What price a welcome? Understanding structure agency in the delivery of respectful midwifery care in Uganda

Abstract

Purpose The purpose of this paper is to present the findings of research on mothers and midwives’ understanding of the concept of respectful care in the Ugandan public health settings. It focusses on one aspect of respect; namely communication that is perhaps least resource-dependent. The research found endemic levels of disrespect and tries to understand the reasons behind these organisational cultures and the role that governance could play in improving respect. Design/methodology/approach The study involved a combination of in-depth qualitative interviews with mothers and midwives together with focus groups with a cohort of midwives registered for a degree. Findings The findings highlight an alarming level of verbal abuse and poor communication that both deter women from attending public health facilities and, when they have to attend, reduces their willingness to disclose information about their health status. Respect is a major factor reducing the engagement of those women unable to afford private care, with health facilities in Uganda. Research limitations/implications Access to quality care provided by skilled birth attendants (midwives) is known to be the major factor preventing improvements in maternal mortality and morbidity in low income settings. Although communication lies at the agency end of the structure-agency continuum, important aspects of governance contribute to high levels of disrespect. Originality/value Whilst there is a lot of research on the concept of respectful care in high income settings applying this to the care environment in low resource settings is highly problematic. The findings presented here generate a more contextualised analysis generating important new insights which we hope will improve the quality of care in Uganda health facilities.

Cultural norms create a preference for traditional birth attendants and hinder health facility-based childbirth in Indonesia and Ethiopia: a qualitative inter-country study

“…The findings in Indonesia were in line with previous studies in the country, despite the inclusion of Southwest Sumba, a site not included in previous studies (Belton et al, 2014;Ambaretnani, 2012;Titaley et al, 2010). Likewise, the findings in Ethiopia supported previous studies from the country (Mesfin et al, 2004;Shiferaw et al, 2013;Worku et al, 2013) and other countries in sub-Saharan Africa (Ackers et al, 2018;Kyei-Nimakoh et al, 2017). Our findings add to the literature by demonstrating the collaborative approach between the different CTC maternal health providers within Indonesia and Ethiopia, who took a pragmatic and problem-solving approach to increase health facility-based childbirth whilst adhering to cultural and traditional norms and responding to related beliefs.…”

Respectful maternity care: Disconnect between perspectives and practices of midwives from a referral hospital in Kampala, Uganda.

“…In other cases, participants were rude to patients, and others scolded or shouted at the women. These ndings con rm reports from earlier studies conducted in Uganda [14,28]. Similar instance of poor communication between health providers and women, as well physical abuse, are common occurrences in other African countries [7,23,33,34].…”

“…While Uganda has made signi cant progress in maternal health care, with 73% deliveries occurring in a health facility and 74% birth being attended by a skilled person, there is certainly room for more improvement [26]. Previous studies report that fear of being neglected or maltreated by health workers [27], high level of verbal abuse and poor communication [28] are some of the barriers that deter women from attending public health facilities in Uganda and this negatively impact access to skilled birth attendance. To address these challenges and start the journey to a positive childbirth experience [8] for Ugandan women, it is vital to examine midwives' understanding of RMC.…”

Optimising Student Learning on International Placements in Low Income Settings: The Contribution of Cultural Brokerage

“…Health worker absenteeism and poor attitudes to time-keeping and a desire to "clear the lines" and leave the facility are very typical behaviours. Our own research has evidenced these behaviours from the perspective of Ugandan health workers themselves as indications of a culture of disrespect [33]. On that basis we do not doubt that this situation took place, but it is important that students understand the factors influencing health worker behaviour and what culture means in this context.…”

“…Does this imply that disrespect is a deep-seated aspect of national culture in Uganda? Certainly, this interpretation does not sit alongside students' cited experiences of the very welcoming Ugandan public during their stays [33]. It is very common for students to come away with the sense that Ugandan health workers "didn't really care".…”