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Maternal and Child Health Journal
Published in: Maternal and Child Health Journal 10/2015

01-10-2015

Association Between Disrespect and Abuse During Childbirth and Women’s Confidence in Health Facilities in Tanzania

Authors: Stephanie Kujawski, Godfrey Mbaruku, Lynn P. Freedman, Kate Ramsey, Wema Moyo, Margaret E. Kruk

Published in: Maternal and Child Health Journal | Issue 10/2015

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Abstract

Objectives

In Tanzania, maternal mortality is high and coverage with health facility delivery low, despite efforts to reduce barriers to utilization. Disrespect and abuse during childbirth has not been explored as a contributor to delivery satisfaction or as a deterrent to institutional delivery. We assessed the association between reported disrespectful treatment during childbirth and delivery satisfaction, perceived quality of care, and intention to deliver at the same facility in the future.

Methods

Interviews using a structured questionnaire were conducted in Tanga Region, Tanzania with women on discharge from delivery at two hospitals. Disrespect and abuse was measured by asking women about specific disrespectful events during childbirth. Multivariable logistic regression models were used to assess the association between disrespect/abuse and (1) satisfaction with delivery, (2) perceived quality of care for delivery, and (3) intent to use the same facility for a future delivery, controlling for confounders.

Results

1388 women participated in the survey (67 % response rate). Disrespect/abuse during childbirth was associated with lower satisfaction with delivery (OR 0.26, 95 % CI 0.19–0.36) and reduced likelihood of rating perceived quality of care as excellent/very good (OR 0.55, 95 % CI 0.35–0.85). Of women who planned to have more children (N = 766), those who experienced disrespect/abuse were half as likely to plan to deliver again at the same facility (OR 0.51, 95 % CI 0.32–0.82).

