Skip to main content
Top
Published in: Reproductive Health 1/2018

Open Access 01-12-2018 | Research

Barriers and facilitators to humanizing birth care in Tanzania: findings from semi-structured interviews with midwives and obstetricians

Authors: Lilian T. Mselle, Thecla W. Kohi, Justine Dol

Published in: Reproductive Health | Issue 1/2018

Login to get access

Abstract

Background

In Tanzania, the provision of humanized care is increasingly being emphasized in midwifery practice, yet studies regarding perceptions and practices of skilled health personnel towards the humanization of birth care are scare. Previous reviews have identified that abuse and disrespect is not limited to individuals but reflects systematic failures and deeply embedded provider attitudes and beliefs. Therefore, the current study aims to explore the perceptions and practices of skilled health personnel on humanizing birth care in Tanzania by identifying current barriers and facilitators.

Methods

Semi-structured interviews were held with skilled health personnel including midwives (n = 6) and obstetricians (n = 2) working in the two district hospitals of Tanzania. Data were analyzed using thematic coding.

Results

Skilled health personnel identified systematic barriers to providing humanizing birth care. Systematic barriers included lack of space and limited facilities. Institutional norms and practices prohibited family involvement during the birth process,including beliefs that limited choice of birth position as well as disrespected beliefs, traditions, and culture. Participants also acknowledged four facilitators that improve the likelihood of humanized care during childbirth in Tanzania: ongoing education of skilled health personnel on respectful maternal care, institutional norms designed for continuous clinic support during childbirth, belief in the benefit of having family become active participants, and respecting maternal wishes when appropriate.

