Prevalence of disrespect and abuse during facility based child birth and associated factors, Jimma University Medical Center, Southwest Ethiopia

Abstract

Background In countries where the proportion of births attended by skilled providers is low, maternal mortality is high. According to the 2016 EDHS report, the proportion of births attended by skilled providers was only 26% and the maternal mortality ratio was 412 per 100,000 live-births. Disrespectful and abusive behavior of health workers and other facility staff experienced by women during facility-based childbirth is important, but the little-understood barrier of institutional delivery. Objective This study assessed the prevalence of disrespect and abuse experienced by mothers during facility-based childbirth and associated factors. Methods A facility based cross-sectional study was undertaken from October to December 2016. Data were collected by face-to-face interview using a structured questionnaire from 290 mothers consecutively included in the study immediately prior to discharge from the hospital. Reports of disrespect and abuse during childbirth were measured using 23 performance indicators. Data were entered into EpiData and analyzed by SPSS; bivariate and multivariable binary logistic regression analyses were performed to identify factors associated with disrespect and abuse. Result Three-fourths ( 217,[74.8%]) of participants were Muslim. Nearly half (142,[49%]) had a primary level of education. Most (232,[80%]) were housewives and 175(60.3%) were from outside Jimma town. The prevalence of disrespect and abuse during childbirth was 91.7% (266/290; 95%CI:0.879,0.946). The most common types of disrespect and abuse reported were culturally inappropriate care (218,[75.2%]), failure to encourage the client to ask questions (220,[75.9%]), the provider not introducing him/herself (232,[80.0%]), failure to obtain consent/permission prior to any procedure (185,[63.8%]) and not using curtains/visual barriers to protect client (237,[81.7%]). Being non-married [95%CI:(0.009,0.222), ≥para-II [95%CI:(0.093,0.862)] and being attended by female care provider [95%CI:(0.026,0.224)] were associated with the reduced chance of reporting disrespect and abuse. However, achieving ≥secondary education [95%CI:(1.028,10.272)] was associated with a higher chance of reporting disrespect and abuse. Conclusion The very high prevalence of abuse or disrespect during facility-based delivery shows a health system in crisis. A key implication of this finding is that efforts to increase facility-based delivery must address disrespect and abuse to ensure higher utilization by women. Making facility-based deliveries attended by female providers may reduce the problem.

Disrespect and Abuse During Facility‐Based Childbirth in North Showa Zone, Ethiopia

“…However, our study demonstrates that 40% of participating women felt ignored/abandoned and 12.9% of women reported healthcare providers were not present when the baby was born. This nding is in line with a study conducted in the southwest of Ethiopia (31). Furthermore, women should be able to have a birth companion of their choice.…”

“…Unfortunately, in this study, 29% of women reported non-digni ed care. Previous studies have documented similar result elsewhere in Ethiopia (21,23,31,33). Non-digni ed care and insults may drive women away from healthcare facilities towards less trained providers who treat them with dignity and respect (40).…”

“…However, this study found that 97.2% of participating women reported non-consented care. This nding is higher than ndings of previous research across all contexts (25,31,42). Best practice is that providers respect the privacy and con dentiality of every childbearing women during counseling, physical examinations, and clinical procedures, as well as in the handling of patients' medical records and other personal information.…”

“…However, two thirds of women who participated in this study had experienced a breach in con dentiality. Studies from other parts of the country have similarly revealed a high level of non-con dential care; common examples include the lack of privacy curtains and women not being appropriately covered during intimate examinations and/or labor and birth (21,23,31).…”

“…Research shows growing evidence of disrespectful and abusive care in Ethiopia (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). Thus, understanding D&A will help inform changes in the practice and culture of maternity care.…”