Compassionate and respectful maternity care during facility based child birth and women’s intent to use maternity service in Bahir Dar, Ethiopia

  • BMC Pregnancy and Childbirth, Volume 18, No. 1, Year 2018

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Study Justification:
– Compassionate and respectful maternity care is crucial for increasing access to skilled maternity care.
– Disrespect and abuse during childbirth is a violation of human rights and a significant barrier to institutional delivery.
Highlights:
– The study was conducted in Bahir Dar, Ethiopia, in public health facilities.
– A total of 284 study participants were included.
– The overall prevalence of respectful maternity care experienced was 57%.
– Factors associated with experiencing disrespect and abuse included living in a rural area, having a caesarian birth, experiencing complications during delivery, and having a future intention to use health facilities.
Recommendations:
– Health facilities should prioritize providing compassionate and respectful maternity care to all women.
– Efforts should be made to address the higher prevalence of disrespect and abuse in rural areas, during caesarian births, and among women with complications.
– Policies and guidelines should be developed and implemented to ensure the rights and dignity of women during childbirth.
Key Role Players:
– Ministry of Health: Responsible for developing and implementing policies and guidelines.
– Health facility administrators: Responsible for ensuring the provision of compassionate and respectful maternity care.
– Health care providers: Responsible for delivering care in a compassionate and respectful manner.
– Community leaders and organizations: Responsible for raising awareness and advocating for respectful maternity care.
Cost Items:
– Training programs for health care providers on compassionate and respectful maternity care.
– Development and dissemination of policies and guidelines.
– Community awareness campaigns.
– Monitoring and evaluation activities to assess the implementation of respectful maternity care practices.
Please note that the cost items provided are general suggestions and may vary depending on the specific context and resources available.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a cross-sectional study, which is appropriate for assessing prevalence and associated factors. The sample size calculation is described, and the response rate is reported. The statistical analysis includes both bivariate and multivariate logistic regression. However, the study is limited to public health facilities in Bahir Dar town, which may limit generalizability. To improve the evidence, future studies could include a larger and more diverse sample, including private health facilities and other regions of Ethiopia.

Background: Compassionate and respectful maternity care is one of the most important facilitating factors to increase access to skilled maternity care. Disrespect and abuse is a violation of human rights and is the main hindering factor preventing skilled birth utilization versus other more commonly recognized deterrents such as financial and geographical obstacles. Methods: Institution based cross-sectional study design was conducted. A structured and pre-tested interviewer administered questionnaire was used to collect the data from 284 study participants. Study participant were selected using a systematic random sampling technique by allocating a proportion to each health facility. The data were entered with Epi data version 3.1statistical software and exported to Statistical Package for Social Sciences version 22.0 for further analysis. Both bivariate and multivariate logistic regression analysis were performed to identify associated factors. P values < 0.05 with 95% confidence level were used to declare statistical significance. Result: A total of 284 respondents participated in the study with a response rate of 100%.The overall prevalence of respectful maternity care experienced was 57%.The multivariable analysis indicated that respondents who live in a rural area [AOR = 6.49(95%CI; 2.59, 16.21)], experience a caesarian birth [AOR = 4.52(95%CI; 1.64, 12.42)], have complications during delivery [AOR = 2.38(95%CI; 1.28, 4.45)] and future intention to use health facility [AOR = 3.57(95%CI; 1.81, 7.07)] were some of the factors associated with experiencing disrespect and abuse. Conclusion: This study showed a high prevalence of disrespect and abuse during facility child birth in Bahir Dar town, Ethiopia as compared to previous literature. Being from rural area, having complications during delivery and mothers who gave birth through caesarian section were more likely to be exposed to disrespect and abuse than other women. Mistreatment of mothers during facility child birth is a health facility failure, a violation of women's rights and a notable barrier for institutional delivery.