Conclusion

To move forward with humanizing the birth process in Tanzania, it will be essential that systematic barriers are addressed as well as changing the mindset of personnel towards respectful maternal care. It will be essential for the government and private hospitals to revalue their labour wards to increase the space and staff allocated to each mother to enhance family-integrated care. Additionally, in-service training as well as incorporation of respectful maternal care during pre-service training is key to changing the culture in the labour ward.
Literature
2.
go back to reference Wagner M. Fish can’t see water: the need to humanize birth. Int J Gynecol Obstet. 2001;75:25–37.CrossRef Wagner M. Fish can’t see water: the need to humanize birth. Int J Gynecol Obstet. 2001;75:25–37.CrossRef
4.
go back to reference Behruzi R, Hatem M, Fraser W, Goulet L, Ii M, Misago C, et al. Facilitators and barriers in the humanization of childbirth practice in Japan. BMC Pregnancy Childbirth. 2010;10:25.CrossRefPubMedPubMedCentral Behruzi R, Hatem M, Fraser W, Goulet L, Ii M, Misago C, et al. Facilitators and barriers in the humanization of childbirth practice in Japan. BMC Pregnancy Childbirth. 2010;10:25.CrossRefPubMedPubMedCentral
5.
go back to reference WHO. The prevention and elimination of disrespect and abuse during facility-based childbirth. 2015. WHO. The prevention and elimination of disrespect and abuse during facility-based childbirth. 2015.
6.
go back to reference Koblinsky M, Moyer CA, Calvert C, Campbell J, Campbell OMR, Feigl AB, et al. Quality maternity care for every woman, everywhere: a call to action. Lancet. 2016;388:2307–20.CrossRefPubMed Koblinsky M, Moyer CA, Calvert C, Campbell J, Campbell OMR, Feigl AB, et al. Quality maternity care for every woman, everywhere: a call to action. Lancet. 2016;388:2307–20.CrossRefPubMed
7.
go back to reference Filby A, Mcconville F, Portela A. What prevents quality midwifery care? A systematic mapping of barriers in low and middle income countries from the provider perspective. PLoS One. 2016;11:1–20.CrossRef Filby A, Mcconville F, Portela A. What prevents quality midwifery care? A systematic mapping of barriers in low and middle income countries from the provider perspective. PLoS One. 2016;11:1–20.CrossRef
8.
go back to reference Bradley S, McCourt C, Rayment J, Parmar D. Disrespectful intrapartum care during facility-based delivery in sub-Saharan Africa: a qualitative systematic review and thematic synthesis of women’s perceptions and experiences. Soc Sci Med. 2016;169:157–70.CrossRefPubMed Bradley S, McCourt C, Rayment J, Parmar D. Disrespectful intrapartum care during facility-based delivery in sub-Saharan Africa: a qualitative systematic review and thematic synthesis of women’s perceptions and experiences. Soc Sci Med. 2016;169:157–70.CrossRefPubMed
9.
go back to reference Mannava P, Durrant K, Fisher J, Chersich M, Luchters S. Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review. Glob Health. 2015;11 Mannava P, Durrant K, Fisher J, Chersich M, Luchters S. Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review. Glob Health. 2015;11
10.
go back to reference Ndwiga C, Warren CE, Ritter J, Sripad P, Abuya T. Exploring provider perspectives on respectful maternity care in Kenya: “Work with what you have”. Reprod Health. 2017;14:99.CrossRefPubMedPubMedCentral Ndwiga C, Warren CE, Ritter J, Sripad P, Abuya T. Exploring provider perspectives on respectful maternity care in Kenya: “Work with what you have”. Reprod Health. 2017;14:99.CrossRefPubMedPubMedCentral
11.
go back to reference Burrowes S, Holcombe SJ, Jara D, Carter D, Smith K. Midwives’ and patients’ perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study. BMC Pregnancy Childbirth. 2017;17:263.CrossRefPubMedPubMedCentral Burrowes S, Holcombe SJ, Jara D, Carter D, Smith K. Midwives’ and patients’ perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study. BMC Pregnancy Childbirth. 2017;17:263.CrossRefPubMedPubMedCentral
12.
go back to reference Mselle LT, Moland KM, Mvungi A, Evjen-Olsen B, Kohi TW. Why give birth in health facility? Users’ and providers’ accounts of poor quality of birth care in Tanzania. BMC Health Serv Res. 2013;13:174.CrossRefPubMedPubMedCentral Mselle LT, Moland KM, Mvungi A, Evjen-Olsen B, Kohi TW. Why give birth in health facility? Users’ and providers’ accounts of poor quality of birth care in Tanzania. BMC Health Serv Res. 2013;13:174.CrossRefPubMedPubMedCentral
13.
go back to reference Shimpuku Y, Patil CL, Norr KF, Hill PD. Women’s perceptions of childbirth experience at a Hospital in Rural Tanzania. Heal Care Women Int. 2013;34:461–81.CrossRef Shimpuku Y, Patil CL, Norr KF, Hill PD. Women’s perceptions of childbirth experience at a Hospital in Rural Tanzania. Heal Care Women Int. 2013;34:461–81.CrossRef
14.
go back to reference Kruk ME, Kujawski S, Mbaruku G, Ramsey K, Moyo W, Freedman LP. Disrespectful and abusive treatment during facility delivery in Tanzania: a facility and community survey. Health Policy Plan. 2018;33:e26–33.CrossRefPubMed Kruk ME, Kujawski S, Mbaruku G, Ramsey K, Moyo W, Freedman LP. Disrespectful and abusive treatment during facility delivery in Tanzania: a facility and community survey. Health Policy Plan. 2018;33:e26–33.CrossRefPubMed
15.
