Direct observation of respectful maternity care in five countries: a cross-sectional study of health facilities in East and Southern Africa - BMC Pregnancy and Childbirth - Vol. 15 - ISBN: 1471-2393 - p.306
Rosen, Heather E.; Lynam, Pamela F.; Carr, Catherine; Reis, Veronica; Ricca, Jim; Bazant, Eva S.; Bartlett, Linda A.
Background Poor quality of care at health facilities is a barrier to pregnant women and their families accessing skilled care. Increasing evidence from low resource countries suggests care women receive during labor and childbirth is sometimes rude, disrespectful, abusive, and not responsive to their needs. However, little is known about how frequently women experience these behaviors. This study is one of the first to report prevalence of respectful maternity care and disrespectful and abusive behavior at facilities in multiple low resource countries.
Methods Structured, standardized clinical observation checklists were used to directly observe quality of care at facilities in five countries: Ethiopia, Kenya, Madagascar, Rwanda, and the United Republic of Tanzania. Respectful care was represented by 10 items describing actions the provider should take to ensure the client was informed and able to make choices about her care, and that her dignity and privacy were respected. For each country, percentage of women receiving these practices and delivery room privacy conditions were calculated. Clinical observers’ open-ended comments were also analyzed to identify examples of disrespect and abuse.
Results A total of 2164 labor and delivery observations were conducted at hospitals and health centers. Encouragingly, women overall were treated with dignity and in a supportive manner by providers, but many women experienced poor interactions with providers and were not well-informed about their care. Both physical and verbal abuse of women were observed during the study. The most frequently mentioned form of disrespect and abuse in the open-ended comments was abandonment and neglect.
Conclusions: Efforts to increase use of facility-based maternity care in low income countries are unlikely to achieve desired gains if there is no improvement in quality of care provided, especially elements of respectful care. This analysis identified insufficient communication and information sharing by providers as well as delays in care and abandonment of laboring women as deficiencies in respectful care. Failure to adopt a patient-centered approach and a lack of health system resources are contributing structural factors. Further research is needed to understand these barriers and develop effective interventions to promote respectful care in this context.
Texto completo (private) :
Méthode: 10 items qui décrivent les actions qui doivent être prises par les soignants de façon à assurer le choix informé, la dignité et la “privacy“ des femmes. + commentaires libres des observateurs
Détail des 10 items observés A l’accueil 1. accueil initial respectueux (“provider greeted the client in a respectful manner“ 2. encourager la femme à avoir un accompagnant (encouraged her to have a support person present) 3. expliquer les interventions avant de les effectuer (explained procedures before proceeding) 4. informer la femme de ce qui se passe / des résultats (informed client of findings) 5. demander si elle a des questions (asked if she had any questions)
Pendant l’accouchement 6. est-ce que le soignant explique à la femme ce qui va se passer (“whether the provider explained what would happen during labor to the client“) 7. encourage à manger/boire (encouraged the client to consume food or fluids) 8. encourage ou aide à se déplacer/prendre des positions différentes (encouraged or assisted the client to ambulate and assume different positions) 9. accompagner avec bienveillance (supported the client in a friendly way) 10. couvrir la femme (draped the client)
Résultats: 2164 accouchements ont été observés. Les femmes sont le plus souvent traitées de façon respectueuse et “supportive“, mais beaucoup d’entre elles font l’expérience de mauvais interactions avec les professionnels, et ne sont pas bien informées sur les soins. Dans les commentaires libres, ce qui revient le plus souvent est l’abandon et la négligence
5 pays à bas revenus, étude qui mesure la prévalence des soins respectueux et des soins non respectueux/maltraitants.
5 low-income countries, a study that measures the prevalence of respectful care and non-respectful care.
5 países de baixa renda, um estudo que mede a prevalência de cuidados respeitosos e cuidados não respeitosos.
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