectful) influences perceptions and experiences of, and decisions to, access postnatal care for women living in sub-Saharan Africa. Search strategy CINAHL plus, Cochrane library, Global Health, Medline, PubMed, Web of Science were searched from 2009—2019. Grey literature was searched on Google Scholar. Selection criteria Qualitative literature in English describing women’s perceptions and experiences of the quality of care they received after childbirth and how this influenced their perceptions of and decisions to access postnatal care. Data analysis Thematic analysis was performed to extract subthemes and themes. Outcomes were themes from the qualitative data used to form a thematic synthesis. Results Fifteen studies were included with data from 985 women interviewed face-to-face across eight countries. Descriptions of respectful care included healthcare providers being kind, supportive and attentive to women’s needs. Women described preferring healthcare services where the healthcare providers communicated in a respectful and caring manner. Descriptions of disrespectful care included verbal and/or physical abuse and power imbalances between women and healthcare providers. Some women were denied postnatal care when attending a healthcare facility after giving birth at home. There is evidence to suggest that vulnerable women (adolescents; women with poor socioeconomic status; women who are HIV positive) are more likely to receive disrespectful care. Conclusions This systematic review describes how aspects of respectful and disrespectful maternity care influence women’s perceptions and experiences of, and decisions to access postnatal care services. There is a need for a renewed focus to prioritise respectful maternity care and to sustainably provide good quality postnatal care to all women and their babies in a way that meets their expectations and health needs.

Postnatal care services in rural Zambia: a qualitative exploration of user, provider, and community perspectives on quality of care

“…Negative or disrespectful attitudes of healthcare providers are a widespread phenomenon in LMICs, affecting users’ perceptions of quality and utilization of services, along the continuum of maternal and intrapartum health services. Bohren et al [ 45 ] concluded that experiences of mistreatment during PNC visits have far-reaching consequences for women and communities outside of the direct woman–provider interaction and that experiences and perceptions of mistreatment, low expectations of the care provided at facilities, and poor reputations of facilities in the community erode many women’s trust in the health system and impact their decision to return there for subsequent PNC visits or future pregnancies [ 46 ]. Unsurprisingly, and in accordance with longstanding literature [ 46 ] , our findings suggest that women prefer PNC services where mothers are treated with respect.…”

“…Bohren et al [ 45 ] concluded that experiences of mistreatment during PNC visits have far-reaching consequences for women and communities outside of the direct woman–provider interaction and that experiences and perceptions of mistreatment, low expectations of the care provided at facilities, and poor reputations of facilities in the community erode many women’s trust in the health system and impact their decision to return there for subsequent PNC visits or future pregnancies [ 46 ]. Unsurprisingly, and in accordance with longstanding literature [ 46 ] , our findings suggest that women prefer PNC services where mothers are treated with respect. In addition, respondents described women preferring healthcare services where the healthcare providers communicated in a respectful, confidential, and caring manner.…”

Factors that influence uptake of routine postnatal care: Findings on women’s perspectives from a qualitative evidence synthesis

“…However, it is likely that women in settings with insufficient resources will more often refer to unhygienic conditions or lack of equipment as a more immediate priority than their experiences, and/or that they perceive less ability to change the situation than women in settings with more resources. A recent qualitative evidence review of studies in sub-Saharan Africa affirmed that aspects of respectful and disrespectful maternity care and women's previous experiences of health care influenced their "decisions to access postnatal care services" [94]. The fact that many of the studies related to experience of care are from high-income settings may reflect the study authors' biases and points to the need to study women and families' experiences more holistically in low-and middle-income settings.…”

Factors that influence the uptake of postnatal care among adolescent girls: a qualitative evidence synthesis

“… 53 59 60 A review of how the experiences of women and girls influence uptake of PNC in African countries similarly highlighted trust as being built through respectful care, defined as health providers being ‘kind, supportive and attentive to women’s needs’ and disrespectful care as including ‘verbal and/or physical abuse and power imbalances between women and healthcare providers’. 61 Building trust and respectful communication with health providers is critically important in this subpopulation, particularly due to the oftentimes higher risk of disrespectful maternity care among adolescent girls. 61 While findings in our primary review also note mothers’ feelings of disrespect and being overlooked, the subpopulation studied in this review strongly emphasise perceived judgement, disrespect and lack of belonging in PNC, citing stigma and negative stereotypes as potential reasons.…”