Perceptions and predictors of respectful maternity care in Malawi: A quantitative cross-sectional analysis

listen audio

Study Justification:
The study aimed to investigate how women perceive their experience of maternity care in Malawi. This is important because access to high-quality, respectful care is a basic human right. A lack of respectful care during childbirth can lead to poor outcomes and negatively impact care-seeking behavior and maternal mental health. By understanding women’s perceptions, improvements can be made to ensure that maternity care is respectful and meets the needs of women in Malawi.
Highlights:
– The study surveyed 660 women who delivered in 25 birth facilities in four districts in Malawi.
– The women’s experience of care was assessed using a validated 30-item, 90-point person-centered maternity care (PCMC) scale.
– The mean PCMC score was 57.5, with the lowest score in communication and autonomy.
– Women reported being prohibited from having a birth companion during labor or delivery, providers not introducing themselves, lack of consent before procedures/examinations, inability to ask questions, and not being involved in care decisions.
– Physical and verbal abuse and a lack of basic amenities were rare, while a lack of communication with patients and social support were common.
– Positive associations were found between PCMC score and early antenatal care, male accompaniment to the facility, male provider, and a lack of complications.
Recommendations:
– Strengthen provider communication skills to improve patient-provider interaction and ensure that women feel heard and involved in their care.
– Encourage patient and companion involvement in care to promote a supportive and respectful environment.
– Emphasize the importance of early antenatal care to improve overall maternity care experience.
– Address any barriers that prevent women from having a birth companion during labor and delivery.
– Implement training programs to ensure that providers consistently introduce themselves and obtain consent before procedures/examinations.
Key Role Players:
– Ministry of Health: Responsible for overseeing and implementing improvements in maternity care.
– Health facility administrators: Involved in implementing changes at the facility level.
– Maternity care providers: Responsible for improving their communication skills and ensuring respectful care.
– Community leaders and organizations: Can play a role in promoting awareness and advocating for respectful maternity care.
Cost Items for Planning Recommendations:
– Training programs for providers to improve communication skills.
– Awareness campaigns to educate women and communities about the importance of respectful maternity care.
– Infrastructure improvements to ensure that birth facilities have the necessary amenities.
– Support programs for birth companions to address any financial or logistical barriers.
– Monitoring and evaluation systems to assess the impact of the recommendations and make necessary adjustments.

Objective: Access to high-quality, respectful care is a basic human right. A lack of respectful care during childbirth is associated with poor outcomes and can negatively influence care-seeking and maternal mental health. We aimed to describe how women perceive their experience of maternity care in Malawi. Methods: We implemented a cross-sectional survey of women (n = 660) who delivered in 25 birth facilities in four districts in Malawi in March 2020 using a validated 30-item, 90-point person-centered maternity care (PCMC) scale. We used descriptive statistics to examine women’s experience of care and analyzed bivariable and multivariable mixed-effects models to evaluate predictors of PCMC. Statistical models accounted for clustering of women at the facility level and included maternal age, marital status, education, parity, mother or infant complications, timing of antenatal care (ANC), provider cadre and gender, facility type and sector, and district. Results: Mean PCMC score was 57.5 (range 21-84), with the lowest score (12.4 of 27 points) in communication and autonomy. Women reported: being prohibited from having a birth companion during labor (49.4%) or delivery (60.3%); providers did not introduce themselves (81.1%); providers did not ask consent before procedures/examinations (42.4%); women felt they could not ask questions (40.9%); and were not involved in care decisions (61.5%). Few women reported being frequently abused physically (2%) or verbally (3.5%); almost all had water/electricity available (>95%). In bivariate analyses, statistically significant positive associations were found between PCMC score and early ANC, male accompaniment to the facility, male provider, and a lack of complications; all associations remained at least potentially statistically significant in multivariable modeling. Conclusions: Physical and verbal abuse and a lack of basic amenities were rare, while a lack of communication with patients and social support were common. Maternal characteristics (like timing of ANC and maternal or newborn complications) were predictors of RMC, while facility/system factors, like facility type and sector, were not. Continued efforts to improve respectful care will require strengthening provider communication skills and encouraging patient and companion involvement in care.

Based on the information provided, here are some potential innovations that can be used to improve access to maternal health:

1. Enhancing communication and autonomy: Develop training programs for healthcare providers to improve their communication skills and ensure that they introduce themselves, ask for consent before procedures/examinations, and encourage women to ask questions and be involved in care decisions.

