Quality of health care (2) Quality of care and respectful care: Intrapartum experiences in Zambia and Tanzania

2 July, 2021

Dear HIFA and HIFA-Zambia colleagues,

CITATION: Lavender T et al. Respectful care an added extra: a grounded theory study exploring intrapartum experiences in Zambia and Tanzania. BMJ Global Health. 6(4), 2021 04. https://gh.bmj.com/content/6/4/e004725


BACKGROUND: Quality of maternal and newborn care is integral to positive clinical, social and psychological outcomes. Respectful care is an important component of this but is suboptimum in many low-income settings. A renewed energy among health professionals and academics is driving an international agenda to eradicate disrespectful health facility care around the globe. However, few studies have explored respectful care from different vantage points.

METHODS: We used Strauss and Corbin's grounded theory methodology to explore intrapartum experiences in Tanzania and Zambia... The process involved application of memos, reflexivity and positionality.

RESULTS: Findings demonstrated that direct and indirect social discrimination led to inequity of care. Health-providers were believed to display manipulative behaviours to orchestrate situations for their own or the woman's benefit, and were often caring against the odds, in challenging environments. Emergent categories were related to the core category: respectful care, an added extra, which reflects the notion that women did not always expect or receive respectful care, and tolerated poor experiences to obtain services believed to benefit them or their babies. Respectful care was not seen as a component of good quality care, but a luxury that only some receive.

CONCLUSION: Both quality of care and respectful care were valued but were not viewed as mutually inclusive. Good quality treatment (transactional care) was often juxtaposed with disrespectful care; with relational care having a lower status among women and healthcare providers. To readdress the balance, respectful care should be a predominant theme in training programmes, policies and audits. Women's and health-provider voices are pivotal to the development of such interventions.

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Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org