“We are the ones who should make the decision” – knowledge and understanding of the rights-based approach to maternity care among women and healthcare providers

Abstract

Background Experiences and perceptions of poor quality of care is a powerful determinant of utilisation of maternity services. With many reports of disrespect and abuse in healthcare facilities in low-resource settings, women’s and healthcare providers’ understanding and perception of disrespect and abuse are important in eliminating disrespect and abuse, but these are rarely explored together. Methods This was a qualitative study assessing the continuum of maternity care (antenatal, intrapartum and postnatal care) at the Maternity Unit of Bwaila Hospital in Lilongwe, Malawi. Focus group discussions (FGDs) were conducted separately for mothers attending antenatal clinic and those attending postnatal clinic. For women who accessed intrapartum care services, in-depth interviews were used. Participants were recruited purposively. Key informant interviews were conducted with healthcare providers involved in the delivery of maternal and newborn health services. Topic guides were developed based on the seven domains of the Respectful Maternity Care (RMC) Charter. Data was transcribed verbatim, coded and analysed using the thematic framework approach. Results A total of 8 focus group discussions and 9 in-depth interviews involving 64 women and 9 key informant interviews with health care providers were conducted. Important themes that emerged included: the importance of a valued patient-provider relationship as determined by a good attitude and method of communication, the need for more education of women regarding the stages of pregnancy and labour, what happens at each stage and which complications could occur, the importance of a woman’s involvement in decision-making, the need to maintain confidentiality when required and the problem of insufficient human resources. Prompt and timely service was considered a priority. Neither women accessing maternity care nor trained healthcare providers providing this care were aware of the RMC Charter. Conclusions This study has highlighted the most essential aspects of respectful maternity care from the viewpoint of both women accessing maternity care and healthcare providers. Although RMC components are in place, healthcare providers were not aware of them. There is the need to promote the RMC Charter among both women who seek care and healthcare providers. Electronic supplementary material The online version of this article (10.1186/s12884-019-2189-7) contains supplementary material, which is available to authorized users.

Utility of the three-delays model and its potential for supporting a solution-based approach to accessing intrapartum care in low- and middle-income countries. A qualitative evidence synthesis

“…At the facility, women can also play a role if they are aware of the care they should receive. Recent evidence demonstrates that educating women about their health rights constitutes an opportunity for a better childbirth experience [ 66 , 67 ]. This can be achieved through maternity open days [ 67 , 68 ], group ANC [ 55 , 69 ] and community-based initiatives providing a platform whereby women share their experiences and learn from each other about how to prepare for childbirth.…”

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

“…1,22 A participatory collaboration between women and their care practitioners in decision-making about their childbirth experience has proved central to the provision of respectful care. 23,24 Institutional limitations including human and fiscal resources are often conceptually linked with issues in the quality of care provided to women. Downe et al 25 conducted a systematic review of the impact of respectful maternity care policies on reducing rates of disrespect and abuse.…”

Ethical aspects of legal abortion from the viewpoint of pregnant women referring to the forensic medicine center in Iran

“…Tariq and Hackert study argued that, according to electronic transmission and accountability of health insurance, the disclosure of health information to the spouses, parents, legal guardians, and the caregiver involved in the patient care should be allowed without the patient's formal consent [17]. Jolly et al, in their study, obtained essential themes, such as the participation of the woman in decision-making and privacy [18]. In the study of Arab et al, the highest score, from both nurses and patients, was given to the two aspects of patient confidentiality and respect for patients [19].…”