Conclusions

Our study highlights disrespectful and abusive treatment during childbirth as an important factor in reducing women’s confidence in health facilities. Improving interpersonal care must be an integral part of quality improvement in maternal health.
Literature
1.
The World Health Organization. (2014) Trends in maternal mortality: 1990–2013. Geneva.
2.
Freedman, L. P., Graham, W. J., Brazier, E., Smith, J. M., Ensor, T., Fauveau, V., et al. (2007). Practical lessons from global safe motherhood initiatives: Time for a new focus on implementation. Lancet, 370(9595), 1383–1391.CrossRefPubMed
3.
Campbell, O. M. R., & Graham, W. J. (2006). Strategies for reducing maternal mortality: Getting on with what works. Lancet, 368(9543), 1284–1299.CrossRefPubMed
4.
Say, L., & Raine, R. (2007). A systematic review of inequalities in the use of maternal health care in developing countries: Examining the scale of the problem and the importance of context. Bulletin of the World Health Organization, 85(10), 812–819.PubMedCentralCrossRefPubMed
5.
Quijada, C., & Comfort, A. (2002). Maternal Health Financing Profile: Tanzania. Bethesda (MD): Abt Associates Inc.
6.
Tanzania National Bureau of Statistics (NBS). (2011) ICF Macro. Tanzania Demographic and Health Survey 2010. Dar es Salaam, Tanzania: NBS and ICF Macro.
7.
Avortri, G. D., Beke, A., & Abekah-Nkrumah, G. (2011). Predictors of satisfaction with child birth services in public hospitals in Ghana. International Journal of Health Care Quality Assurance, 24(3), 223–237.CrossRefPubMed
8.
Wild, K., Barclay, L., Kelly, P., & Martins, N. (2010). Birth choices in Timor-Leste: A framework for understanding the use of maternal health services in low resource settings. Social Science and Medicine, 71(11), 2038–2045.CrossRefPubMed
9.
Lule, G., Tugumisirize, J., & Ndekha, M. (2000). Quality of care and its effects on utilisation of maternity services at health centre level. East African Medical Journal, 77(5), 250–255.PubMed
10.
Audo, M., Ferguson, A., & Njoroge, P. (2005). Quality of health care and its effects in the utilisation of maternal and child health services in Kenya. East African Medical Journal, 82(11), 547–553.PubMed
11.
Tayelgn, A., Zegeye, D. T., & Kebede, Y. (2011). Mothers’ satisfaction with referral hospital delivery service in Amhara Region, Ethiopia. BMC Pregnancy Childbirth, 11(1), 78.PubMedCentralCrossRefPubMed
12.
Sofaer, S., & Firminger, K. (2005). Patient perceptions of the quality of health services. Annual Review of Public Health, 26(35), 513–559.CrossRefPubMed
13.
Shafiei, T., Small, R., & McLachlan, H. (2012). Women’s views and experiences of maternity care: A study of immigrant Afghan women in Melbourne, Australia. Midwifery, 28(2), 198–203.CrossRefPubMed
14.
Bazant, E. S., & Koenig, M. A. (2009). Women’s satisfaction with delivery care in Nairobi’s informal settlements. International Journal for Quality in Health Care, 21(2), 79–86.CrossRefPubMed
15.
Hulton, L. A., Matthews, Z., & Stones, R. W. (2007). Applying a framework for assessing the quality of maternal health services in urban India. Social Science and Medicine, 64(10), 2083–2095.CrossRefPubMed
16.
Larson, E., Hermosilla, S., Kimweri, A., Mbaruku, G. M., & Kruk, M. E. (2014). Determinants of perceived quality of obstetric care in rural Tanzania: A cross-sectional study. BMC Health Services Research, 14, 483.PubMedCentralCrossRefPubMed
17.
Andaleeb, S. S. (2001). Service quality perceptions and patient satisfaction: A study of hospitals in a developing country. Social Science and Medicine, 52(9), 1359–1370.CrossRefPubMed
18.
Atkinson, S., & Haran, D. (2005). Individual and district scale determinants of users’ satisfaction with primary health care in developing countries. Social Science and Medicine, 60(3), 501–513.CrossRefPubMed
19.
Nabbuye-Sekandi, J., Makumbi, F. E., Kasangaki, A., Kizza, I. B., Tugumisirize, J., Nshimye, E., et al. (2011). Patient satisfaction with services in outpatient clinics at Mulago hospital, Uganda. International Journal for Quality in Health Care, 23(5), 516–523.CrossRefPubMed
20.
Aldana, J., Piechulek, H., & Al-Sabir, A. (2001). lient satisfaction and quality of health care in rural Bangladesh. Bulletin of the World Health Organization, 79(6), 512–517.
21.
Kruk, M. E., Paczkowski, M., Mbaruku, G., de Pinho, H., & Galea, S. (2009). Women’s preferences for place of delivery in rural Tanzania: A population-based discrete choice experiment. American Journal of Public Health, 99(9), 1666–1672.PubMedCentralCrossRefPubMed
22.
Otis, K. E., & Brett, J. A. (2008). Barriers to hospital births: Why do many Bolivian women give birth at home? Revista Panamericana de Salud Pública, 24(1), 46–53.CrossRef
23.
