Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC International Health and Human Rights
Published in: BMC International Health and Human Rights 1/2016

Open Access 01-12-2016 | Research article

Maternity care and Human Rights: what do women think?

Authors: Andrea Solnes Miltenburg, Fleur Lambermon, Cees Hamelink, Tarek Meguid

Published in: BMC International Health and Human Rights | Issue 1/2016

Login to get access

Abstract

Background

A human rights approach to maternal health is considered as a useful framework in international efforts to reduce maternal mortality. Although fundamental human rights principles are incorporated into legal and medical frameworks, human rights have to be translated into measurable actions and outcomes. So far, their substantive applications remain unclear. The aim of this study is to explore women’s perspectives and experiences of maternal health services through a human rights perspective in Magu District, Tanzania.

Methods

This study is a qualitative exploration of perspectives and experiences of women regarding maternity services in government health facilities. The point of departure is a Human Rights perspective. A total of 36 semi-structured interviews were held with 17 women, between the age of 31 and 63, supplemented with one focus group discussion of a selection of the interviewed women, in three rural villages and the town centre in Magu District. Data analysis was performed using a coding scheme based on four human rights principles: dignity, autonomy, equality and safety.

Results

Women’s experiences of maternal health services reflect several sub-standard care factors relating to violations of multiple human rights principles. Women were aware that substandard care was present and described a range of ways how the services could be delivered that would venerate human rights principles. Prominent themes included: ‘being treated well and equal’, ‘being respected’ and ‘being given the appropriate information and medical treatment’.

