Mitigating the mistreatment of childbearing women: evaluation of respectful maternity care intervention in Ethiopian hospitals

Abstract

ObjectivesThere is a lack of evidence on approaches to mitigating mistreatment during facility-based childbirth. This study compares the experiences of mistreatment reported by childbearing women before and after implementation of a respectful maternity care intervention.DesignA pre–post study design was undertaken to quantify changes in women’s experiences of mistreatment during facility-based childbirth before and after the respectful maternity care intervention.InterventionA respectful maternity care intervention was implemented in three hospitals in southern Ethiopia between December 2017 and September 2018 and it included training of service providers, placement of wall posters in labour rooms and post-training supportive visits for quality improvement.Outcome measuresA 25-item questionnaire asking women about mistreatment experiences was administered to 388 women (198 in the pre-intervention, 190 in the post-intervention). The outcome variable was the number of mistreatment components experienced by women, expressed as a score out of 25. Multilevel mixed-effects Poisson modelling was used to assess the change in mistreatment score from pre-intervention to post-intervention periods.ResultsThe number of mistreatment components experienced by women was reduced by 18% when the post-intervention group was compared with the pre-intervention group (adjusted regression coefficient (Aβ)=0.82, 95% CI 0.74 to 0.91). Women who had a complication during pregnancy (Aβ=1.17, 95% CI 1.01 to 1.34) and childbirth (Aβ=1.16, 95% CI 1.03 to 1.32) experienced a greater number of mistreatment components. On the other hand, women who gave birth by caesarean birth after trial of vaginal birth (Aβ=0.76, 95% CI 0.63 to 0.92) and caesarean birth without trial of vaginal birth (Aβ=0.68, 95% CI 0.47 to 0.98) experienced a lesser number of mistreatment components compared with those who had vaginal birth.ConclusionsWomen reported significantly fewer mistreatment experiences during childbirth following implementation of the intervention. Given the variety of factors that lead to mistreatment in health facilities, interventions designed to mitigate mistreatment need to involve structural changes.

Unveiling respectful maternity care as a way to address global inequities in maternal health

“…Here, I am largely drawing from an implementation research from Ethiopia that explored health system constraints to the promotion of RMC in public hospitals and tested a multicomponent intervention (staff training, placement of wall posters and post-training onsite support for quality improvement) that was designed to promote RMC. [18][19][20] The study used an interventional mixed methods design that included surveys of both women and service providers before and after the intervention, focus group discussions with service providers before and after the intervention and in-depth interviews with key informants before the intervention. Based on the findings of the study and other implementation studies from Kenya, Nigeria and Tanzania, [21][22][23] I have synthesised approaches to the promotion of RMC (figure 1).…”

Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care

“… 36 The survey of women revealed that the number of mistreatment components women experienced during childbirth in the study hospitals was reduced by 18% after the RMC intervention. 37 The mixed-methods study revealed that service providers’ awareness of the rights of childbearing women, perceptions and attitudes about RMC, and motivation to provide respectful care improved after the RMC intervention. 36 …”

“…In two other studies, we have reported on the evaluation of the RMC intervention (survey of women before and after the intervention) 37 and the lessons learned through its implementation, including the enablers of RMC (mixed-methods study among service providers who participated in the intervention). 36 The survey of women revealed that the number of mistreatment components women experienced during childbirth in the study hospitals was reduced by 18% after the RMC intervention.…”

“…Further detail about the evaluation of the intervention from women's and service providers’ perspectives is available in other studies published elsewhere. 36 , 37 Implementation of the whole set of components of the intervention lasted for three months. All service providers who assist women in the study hospitals ( n = 69) were invited to participate in the intervention.…”

Adherence to respectful maternity care guidelines during COVID-19 pandemic and associated factors among healthcare providers working at hospitals in northwest Ethiopia: A multicenter, observational study

“…Besides, avoidance of ill-treatment and disrespectful care during childbirth is simple but determinant for better maternal health outcomes and the good adherence of women to maternal and neonatal health services given during the postnatal period. 16 However, a lot of women were treated disrespectfully at the time of childbirth and other obstetric care. 14 One in three women is subjected to abuse and violence during labor and delivery.…”