This study was conducted in public health facilities in Bahir Dar town. Bahir Dar is located in North Western part of Ethiopia, in Amhara National Regional State, at a distance of 565 km from Addis Ababa. The total population of the town is 290,437of which 142,068 are males and 148,369 are female. In Bahir, Dare town there are 10 public health centers and two public hospitals and two private health institutions. The study was conducted in five public health facilities; four health centers and one referral hospital. Institution based cross-sectional study was conducted from Feb 2- April 26–2017. Mothers who gave birth in Bahir Dar tow health facilities. A single proportion formula was used to estimate the sample size required for the study. The sample size calculation assumed the proportion (p) estimated level of respectful and abuse free maternity care 21.4% [17]. Adding non-response rate of 10% and considering the assumption of 95% confidence level, 5% margin of error the final sample size was 284 mothers. In this study area there are ten public health centers and two public hospitals (one referral hospital and second general hospital). Four public health centers and one referral hospital was randomly selected. The allocation of the sample to health facilities was made proportionally based on the average number of clients who received childbirth services at each facility in the month preceding the data collection period. Felege-Hiwot Referral Hospital 129: Bahir Dar Health center 48: Han Health center 29: Tis-Abay Health center 45 and Shinbut Health center 33. Individual participants in each of the health facilities were selected by systematic random sampling during the data collection period until the required sample size at each health facility was obtained. The sampling interval k = 3 was calculated by dividing the source population to the total sample size and this interval was used in all health facility to select study participants. The first client was selected by simple random sampling among the first three maternity care users in the sampling frame. A universal human right that is due to every childbearing woman in every health system around the world in which the maternity care is expanded beyond the prevention of morbidity or mortality to encompass respect for women’s basic human rights, including respect for women’s autonomy, dignity, feelings, choices, and preferences, such as having a companion wherever possible [18]. The data collection method that was used in this study was face to face interviews using a structured questionnaire. The English version questionnaire was translated into local language Amharic to obtain data from the study participants and to ensure clarity of its content. Then the Amharic version was transcribed back to English version to check for consistency. It was prepared by the principal investigator based on literature reviews, and from Maternal and Child Health Integrated Program (MCHIP) as part of their respectful maternity care tool kit [3]. The questionnaire was designed to obtain information on socio demographic-characteristics and factors associated with disrespect and abuse. The instrument was pretested for its reliability. The content validity of the questionnaire was reviewed by experienced public health professionals. Before actual data collection occurred two day training was provided for data collectors and the supervisor about techniques of data collection and briefed on each questions included in the data collection tool. Pretest was done on 10% (28) of mothers receiving care in a health center that was not included in the study prior to the actual study period. After pre-testing the questionnaire, Cronbatch’s Alpha was calculated by using SPSS window version 22.0 to test internal consistency (reliability) of the item and Cronbatch’s Alpha greater than 0.7 was considered as reliable. Data were collected by trained midwives and nurses. During data collection regular supervision was done by the supervisors. First the collected data were checked manually for completion and any incomplete or misfiled questions. The data were cleaned and stored for consistency, entered into Epi Data version 3.1 software then exported to statistical package for social sciences (SPSS) version 22.0 software for analysis. The accuracy of the data entry was checked by double data entry. Any errors identified during data entry were corrected by reviewing the original completed questionnaire. Descriptive statistics were done and presented using tables and figures. Initially, bivariate logistic regression was carried out to see the association of each of the independent variables with the outcome variable. Thereafter, the multivariable logistic regression method was used. The variables that were not significant in the bivariate logistic regression were not considered in the multiple regression analysis. P- Value of < 0.05 and 95% confidence level was used as a difference of statistical significance. Finally, results were compiled and presented using tables, graphs, and text.

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Based on the information provided, it seems that the study is focused on identifying factors associated with disrespect and abuse during facility-based childbirth in Bahir Dar, Ethiopia. The goal is to improve access to skilled maternity care by addressing this issue. Here are some potential recommendations for innovations to improve access to maternal health based on the study:

1. Training and education programs: Develop comprehensive training programs for healthcare providers to promote compassionate and respectful maternity care. This can include modules on communication skills, empathy, and human rights.

2. Quality improvement initiatives: Implement quality improvement initiatives in health facilities to ensure that respectful maternity care is prioritized. This can involve regular monitoring and evaluation of healthcare provider behavior, feedback mechanisms for patients, and accountability mechanisms for addressing disrespectful and abusive practices.

3. Community engagement: Engage the community in promoting respectful maternity care and raising awareness about women’s rights during childbirth. This can be done through community dialogues, education campaigns, and involving community leaders and influencers in advocating for respectful maternity care.