Mrisho, M., Schellenberg, J. A., Mushi, A. K., Obrist, B., Mshinda, H., Tanner, M., et al. (2007). Factors affecting home delivery in rural Tanzania. Tropical Medicine and International Health, 12(7), 862–872.CrossRefPubMed
24.
Kruk, M. E., Mbaruku, G., McCord, C. W., Moran, M., Rockers, P. C., & Galea, S. (2009). Bypassing primary care facilities for childbirth: A population-based study in rural Tanzania. Health Policy Planning., 24(4), 279–288.CrossRefPubMed
25.
Kruk, M. E., Hermosilla, S., Larson, E., & Mbaruku, G. M. (2014). Bypassing primary care clinics for childbirth: A cross-sectional study in the Pwani region, United Republic of Tanzania. Bulletin of the World Health Organization, 92(4), 246–253.PubMedCentralCrossRefPubMed
26.
Burroughs, T. E., Davies, A. R., Cira, J. C., & Dunagan, W. C. (1999). Understanding patient willingness to recommend and return: A strategy for prioritizing improvement opportunities. Joint Commission Journal on Quality Improvement, 25(6), 271–287.PubMed
27.
Otani, K., & Waterman, B. (2010). How patient reactions to hospital care attributes affect the evaluation of overall quality of care, willingness to recommend, and willingness to return. Journal of Healthcare Management, 55(1), 25–37.PubMed
28.
Bowser D, Hill K. (2010). Exploring evidence for disrespect and abuse in facility-based childbirth. Report of a landscape analysis. Washington, DC: USAID.
29.
Human Rights Watch. (2011). Stop making excuses: Accountability for maternal health care in South Africa. New York.
30.
Radoff, K. A., Levi, A., & Thompson, L. M. (2012). From home to hospital: Mistreatment of childbearing women and barriers to facility-based birth in nicaragua. International Journal of Childbirth, 2(1), 40–50.CrossRef
31.
Jewkes, R., Abrahams, N., & Mvo, Z. (1998). Why do nurses abuse patients? Reflections from South African obstetric services. Social Science and Medicine, 47(11), 1781–1795.CrossRefPubMed
32.
D’Ambruoso, L., Abbey, M., Hussein, J. (2005). Please understand when I cry out in pain: Women’s accounts of maternity services during labour and delivery in Ghana. BMC Public Health 5(140).
33.
Mselle, L. T., Moland, K. M., Mvungi, A., Evjen-Olsen, B., & Kohi, T. W. (2013). Why give birth in health facility? Users’ and providers’ accounts of poor quality of birth care in Tanzania. BMC Health Services Research, 13, 174.PubMedCentralCrossRefPubMed
34.
Kruk, M. E., Kujawski, S., Mbaruku, G., Ramsey, K., Moyo, W., & Freedman, L. P. (2014). Disrespectful and abusive treatment during facility delivery in Tanzania: A facility and community survey. Health Policy Planning. doi:10.​1093/​heapol/​czu079.PubMed
35.
Filmer, D., & Pritchett, L. (2001). Estimating wealth effects without expenditure data–or tears: An application to educational enrollments in states of India. Demography, 38(1), 115–132.PubMed
36.
Gilson, L. (2003). Trust and the development of health care as a social institution. Social Science and Medicine, 56(7), 1453–1468.CrossRefPubMed
37.
Russell, S. (2005). Treatment-seeking behaviour in urban Sri Lanka: Trusting the state, trusting private providers. Social Science and Medicine, 61(7), 1396–1407.CrossRefPubMed
38.
Senarath, U., Fernando, D. N., & Rodrigo, I. (2006). Factors determining client satisfaction with hospital-based perinatal care in Sri Lanka. Tropical Medicine and International Health, 11(9), 1442–1451.CrossRefPubMed
39.
Hall, J. A., & Dornan, M. C. (1990). Patient sociodemographic characteristics as predictors of satisfaction with medical care: A meta-analysis. Social Science and Medicine, 30(7), 811–818.CrossRefPubMed
40.
Tateke, T., Woldie, M., & Ololo, S. (2012). Determinants of patient satisfaction with outpatient health services at public and private hospitals in Addis Ababa, Ethiopia. African Primary Health Care and Family Medicine, 4(1), 1–11.
41.
Rahmqvist, M., & Bara, A. (2010). Patient characteristics and quality dimensions related to patient satisfaction. International Journal for Quality in Health Care, 22(2), 86–92.CrossRefPubMed
42.
Al-Mandhari, A. S., Hassan, A. A., & Haran, D. (2004). Association between perceived health status and satisfaction with quality of care: Evidence from users of primary health care in Oman. Family Practice, 21(5), 519–527.CrossRefPubMed
43.
Gabrysch, S., & Campbell, O. M. R. (2009). Still too far to walk: Literature review of the determinants of delivery service use. BMC Pregnancy Childbirth., 9, 34.PubMedCentralCrossRefPubMed
Metadata
Title
Association Between Disrespect and Abuse During Childbirth and Women’s Confidence in Health Facilities in Tanzania
Authors
Stephanie Kujawski
Godfrey Mbaruku
Lynn P. Freedman
Kate Ramsey
Wema Moyo
Margaret E. Kruk
Publication date
01-10-2015
Publisher
Springer US
Published in
Maternal and Child Health Journal / Issue 10/2015
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-015-1743-9

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