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Women’s perceptions of respectful maternity care (RMC) are critical to its definition and measurement globally. We evaluated these in relation to globally defined RMC norms. We conducted a descriptive study involving eight focus group discussions with 50 pregnant women attending antenatal clinic at one primary and one secondary health facility each in the North-west and South-west local government areas of Ibadan Metropolis, Nigeria. One focus group each with primigravidae and multiparas were held per facility between 21 and 25 October 2019. Shakibazadeh et al’s 12 domains of RMC served as the thematic framework for data analysis. The women’s perceptions of RMC resonated well with seven of its domains, emphasising provider-client inter-personal relationships, preserving their dignity, effective communication, and non-abandonment of care, but with mixed perceptions for two domains. However, their perceptions deviated for four domains, namely maintaining privacy and confidentiality; ensuring continuous access to family support such as birth companions; obtaining informed consent; and respecting women’s choices about mobility during labour, food and fluid intake, and birth position. The physical environment was not mentioned as contributing to an experience of RMC. Whilst the perceptions of the Nigerian women studied about RMC were similar to those accepted internationally, there were significant deviations which may be related to cultural differences and societal disparities. Different interpretations of RMC may influence women’s demand for such care in different settings and challenge strategies for promoting a universal standard of care.
This cross-sectional exploratory qualitative study was conducted in Ibadan North-west and South-west local government areas (LGAs) within the Ibadan Metropolis, South-western Region, Nigeria. There are six public primary health care (PHC) facilities and one secondary health facility (SHF) offering maternal and child health services in the North-west LGA, while there are three public primary and three secondary health facilities in the South-west LGA. The PHC facilities send referrals to the SHFs. The South-West LGA is one of the LGAs with the largest slums in the Ibadan Metropolis,15 and the main occupation of the people is trading.16 The North-west LGA is located in the centre of the city and is predominantly urban. The population are artisans and civil servants as well as traders.17 The character of each LGA is reflected in the socio-demographic characteristics of pregnant women accessing the health facilities within it. The two LGAs (Ibadan North-West and South-West) were selected purposively (one predominantly urban and one including more slums, though urban). One secondary and one primary public health facility were selected in each of these two LGAs, giving a total of four health facilities. There was only one public SHF in the North-west LGA; otherwise, both primary and secondary health facilities were selected based on their relatively large volume of clients. The study participants were pregnant women in their first or second trimester who were registered at these health facilities. They were selected by the research assistants with support from the nursing staff who introduced the research assistants and explained the purpose of the research to them. Pregnant women who were not in any form of distress, had completed their antenatal clinic (ANC) routines for the day and were willing to participate were recruited until predetermined quotas for primigravidae and multiparous women, respectively, were reached. Two focus group discussions (FGDs) were conducted per facility, one with six multiparous women (women who have delivered before) and another with six primigravidae (women with their first pregnancy). This gave a total of eight FGDs. Pregnant women who were ill or in any form of discomfort were excluded. The guide explored the women’s perceptions of RMC and how these are commonly demonstrated during childbirth. Probing questions included, “what do you understand by the word respect, and how should this be demonstrated by health providers when you come to deliver?” The FGD guide was translated into Yoruba and back-translated to English. The FGDs were conducted in English or Yoruba depending on the preferred language of each group. Five FGD sessions were conducted in Yoruba. The FGD guide was pretested for length, adequacy and comprehensibility among separate groups of multiparous pregnant women and primigravidae recruited at the ANC of a primary health facility in Ile-Ife, a neighbouring town. Respondents’ socio-demographic data obtained consisted of their age, level of education, occupation, number of pregnancies and deliveries, and their current gestational age. We asked multiparous women if they had ever delivered in that facility, at home, in a church or mosque, or a faith-based organisation (called mission homes). The FGDs were conducted from 21 to 25 October 2019 in a separate and secluded room away from the nurses and other staff within the facility, during one of their regular antenatal clinic days and after all health education activities had been concluded. The health providers introduced the research team to the women. The principal investigator is a Community Health Physician with expertise in conducting qualitative interviews and a deep understanding of the RMC concept. The FGDs lasted about 50 min on average. The researchers involved in the FGDs were all females, which helped to prevent gender and social desirability bias. Interesting responses were probed. All the FGDs were audio-recorded using a digital voice recorder. The audio-recorded discussions were transcribed verbatim. FGDs conducted in Yoruba were translated into English. Thematic content analysis18 was done using the NVIVO 11 software. The transcribed FGDs were imported, initially coded using deductive coding guided by the 12 domains of RMC proposed by Shakibazadeh et al13 as their thematic framework. Afterwards, inductive coding was done for the remaining information not yet coded. Coding was primarily done by the principal investigator, and also by a research assistant whose codes were compared with those of the principal Investigator. Ethical approvals were obtained from the Human Research Ethics Committee (HREC) of the University of the Witwatersrand (clearance Number M190658, 2 October 2019), as well as the Oyo State Ministry of Health (Ref. Number AD/13/479/1386, 31 July 2019). Written informed consent for participating and recording of their voices was obtained from each participant. The researchers had no prior relationship with the pregnant women interviewed. They were introduced as researchers; details about their qualifications and positions were not disclosed, to minimise any power imbalance that could coerce the women into participating. There were no inducements given before participation. A stipend of N=500 (1.4 USD) was given for transportation.
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