The prevalence of disrespect and abuse during facility-based maternity care in Malawi: evidence from direct observations of labor and delivery

Abstract

BackgroundThere is increasing evidence throughout the world that the negative treatment of pregnant women during labor and delivery can be a barrier to seeking skilled maternity care. At this time, there has been little quantitative evidence published on disrespect and abuse (D&A) in Malawi. The objective of this research is to describe the prevalence of disrespect and abuse during labor and delivery through the secondary analysis of direct clinical observations and to describe the association between the observation of D&A items with the place of delivery and client background characteristics.MethodsAs part of the evaluation of the Helping Babies Breathe intervention, direct observations of labor and delivery were conducted in August 2013 from 27 out of the 28 districts in Malawi. Frequencies of disrespect and abuse items organized around the Bowser and Hill categories of disrespect and abuse and presented in the White Ribbon Alliance’s Universal Rights of Childbearing Women Framework were calculated. Bivariate analysis was done to assess the association between selected client background characteristics and the place of delivery with the disrespect and use during childbirth.ResultsA total of 2109 observations were made across 40 facilities (12 health centers and 28 hospitals) in Malawi. The results showed that while women were frequently greeted respectfully (13.9% were not), they were often not encouraged to ask the health provider questions (73.1%), were not given privacy (58.2%) and were not encouraged to have a support person present with them (83.2%). Results from the bivariate analysis did not show a consistent relationship between place of delivery and D&A items, where the odds of being shouted at was lower in a health center when compared to a hospital (OR: 0.19; CI: 0.59–0.62) while there was a higher odds of clients not being asked if they have any concerns if they were in a health center when compared to a hospital (OR: 2.40; CI: 1.06–5.44). Women who were HIV+ had significantly lower odds of not having audio and visual privacy (OR: 0.34, CI: 0.12–0.97), of not being asked about her preferred delivery position (OR: 0.17, CI: 0.05–0.65) and of not being asked if she has any other problems she is concerned about (OR 0.38, CI:0.15–0.96).ConclusionThis study is among the first to quantify the prevalence of disrespect and abuse during labor and delivery in Malawi through direct clinical observations. Measurement of the poor treatment of women during childbirth is essential for understanding the scope of the problem and how to address this issue.

Efficacy of companion-integrated childbirth preparation for childbirth fear, self-efficacy, and maternal support in primigravid women in Malawi

“…Nevertheless, studies have reported issues with the misuse of birth companions who mostly provide instrumental support to care providers [20] and underutilization [21] in resource-limited settings. Birth companions rarely accompany a pregnant woman to the labor ward during childbirth but are sometimes allowed into the labor ward to intimidate and force the pregnant woman to cooperate with care providers' demands [22].…”

Respectful maternity care and its related factors in maternal units of public and private hospitals in Tabriz: a sequential explanatory mixed method study protocol

“…In a review article in Iran, Azami et al (2014) found that in nearly 40% of the cases, mothers selected cesarean section because of their fear of NVD [12]. There is also evidence that mothers may not seek maternity care, if they face D&A [13]. The WHO emphasized the important role of RMC in statements entitled "RMC improves lactation" [14] and "recommendations for improving the childbirth experience" [15].…”

The Proportion and Nature of Disrespect and Abuse during facility-based care in a rural and an urban setting in Kano, northwest Nigeria; A mixed-method study

“…D&A can apparently constitute a barrier to facility delivery with its attendant complications, including maternal mortality [7]. Many factors have been identified to contribute to D&A in health facilities such as poor communication between women and healthcare providers; inadequate healthcare policies; prejudices from healthcare providers; and demoralization of healthcare providers in poorly performing health facilities [6,9,10].Although there are variations in prevalence, reports of high prevalence rates of D&A among women during facility birth have been documented in several countries [8,11,12]. For instance, approximately 13-28%women who accessed obstetrics and gynaecology services in Northern Europe experienced some form of abuse in healthcare centres [8].…”