Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care

Abstract

Despite global attention, physical and verbal abuse remains prevalent in maternity and newborn healthcare. We aimed to establish theoretical principles for interventions to reduce such abuse. We undertook a mixed methods systematic review of health and social care literature (MEDLINE, SocINDEX, Global Index Medicus, CINAHL, Cochrane Library, Sept 29th 2020 and March 22nd 2022: no date or language restrictions). Papers that included theory were analysed narratively. Those with suitable outcome measures were meta-analysed. We used convergence results synthesis to integrate findings. In September 2020, 193 papers were retained (17,628 hits). 154 provided theoretical explanations; 38 were controlled studies. The update generated 39 studies (2695 hits), plus five from reference lists (12 controlled studies). A wide range of explicit and implicit theories were proposed. Eleven non-maternity controlled studies could be meta-analysed, but only for physical restraint, showing little intervention effect. Most interventions were multi-component. Synthesis suggests that a combination of systems level and behavioural change models might be effective. The maternity intervention studies could all be mapped to this approach. Two particular adverse contexts emerged; social normalisation of violence across the socio-ecological system, especially for ‘othered’ groups; and the belief that mistreatment is necessary to minimise clinical harm. The ethos and therefore the expression of mistreatment at each level of the system is moderated by the individuals who enact the system, through what they feel they can control, what is socially normal, and what benefits them in that context. Interventions to reduce verbal and physical abuse in maternity care should be locally tailored, and informed by theories encompassing all socio-ecological levels, and the psychological and emotional responses of individuals working within them. Attention should be paid to social normalisation of violence against ‘othered’ groups, and to the belief that intrapartum maternal mistreatment can optimise safe outcomes.

A multi-component intervention to reduce bias during family planning visits: qualitative insights on implementation from Burkina Faso, Pakistan and Tanzania

“…These results also indicate that outer setting factors – health system, communities and context – may also affect scalability. Interventions attending to multiple levels of the socioecological model have larger impact [ 33 – 35 ]. It is impossible for all programs to address all constraints, however, so implementers should carefully consider which contextual factors may be most essential to “bundle” with behavior change interventions in order to see maximum impact.…”

Adoption of policies to improve respectful maternity care in Timor-Leste

“…In addition to policy guidance, calls for improvements in training and supportive supervision are echoed across existing literature [2,8,21,[28][29][30][31]. Training should include confronting the normalisation of violence against women within families and across systems, the belief that mistreatment is necessary to minimise clinical harm, reflection on our own psychological and emotional responses in various scenarios [32] and strategies that encouraged introspection and cultural humility [33].…”

When addressing resources is not enough: lessons learned from a respectful maternal and neonatal care provider training intervention evaluation in Kenya and Tanzania

“…In addition to the WHO guidelines, a recently released series of five papers explored in depth the complex myriad of contributing factors and proposed a range of high-level strategies to end childbirth mistreatment and improve respectful care [ 15 – 19 ]. The identification of the contributing factors to childbirth abuse opens the door to effective interventions at all healthcare levels.…”