Respectful maternity care and associated factors among women who delivered at Harar hospitals, eastern Ethiopia: a cross-sectional study

Abstract

Background: In Ethiopia, approximately three-fourths of mothers do not deliver in health facilities. Disrespect and abuse during childbirth fallouts in underutilization of institutional delivery that upshots maternal morbidity and mortality. Thus, the ambition of this study was to assess respectful maternity care and associated factors in Harar hospitals, Eastern Ethiopia. Methods: A facility-based cross-sectional study was conducted from April 01 to July 01, 2017. A total of 425 women, delivered at Harar town hospitals, were nominated using a systematic random sampling technique. A pretested and organized questionnaire was used to collect the data. After checking for completeness, the data were entered into EpiData version 3.1 and exported to SPSS version 22.0 for cleaning and analyses. Both bivariate and multivariable logistic regression was computed to identify factors associated with respectful maternity care. Statistical significance was declared at a P-value of < 0.05. Results: Data were collected on 425 women. Overall, only 38.4% (95% CI: 33.7, 42.0%) of women received respectful maternity care. Delivering at private hospitals [AOR: 2.3, 95% CI: 1.25, 4.07], having ANC follow-up [AOR: 1.8, 95% CI: 1.10, 3.20], planned pregnancy [AOR: 3.0, 95% CI: 1.24, 7.34], labor attended by male provider [AOR: 1.8, 95% CI: 1.14, 2.77] and normal maternal outcome [AOR: 2.3, 95% CI: 1.13, 4.83] were significantly associated with respectful maternity care. Conclusions: Only four out of ten women received respectful care during labor and delivery. Providing womenfriendly, abusive free, timely and discriminative free care are the bases to improve the uptake of institutional delivery. Execution of respectful care advancement must be the business of all healthcare providers. Furthermore, to come up with a substantial reduction in maternal mortality, great emphasis should be given to make the service woman-centered.

Disrespect and Abuse during Childbirth in Ethiopia: A Systematic Review

“…Physical abuse during childbirth was reported in eighteen of the cross-sectional and qualitative studies [ 14 , 31 – 37 , 39 – 45 , 49 – 51 ] and ranged from 9% to 87.9%. To include, being beaten, slapped, and/or pinched by the health care provider [ 14 , 31 , 33 – 37 , 39 , 41 , 44 , 45 , 48 – 51 ] and care providers used force to push the abdomen down (used fundal pressure) to deliver their babies [ 32 , 40 , 45 ], episiotomy done or perineum sutured without antipain (anesthesia) [ 39 , 43 , 45 ], restrained or tied down during labor [ 36 , 40 ], legs apart harshly and forcefully during labor were reported in 33.8% [ 36 ] and 13.9% [ 50 ] of them, 1.8% faced previous experience of sexual abuse by the caregiver [ 37 ], and a qualitative studies have argued that painful per-vaginal exam have been carried out multiple times without notifying the findings [ 34 , 42 ]; “The caregivers have psychologically wounded us, They have come and did vaginal exams repeatedly as easy as anything but it is a huge trauma to us” [ 42 ].…”

“…They made negative comments and mocking [ 32 , 34 , 44 ] …“Some of them heap scorn on you when you are in labor” [ 34 ]. Unfriendly, unwelcomed, and impolite approaches of health care providers were found in seven of cross-sectional studies [ 14 , 32 , 38 , 43 , 45 , 48 , 51 ]. In a qualitative study done on women who gave birth at home and who had previous experience of facility-based childbirth, one woman stated, “The traditional birth attendants will take care of your feelings; they treat you with sympathy.…”

<p>Respectful Maternity Care and Associated Factors Among Women Who Attended Delivery Services in Referral Hospitals in Northwest Amhara, Ethiopia: A Cross-Sectional Study</p>

“…Respectful care: was measured by four performance standards (friendly care, timely care, discrimination-free care, and abuse-free care). 12 In each performance standard, there were Likert type items to measure each category. During analysis, the responses of “strongly agree” and “agree” were classified as “Yes” (received RMC), and the responses of “strongly disagree”, “disagree” and “neutral” were classified as “No” (disrespected and abused) for positive statements for each standard.…”

<p>Reducing Disrespect and Abuse of Women During Antenatal Care and Delivery Services at Injibara General Hospital, Northwest Ethiopia: A Pre–Post Interventional Study</p>

“…25 Similarly, studies in different parts of Ethiopia on the issue reported a high prevalence, ranging from 36-98.9%. 2,[26][27][28][29][30] Disrespect and abuse are universal maternal health care utilization problems. However, it is unspoken that has been attributed to courtesy bias where women do not tend to report D&A while still in the health facility.…”