Conclusion

Women in this rural Tanzanian setting are aware that their experiences of maternity care reflect violations of their basic rights and are able to voice what basic human rights principles mean to them as well as their desired applications in maternal health service provision.
Appendix
Available only for authorised users
Literature
1.
Raven JH, Tolhurst RJ, Tang S, van den Broek N. What is quality in maternal and neonatal health care? Midwifery. 2011;28:1–8.
2.
Bowser D, Hill K. Exploring Evidence for Disrespect and Abuse in Facility based Childbirth. Report of a Landscape analysis. USAID-TRAction Project. Harvard School of Public Health: University Research Co., LLC; 2010.
3.
Langer A, Villar J, Romero M, Nigenda G, Piaggio G, Kuchaisit C, et al. Are women and providers satisfied with antenatal care? Views on a standard and a simplified, evidence-based model of care in four developing countries. BMC Womens Health. 2002;2:7.CrossRefPubMedPubMedCentral
4.
D’Ambruoso L, Abbey M, Hussein J. Please understand when I cry out in pain: women’s accounts of maternity services during labour and delivery in Ghana. BMC Public Health. 2005;5:140.CrossRefPubMedPubMedCentral
5.
Yakong VN, Rush KL, Bassett-Smith J, Bottorff JL, Robinson C. Women’s experiences of seeking reproductive health care in rural Ghana: Challenges for maternal health service utilization. J Adv Nurs. 2010;66:2431–41.CrossRefPubMed
6.
Kumbani LC, Chirwa E, Malata A, Odland JO, Bjune G. Do Malawian women critically assess the quality of care? A qualitative study on women’s perceptions of perinatal care at a district hospital in Malawi. Reprod Health. 2012;9:30.CrossRefPubMedPubMedCentral
7.
Mathole T, Lindmark G, Majoko F, Ahlberg BM. A qualitative study of women’s perspectives of antenatal care in a rural area of Zimbabwe. Midwifery. 2004;20:122–32.CrossRefPubMed
8.
Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, et al. Factors affecting home delivery in rural Tanzania. Trop Med Int Heal. 2007;12:862–72.CrossRef
9.
Donabedian A. The quality of care. How can it be assessed? J Am Med Assoc. 1988;260:1743–8.CrossRef
10.
11.
Rosen HE, Lynam PF, Carr C, Reis V, Ricca J, Bazant ES. Direct observation of respectful maternity care in five countries : a cross-sectional study of health facilities in East and Southern Africa. BMC Pregnancy Childbirth. 2015;306:1–11.
12.
Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Diniz A, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-Methods systematic review. PLOS Medicine. 2015;1:1–32.
13.
Freedman LP. Using human rights in maternal mortality programs: from analysis to strategy. Int J Gynaecol Obstet. 2001;75:51–60.CrossRefPubMed
14.
Meguid T. (Re)Humanising Health Care – placing dignity and agency of the patient at the centre. Nord J Hum Rights. 2016;34:60–4.CrossRef
15.
16.
Cook RJ, Dickens BM, Fathalla MF. Reproductive health and human rights. Integrating medicine, ethics, and law. New York: Oxford University Press Inc; 2003.
17.
Mann J. Dignity and health: The UDHR’s revolutionary first article. Health Hum Rights. 1998;3:30–8.CrossRefPubMed
18.
Meguid T. Notes on the rights of a poor woman in a poor country. Health Hum Rights. 2008;10:105–8.CrossRefPubMed
19.
Hamelink CJ. Human Rights: The implementation gap. J Int Commun. 1998;5:54–74.CrossRef
20.
Yamin AE. Suffering and powerlessness: the significance of promoting participation in rights-based approaches to health. Health and Human Rights Journal. 2009;11:5–22.CrossRef
21.
Freedman LP, Ramsey K, Abuya T, Bellows B, Ndwiga C, Warren C, et al. Defining disrespect and abuse of women in childbirth: A research, policy and rights agenda. Bull World Health Organ. 2014;92:915–7.CrossRefPubMedPubMedCentral
22.
Kruk ME, Paczkowski M, Mbaruku G, De Pinho H, Galea S. Women’s preferences for place of delivery in rural Tanzania: A population-based discrete choice experiment. Am J Public Health. 2009;99:1666–72.CrossRefPubMedPubMedCentral
23.
Muula AS. Will health rights solve Malawi’s health problems? Croat Med J. 2005;46:853–9.PubMed
24.
25.
van Gennip IE, Pasman HRW, Oosterveld-Vlug MG, Willems DL, Onwuteaka-Philipsen BD. The development of a model of dignity in illness based on qualitative interviews with seriously ill patients. Int J Nurs Stud. 2013;50:1080–9.CrossRefPubMed
26.
27.
Leget C. Analyzing dignity: A perspective from the ethics of care. Med Heal Care Philos. 2013;16:945–52.CrossRef
28.
Mann JM, Gostin L, Gruskin S, Brennan T, Lazzarini Z, Fineberg HV. Health and human rights. Health Hum Rights. 1994;1:6–23.CrossRefPubMed
29.
Freedman L. Using human rights in maternal mortality programs: from analysis to strategy. Int J Obstet Gynaecol. 2001;75:51–60.CrossRef
30.
Chochinov HM, Hack T, McClement S, Kristjanson L, Harlos M. Dignity in the terminally ill: A developing empirical model. Soc Sci Med. 2002;54:433–43.CrossRefPubMed
31.
Torres WJ, Bergner RM. Humiliation: its nature and consequences. J Am Acad Psychiatry Law. 2010;38:195–204.PubMed
32.
Randers I, Mattiasson AC. Autonomy and integrity: Upholding older adult patients’ dignity. J Adv Nurs. 2004;45:63–71.CrossRefPubMed
33.
Delmar C, Alenius-Karlsson N, Mikkelsen AH. The implications of autonomy: Viewed in the light of efforts to uphold patients dignity and integrity. Int J Qual Stud Health Well-being. 2011;6:1–9.CrossRef
