Citation, abstract, key messages and a comment from me below.
CITATION: Patience A Afulani, Ann Marie Kelly, Laura Buback, Joseph Asunka, Leah Kirumbi, Audrey Lyndon. Providers’ perceptions of disrespect and abuse during childbirth: a mixed-methods study in Kenya. Health Policy and Planning, , czaa009, https://doi.org/10.1093/heapol/czaa009
ABSTRACT: Disrespect and abuse during childbirth are violations of women’s human rights and an indicator of poor-quality care. Disrespect and abuse during childbirth are widespread, yet data on providers’ perspectives on the topic are limited. We examined providers’ perspectives on the frequency and drivers of disrespect and abuse during facility-based childbirth in a rural county in Kenya. We used data from a mixed-methods study in a rural county in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical) in 2016. Providers were asked structured questions on disrespect and abuse, followed by open-ended questions on why certain behaviours were exhibited (or not). Most providers reported that women were often treated with dignity and respect. However, 53% of providers reported ever observing other providers verbally abuse women and 45% reported doing so themselves. Observation of physical abuse was reported by 37% of providers while 35% reported doing so themselves. Drivers of disrespect and abuse included perceptions of women being difficult, stress and burnout, facility culture and lack of accountability, poor facility infrastructure and lack of medicines and supplies, and provider attitudes. Provider bias, training and women’s empowerment influenced how different women were treated. We conclude that disrespect and abuse are driven by difficult situations in a health system coupled with a facilitating sociocultural environment. Providers resorted to disrespect and abuse as a means of gaining compliance when they were stressed and feeling helpless. Interventions to address disrespect and abuse need to tackle the multiplicity of contributing factors. These should include empowering providers to deal with difficult situations, develop positive coping mechanisms for stress and address their biases. We also need to change the culture in facilities and strengthen the health systems to address the system-level stressors.
- Many maternity providers have witnessed or engaged in disrespect and abuse of women during childbirth.
- Disrespect and abuse are driven by difficult situations in a health system and sociocultural environment that facilitates it. Providers resorted to disrespect and abuse as a means of gaining compliance when they were stressed and feeling helpless.
- Provider implicit biases influence the patient–provider interaction, leading to differential treatment of women during childbirth.
- Interventions to address disrespect and abuse need to tackle the multiplicity of factors that drive and facilitate it. This should include empowering providers to deal with difficult situations as well as changing the culture in facilities and strengthening the health system to address the system-level stressors.
COMMENT (Neil PW): This paper confirms what many of us have been saying on HIFA over the past 2-3 years: Disrespect and abuse of women during childbirth by healthcare providers is likely to be due in large part to the difficult conditions under which many healthcare providers have to work. Part of the solution must lie in improving working conditions. This means that health systems need to be not only patient-centred, but also healthcare-provider-centred.
The HIFA campaign focuses on the Information needs of healthcare providers, but their full range of needs (which HIFA describes by the acronym SEISMIC) must be met to empower healthcare providers to deliver high quality care. http://www.hifa.org/about-hifa/hifa-universal-health-coverage-and-human-...
Best wishes, Neil
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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil AT hifa.org