4. Strengthening referral systems: Improve the referral systems between health centers and hospitals to ensure that women with complications during delivery are promptly and safely transferred to higher-level facilities. This can involve training healthcare providers on referral protocols, improving communication channels between facilities, and providing necessary resources for transportation.

5. Empowering women: Empower women to assert their rights and make informed decisions about their maternity care. This can be done through antenatal education programs, providing information on women’s rights during childbirth, and promoting shared decision-making between healthcare providers and women.

It’s important to note that these recommendations are based on the information provided and may need to be further tailored to the specific context and needs of Bahir Dar, Ethiopia.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health would be to prioritize and implement compassionate and respectful maternity care in health facilities. This recommendation is based on the finding that disrespect and abuse during facility childbirth is a significant barrier to skilled birth utilization.

To implement this recommendation, the following steps can be taken:

1. Training and education: Health care providers should receive training on compassionate and respectful maternity care, including the importance of treating women with dignity, respect, and empathy during childbirth. This training should focus on communication skills, cultural sensitivity, and understanding women’s rights.

2. Policy development and enforcement: Health facilities should develop and enforce policies that promote compassionate and respectful maternity care. These policies should clearly outline the expected behavior of health care providers and the consequences for any violations. Regular monitoring and evaluation should be conducted to ensure compliance.

3. Community engagement: Community members, including women and their families, should be engaged in discussions and awareness campaigns about the importance of compassionate and respectful maternity care. This can help create a supportive environment and encourage women to seek skilled maternity care.

4. Quality improvement initiatives: Health facilities should implement quality improvement initiatives to address any gaps in compassionate and respectful maternity care. This can include regular feedback mechanisms, such as suggestion boxes or surveys, to gather feedback from women about their experiences. The feedback should be used to identify areas for improvement and implement necessary changes.

5. Collaboration and partnerships: Collaboration between health facilities, government agencies, non-governmental organizations, and other stakeholders is crucial to ensure the successful implementation of compassionate and respectful maternity care. Partnerships can help mobilize resources, share best practices, and advocate for policy changes.

By implementing these recommendations, it is expected that access to maternal health will be improved as women will feel more comfortable and empowered to seek skilled maternity care.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Strengthening health facility infrastructure: Investing in the improvement of health facility infrastructure, including the availability of clean and well-equipped delivery rooms, can help create a conducive environment for safe and respectful maternity care.

2. Enhancing healthcare provider training: Providing comprehensive training to healthcare providers on compassionate and respectful maternity care can help ensure that women receive quality care that respects their rights and preferences.

3. Promoting community awareness and education: Conducting awareness campaigns and educational programs in the community can help increase knowledge about the importance of skilled maternity care and encourage women to seek care from health facilities.

4. Addressing financial barriers: Implementing strategies to reduce financial barriers, such as providing subsidies or health insurance coverage for maternal health services, can help improve access for women who may face financial constraints.

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

1. Define the indicators: Identify specific indicators that can measure access to maternal health, such as the percentage of women receiving skilled maternity care, the percentage of women experiencing respectful care, or the percentage of women delivering in health facilities.

2. Collect baseline data: Gather data on the current status of the indicators in the target population or area. This can be done through surveys, interviews, or existing data sources.

3. Introduce the recommendations: Implement the recommended interventions or strategies in the target population or area. This may involve training healthcare providers, conducting community awareness campaigns, or implementing financial support programs.

4. Monitor and collect data: Continuously collect data on the indicators after the implementation of the recommendations. This can be done through follow-up surveys, interviews, or monitoring systems.

5. Analyze the data: Compare the baseline data with the post-intervention data to assess the impact of the recommendations on the indicators. Statistical analysis, such as bivariate and multivariate regression analysis, can be used to identify associated factors and measure the significance of the changes.

6. Evaluate and adjust: Evaluate the effectiveness of the recommendations and make adjustments as needed. This may involve refining the interventions, addressing any challenges or barriers, and scaling up successful strategies.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and identify effective strategies for implementation.


Statistics:
Citations: 45
Identifiers:
DOI: 10.1186/s12884-018-1909-8
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Workforce
Study Countries:
Ethiopia
Study Design:
Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Female
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