2. Birth companion support: Implement policies that allow women to have a birth companion during labor and delivery, as this has been shown to improve the overall experience of childbirth.

3. Strengthening antenatal care (ANC): Promote early ANC attendance by providing education and awareness campaigns to emphasize the importance of early and regular prenatal care. This can help identify and address any potential complications early on.

4. Male involvement: Encourage male accompaniment to the facility and consider having male healthcare providers available, as this has been associated with higher scores of person-centered maternity care.

5. Facility improvements: Ensure that basic amenities such as water and electricity are consistently available in all birth facilities to provide a safe and comfortable environment for women during childbirth.

6. Provider training and support: Offer ongoing training and support for healthcare providers to improve their understanding of respectful maternity care and to address any biases or discriminatory practices that may exist.

7. Community engagement: Engage with local communities to raise awareness about respectful maternity care and empower women to demand and expect high-quality care during childbirth.

It is important to note that these recommendations are based on the specific findings and context described in the research article. Further research and consultation with experts in the field would be necessary to develop and implement these innovations effectively.
AI Innovations Description
Based on the description provided, the recommendation to develop into an innovation to improve access to maternal health is to focus on improving respectful maternity care (RMC). Here are some steps that can be taken:

1. Training and education: Develop comprehensive training programs for healthcare providers to improve their communication skills and ensure they understand the importance of respectful care. This can include training on introducing themselves, obtaining consent, and involving women in care decisions.

2. Patient empowerment: Implement strategies to empower women and encourage their active participation in their own care. This can be done through educational materials, support groups, and initiatives that promote informed decision-making.

3. Birth companions: Advocate for the presence of birth companions during labor and delivery. This can provide emotional support to women and help them feel more comfortable and empowered during the childbirth process.

4. Facility improvements: Assess the availability of basic amenities in birth facilities and address any deficiencies. This can include ensuring access to water and electricity, as well as maintaining a clean and safe environment.

5. Community engagement: Engage with the community to raise awareness about the importance of respectful maternity care and encourage women to seek care early in their pregnancy. This can be done through community meetings, outreach programs, and partnerships with local organizations.

6. Monitoring and evaluation: Establish mechanisms to monitor and evaluate the implementation of respectful maternity care practices. This can include regular assessments of healthcare facilities, feedback from women, and tracking of key indicators related to maternal health outcomes.

By implementing these recommendations, it is possible to improve access to maternal health by ensuring that women receive high-quality, respectful care during childbirth.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Strengthen provider communication skills: Training healthcare providers in effective communication techniques can improve the overall experience of maternity care. This includes introducing themselves, asking for consent before procedures, and encouraging patients to ask questions.

2. Encourage patient and companion involvement: Promoting patient and companion involvement in care decisions can help empower women and create a more patient-centered approach. Allowing birth companions during labor and delivery can provide emotional support and improve the overall experience.

3. Improve access to basic amenities: While the study found that water and electricity were generally available, ensuring consistent access to these basic amenities in all birth facilities is crucial. This can contribute to a safer and more comfortable environment for women during childbirth.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Gather information on the current state of maternal health access, including factors such as provider communication, patient involvement, and availability of basic amenities. This can be done through surveys, interviews, or existing data sources.

2. Define indicators: Identify specific indicators that can measure the impact of the recommendations. For example, indicators could include the percentage of women reporting positive communication experiences, the percentage of women with birth companions, and the availability of basic amenities in all birth facilities.

3. Introduce interventions: Implement the recommended interventions, such as training healthcare providers in communication skills, promoting patient and companion involvement, and ensuring access to basic amenities. These interventions can be implemented in selected facilities or districts.

4. Data collection post-intervention: After a sufficient period of time, collect data again using the same indicators identified in step 2. This will help assess the impact of the interventions on improving access to maternal health.

5. Analyze and compare data: Compare the data collected before and after the interventions to determine the impact of the recommendations. This can be done through statistical analysis to identify any significant changes in the indicators.

6. Draw conclusions and make recommendations: Based on the analysis, draw conclusions about the effectiveness of the interventions in improving access to maternal health. Identify any gaps or areas that require further improvement. Use the findings to make recommendations for scaling up successful interventions or implementing additional strategies.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions for future interventions.

Partagez ceci :
Facebook
Twitter
LinkedIn
WhatsApp
Email