34.
Vernooij-Dassen MJFJ, Osse BHP, Schadé E, Grol RPTM. Patient autonomy problems in palliative care: systematic development and evaluation of a questionnaire. J Pain Symptom Manage. 2005;30:264–70.CrossRefPubMed
35.
Will JF. A brief historical and theoretical perspective on patient autonomy and medical decision making: Part II: The autonomy model. Chest. 2011;139:1491–7.CrossRefPubMed
36.
37.
Stevenson A. Oxford dictionary of English. 3rd ed. Oxford: Oxford University Press; 2015
38.
Meguid T. The challenge of the periphery. Cape Town & Windhoek: Harps; 2001.
39.
Macnaughton G. Untangling equality and non-discrimination to promote the right to health care for all. Health and Human Rights. 2009;11:47–64.PubMed
40.
Burns JK. Mental Health and Inequality: a human rights approach to inequality, discrimination, and mental disability. Health and Human Rights. 2009;11:19–31.PubMed
41.
42.
Cook RJ. Human rights law and safe motherhood. Eur J Heal Law. 1998;5:357–75.CrossRef
43.
Donnely J. Universal human rights in theory and practice. 2nd ed. New York: Cornell University Press; 2003.
44.
Galadanci HS. Protecting patient safety in resource-poor settings. Best Pract Res Clin Obstet Gynaecol. 2013;27:497–508.CrossRefPubMed
45.
Irurita VF. Factors affecting the quality of nursing care: the patient’s perspective. Int J Nurs Pract. 1999;5:86–94.CrossRefPubMed
46.
Jha AK, Prasopa-Plaizier N, Larizgoitia I, Bates DW, Research Priority Setting Working Group of the WHO World Alliance for Patient Safety. Patient safety research: an overview of the global evidence. Qual Saf Health Care. 2010;19:42–7.CrossRefPubMed
47.
Cohen J, Ezer T. Human rights in patient care: a theoretical and practical framework. Health Hum Rights. 2013;15:7–19.PubMed
48.
Wijssen F, Tanner R. I am Just a Sukuma: globalization and identity construction in Northwest Tanzania. Amsterdam: Rodopi Bv Editions; 2002.
49.
McMahon S a, George AS, Chebet JJ, Mosha IH, Mpembeni RN, Winch PJ. Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania. BMC Pregnancy Childbirth. 2014;14:268.CrossRefPubMedPubMedCentral
50.
Kruger L, Schoombee C. The other side of caring: abuse in a South African maternity ward. J Reprod Infant Psychol. 2010;28:84–101.CrossRef
51.
WHO. The Right to Health. Factsheet no 323. Geneva: WHO; 2007. Accessed 10th of Dec 2015.
52.
Kabakian-Khasholian T, Campbell O, Shediac-Rizkallah M, Ghorayeb F. Women’s experiences of maternity care: Satisfaction or passivity? Soc Sci Med. 2000;51:103–13.CrossRefPubMed
53.
Kujawski S, Mbaruku G, Freedman LP, Ramsey K, Moyo W, Kruk ME. Association between disrespect and abuse during childbirth and women’s confidence in health facilities in Tanzania. Matern Child Health J. 2015;19:2243–50.CrossRefPubMed
54.
Baillie L. Patient dignity in an acute hospital setting: A case study. Int J Nurs Stud. 2009;46:22–36.CrossRef
55.
Brown H. “If we sympathise with them, they’ll relax” Fear/respect and medical care in a Kenyan hospital. Med Antropol. 2010;22:125–42.
56.
Roth Allen D. Managing motherhood, managing risk: fertility and danger in west central Tanzania. Ann Arbor: University of Michigan; 2004.
57.
Amoakohene MI. Violence against women in Ghana: A look at women’s perceptions and review of policy and social responses. Soc Sci Med. 2004;59:2373–85.CrossRefPubMed
58.
Cialdini R, Kallgren C, Reno R. A focus theory of normative conduct: a theoretical refinement and reevaluation of the role of norms in humam behavior. Adv Exp Soc Psychol. 1991;24:201–34.CrossRef
59.
Miller S, Lalonde A. The global epidemic of abuse and disrespect during childbirth: History, evidence, interventions, and FIGO’s mother-baby friendly birthing facilities initiative. Int J Gynecol Obstet. 2015;131:S49–52.CrossRef
60.
Freedman LP, Kruk ME. Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas. Lancet. 2014;6736:1–2.
61.
Spangler S a. Assessing skilled birth attendants and emergency obstetric care in rural Tanzania: the inadequacy of using global standards and indicators to measure local realities. Reprod Health Matters. 2012;20:133–41.CrossRefPubMed
62.
Erdman JN. Commentary bioethics, human rights, and childbirth. Heal Hum Rights J. 2015;17:43–51.CrossRef
Metadata
Title
Maternity care and Human Rights: what do women think?
Authors
Andrea Solnes Miltenburg
Fleur Lambermon
Cees Hamelink
Tarek Meguid
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC International Health and Human Rights / Issue 1/2016
Electronic ISSN: 1472-698X
DOI
https://doi.org/10.1186/s12914-016-0091-1

Other articles of this Issue 1/2016

BMC International Health and Human Rights 1/2016 Go to the issue

Research article

Risk factors associated with the practice of child marriage among Roma girls in Serbia

Research article

Intimate partner violence as seen in post-conflict eastern Uganda: prevalence, risk factors and mental health consequences

Research article

Legal knowledge, needs, and assistance seeking among HIV positive and negative women in Umlazi, South Africa

Research article

Sex trafficking and sexual exploitation in settings affected by armed conflicts in Africa, Asia and the Middle East: systematic review

Research article

Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review

Research article

Diabetes self-management among Arab Americans: patient and provider perspectives