go back to reference Ratcliffe HL, Sando D, Lyatuu GW, Emil F, Mwanyika-Sando M, Chalamilla G, et al. Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital. Reprod Health. 2016;13:79.CrossRefPubMedPubMedCentral Ratcliffe HL, Sando D, Lyatuu GW, Emil F, Mwanyika-Sando M, Chalamilla G, et al. Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital. Reprod Health. 2016;13:79.CrossRefPubMedPubMedCentral
16.
go back to reference McMahon S, 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 McMahon S, 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
18.
go back to reference Shimoda K, Horiuchi S, Leshabari S, Shimpuku Y. Midwives’ respect and disrespect of women during facility-based childbirth in urban Tanzania: a qualitative study. Reprod Health. 2018;15:1–13.CrossRef Shimoda K, Horiuchi S, Leshabari S, Shimpuku Y. Midwives’ respect and disrespect of women during facility-based childbirth in urban Tanzania: a qualitative study. Reprod Health. 2018;15:1–13.CrossRef
21.
go back to reference United Nations Population Fund. The state of the world’s midwifery: a universal pathway. Geneva: A women’s right to health; 2014. United Nations Population Fund. The state of the world’s midwifery: a universal pathway. Geneva: A women’s right to health; 2014.
22.
go back to reference Ratcliffe HL, Sando D, Mwanyika-Sando M, Chalamilla G, Langer A, McDonald KP. Applying a participatory approach to the promotion of a culture of respect during childbirth. Reprod Health. 2016;13:80.CrossRefPubMedPubMedCentral Ratcliffe HL, Sando D, Mwanyika-Sando M, Chalamilla G, Langer A, McDonald KP. Applying a participatory approach to the promotion of a culture of respect during childbirth. Reprod Health. 2016;13:80.CrossRefPubMedPubMedCentral
23.
go back to reference National Bureau of Statistics (NBS) and Office of Chief Government Statistician (OCGS). The United Republic of Tanzania. Dar es Salaam: Mortality and Health Report 2015; 2015. National Bureau of Statistics (NBS) and Office of Chief Government Statistician (OCGS). The United Republic of Tanzania. Dar es Salaam: Mortality and Health Report 2015; 2015.
24.
go back to reference Patton M. Qualitative Research & Evaluation Methods. Thousand Oaks: SAGE Publications; 2002. Patton M. Qualitative Research & Evaluation Methods. Thousand Oaks: SAGE Publications; 2002.
25.
go back to reference World Health Organization. Definition of skilled health personnel providing care during childbirth. Geneva: The 2018 joint statement by WHO, UNFPA, UNICEF, ICM, ICN, FIGO and IPA; 2018. World Health Organization. Definition of skilled health personnel providing care during childbirth. Geneva: The 2018 joint statement by WHO, UNFPA, UNICEF, ICM, ICN, FIGO and IPA; 2018.
26.
go back to reference Kvale S. Interviews: an introduction to qualitative research interviewing. Thousand Oaks: SAGE Publications; 1996. Kvale S. Interviews: an introduction to qualitative research interviewing. Thousand Oaks: SAGE Publications; 1996.
27.
go back to reference Minichiello V, Aroni R, Timewell E, Alexander L. In-depth interviewing. 2nd edition. Longman: Pearson Education Australia; 1995. Minichiello V, Aroni R, Timewell E, Alexander L. In-depth interviewing. 2nd edition. Longman: Pearson Education Australia; 1995.
28.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef
29.
go back to reference Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qual Res. 2001;1:385–405.CrossRef Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qual Res. 2001;1:385–405.CrossRef
30.
go back to reference Polit D, Beck C. Nursing research. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. Polit D, Beck C. Nursing research. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.
31.
go back to reference Warren N, Beebe M, Chase RP, Doumbia S, Winch PJ. Nègènègèn: sweet talk, disrespect, and abuse among rural auxiliary midwives in Mali. Midwifery. 2015;31:1073–80.CrossRefPubMed Warren N, Beebe M, Chase RP, Doumbia S, Winch PJ. Nègènègèn: sweet talk, disrespect, and abuse among rural auxiliary midwives in Mali. Midwifery. 2015;31:1073–80.CrossRefPubMed
32.
go back to reference Shakibazadeh E , Namadian M, Bohren MA, Vogel JP, Rashidian A, Nogueira Pileggi V, Madeira S, Leathersich S, Tuncalp Ӧ, Oladapo OT, Souza JP, Guulmezoglu AM. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. BJOG 2018;125: 932–42. Shakibazadeh E , Namadian M, Bohren MA, Vogel JP, Rashidian A, Nogueira Pileggi V, Madeira S, Leathersich S, Tuncalp Ӧ, Oladapo OT, Souza JP, Guulmezoglu AM. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. BJOG 2018;125: 932–42.
33.
go back to reference Kujawski SA, Freedman LP, Ramsey K, Mbaruku G, Mbuyita S, Moyo W, et al. Community and health system intervention to reduce disrespect and abuse during childbirth in Tanga region, Tanzania: a comparative before-and-after study. PLoS Med. 2017;14:1–16.CrossRef Kujawski SA, Freedman LP, Ramsey K, Mbaruku G, Mbuyita S, Moyo W, et al. Community and health system intervention to reduce disrespect and abuse during childbirth in Tanga region, Tanzania: a comparative before-and-after study. PLoS Med. 2017;14:1–16.CrossRef
Metadata
Title
Barriers and facilitators to humanizing birth care in Tanzania: findings from semi-structured interviews with midwives and obstetricians
Authors
Lilian T. Mselle
Thecla W. Kohi
Justine Dol
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2018
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-018-0583-7

Other articles of this Issue 1/2018

Reproductive Health 1/2018 Go to the issue