Overview of literature on RMC and applications to Tanzania

Abstract

Respectful maternity care research in Tanzania continues to increase. This is an overview of the literature summarizing research based on the domains which comprise this quality of care indicator, ranging from exploratory and descriptive to quantitative measurements of birth perinatal outcomes when respectful interventions are made. The domains of respectful care are reflected in the seven Universal Rights of Childbearing Women but go further to implicate facility administrators and policy makers to provide supportive infrastructure to allay disrespect and abuse.The research methodologies continue to be problematic and several ethical cautions restrict how much control is possible. Similarly, the barriers to collecting accurate accounts in qualitative studies of disrespect require astute interviewing and observation techniques. The participatory community-based and the critical sociology and human rights frameworks appear to provide a good basis for both researcher and participants to identify problems and determine possible solutions to the multiple factors that contribute to disrespect and abuse. The work-life conditions of midwives in the Global South are plagued with poor infrastructure and significantly low resources which deters respectful care while decreasing retention of workers. Researchers and policy-makers have addressed disrespectful care by building human resource capacity, by strengthening professional organizations and by educating midwives in low-resource countries. Furthermore, researchers encourage midwives not only to acquire attitudinal change and to adopt respectful maternity care skills, but also to emerge as leaders and change agents.Safe methods for conducting care while addressing low resources, skilled management of conflict and creative innovations to engage the community are all interventions that are being considered for quality improvement research. Tanzania is poised to evaluate the outcomes of education workshops that address all seven domains of respectful care.

Disrespect and abuse in maternity care in a low-resource setting in Tanzania: Provider’s perspectives of practice

“…The main areas of concern were; lack of working equipment and supplies, space constraints, unclear processes, high workload, lack of commitment from leadership, vague and unfulfilled policies (e.g., free treatment for pregnant women and under-five children), and shortage of qualified staff. These findings are similar to those in several studies from within and in other countries [ 17 , 26 , 30 , 32 , 33 ]. For example, a study in Tanzania reported a lack of partitions between beds and that women shared beds [ 32 ].…”

“…They cited lack of resources and poor leadership as contributing to the bridging of professional ethics and integrity, e.g., lack of screening curtains and private rooms affect privacy and confidentiality during care. Studies in other areas have reported similar findings [ 9 , 17 , 32 ]. These findings imply that environmental factors are essential components that may influence the client’s care.…”

“…Violence against healthcare providers has been relatively reported worldwide however, there is a paucity of literature on women and relatives’ disrespect and abuse of maternity healthcare providers in Tanzania. However, a study in Tanzania reported that health providers might act disrespectfully due to the existing inequality, where they hold authority over women, though they are the victims of continuous health system challenges and poor working conditions [ 17 ].…”

“…Disrespectful and abusive care is associated with women stopping seeking maternal health services from health facilities. In Tanzania, only 50% of childbirth in 2010 [ 15 ] and 62% in 2016 [ 16 ] utilized maternity healthcare services, and disrespect and abuse are highlighted among the reasons [ 17 ]. Women in rural Tanzania have declared that they would deliver at a health facility if maternity healthcare providers would use positive language and welcoming approaches [ 17 ].…”

Competencies for respectful maternity care: Identifying those most important to midwives worldwide

“…A second "prong" is that health care practitioners themselves must feel valued and respected by their superiors and must value each other. Recent literature 43,44 points out that the low status of midwives in many health system hierarchies, and organizational cultures of blame and a lack of consideration of midwives as essential health workers, effectively constitutes disrespect and abuse of the midwives themselves. Both caregivers and their patients have the right to dignified treatment.…”