Skip to main content
Top
Published in: BMC Pregnancy and Childbirth 1/2024

Open Access 01-12-2024 | Research

Refugee women’s and providers’ perceptions of person-centered maternity care: a qualitative study in two refugee camps in Chad

Authors: Alexis Ngarmbatedjimal, Mahamat Abdelaziz, Vincent de Paul Allambademel, Aminata Diarra, Valentin Djerambete, Thérèse Kodjimadje, Samy Luketa, Robert Madjigoto, Yodé Miangotar, Alladoum Ndingayande, Salomon Tamira, Theodora Varelis, Katchebe Vourbane, Sara E. Casey

Published in: BMC Pregnancy and Childbirth | Issue 1/2024

Login to get access

Abstract

Background

Globally, mistreatment of women during labor and delivery is a common human rights violation. Person-centered maternity care (PCMC), a critical component of quality of care, is respectful and responsive to an individual’s needs and preferences. Factors related to poor PCMC are often exacerbated in humanitarian settings.

Methods

We conducted a qualitative study to understand Sudanese refugee women’s experiences, including their perceptions of quality of care, during labor and delivery at the maternities in two refugee camps in eastern Chad, as well as maternity health workers’ perceptions of PCMC and how they could be better supported to provide this. In-depth interviews were conducted individually with 22 women who delivered in the camp maternities and five trained midwives working in the two maternities; and in six dyads with a total of 11 Sudanese refugee traditional birth attendants and one assistant midwife. In addition, facility assessments were conducted at each maternity to determine their capacity to provide PCMC.

Results

Overall, women reported positive experiences in the camp maternities during labor and delivery. Providers overwhelmingly defined respectful care as patient-centered and respect as being something fundamental to their role as health workers. While very few reported incidents of disrespect between providers and patients in the maternity, resource constraints, including overwork of the providers and overcrowding, resulted in some women feeling neglected.

Conclusions

Despite providers’ commitment to offering person-centered care and women’s generally positive experiences in this study, one of few that explored PCMC in a refugee camp, conflict and displacement exacerbates the conditions that contribute to mistreatment during labor and delivery. Good PCMC requires organizational emphasis and support, including adequate working conditions and ensuring suitable resources so health workers can effectively perform.
Appendix
Available only for authorised users
Footnotes
1
The 7 signal functions of basic EmONC: administer parenteral antibiotics; administer uterotonic drugs; administer parenteral anticonvulsants for pre-eclampsia and eclampsia; manually remove the placenta; remove retained products of conception; perform assisted vaginal delivery; perform basic neonatal resuscitation. (Monitoring Emergency Obstetric Care: A Handbook. Geneva: World Health Organization, 2009).
 
Literature
2.
go back to reference Garry S, Checchi F. Armed conflict and public health: into the 21st century. J Public Health. 2020;42(3):e287–98.CrossRef Garry S, Checchi F. Armed conflict and public health: into the 21st century. J Public Health. 2020;42(3):e287–98.CrossRef
3.
go back to reference Rammohan A, Mavisakalyan A, Vu L, Goli S. Exposure to conflicts and the continuum of maternal healthcare: analyses of pooled cross-sectional data for 452,192 women across 49 countries and 82 surveys. PLOS Med. 2021;18(9):e1003690.CrossRefPubMedPubMedCentral Rammohan A, Mavisakalyan A, Vu L, Goli S. Exposure to conflicts and the continuum of maternal healthcare: analyses of pooled cross-sectional data for 452,192 women across 49 countries and 82 surveys. PLOS Med. 2021;18(9):e1003690.CrossRefPubMedPubMedCentral
4.
go back to reference Jawad M, Hone T, Vamos EP, Cetorelli V, Millett C. Implications of armed conflict for maternal and child health: a regression analysis of data from 181 countries for 2000–2019. PLOS Med. 2021;18(9):e1003810.CrossRefPubMedPubMedCentral Jawad M, Hone T, Vamos EP, Cetorelli V, Millett C. Implications of armed conflict for maternal and child health: a regression analysis of data from 181 countries for 2000–2019. PLOS Med. 2021;18(9):e1003810.CrossRefPubMedPubMedCentral
5.
go back to reference Simonovic D. A human rights-based approach to mistreatment and violence against women in reproductive health services with a focus on childbirth and obstetric violence. Note by the Secretary-General. UN General Assembly; 2019 Jul. Report No.: A/74/137. Available from: https://digitallibrary.un.org/record/3823698?ln=en. Accessed 8 Sept 2023 Simonovic D. A human rights-based approach to mistreatment and violence against women in reproductive health services with a focus on childbirth and obstetric violence. Note by the Secretary-General. UN General Assembly; 2019 Jul. Report No.: A/74/137. Available from: https://​digitallibrary.​un.​org/​record/​3823698?​ln=​en. Accessed 8 Sept 2023
6.
go back to reference Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gülmezoglu AM. Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reprod Health. 2014;19(11):71.CrossRef Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gülmezoglu AM. Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reprod Health. 2014;19(11):71.CrossRef
7.
go back to reference Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLOS Med. 2015;12(6):e1001847.CrossRefPubMedPubMedCentral Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLOS Med. 2015;12(6):e1001847.CrossRefPubMedPubMedCentral
8.
go back to reference Austin J, Guy S, Lee-Jones L, McGinn T, Schlecht J. Reproductive health: a right for refugees and internally displaced persons. Reprod Health Matters. 2008;16:10–21.CrossRefPubMed Austin J, Guy S, Lee-Jones L, McGinn T, Schlecht J. Reproductive health: a right for refugees and internally displaced persons. Reprod Health Matters. 2008;16:10–21.CrossRefPubMed
9.
go back to reference Bashour H, Kharouf M, DeJong J. Childbirth experiences and delivery care during times of war: testimonies of syrian women and doctors. Front Glob Womens Health. 2021;2:38.CrossRef Bashour H, Kharouf M, DeJong J. Childbirth experiences and delivery care during times of war: testimonies of syrian women and doctors. Front Glob Womens Health. 2021;2:38.CrossRef
10.
go back to reference American Geriatrics Society Expert Panel on Person-Centered Care. Person-centered care: a definition and essential elements. J Am Geriatr Soc. 2016;64(1):15–8.CrossRef American Geriatrics Society Expert Panel on Person-Centered Care. Person-centered care: a definition and essential elements. J Am Geriatr Soc. 2016;64(1):15–8.CrossRef
12.
go back to reference Sudhinaraset M, Afulani P, Diamond-Smith N, Bhattacharyya S, Donnay F, Montagu D. Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity [version 1; peer review: 2 approved, 2 approved with reservations]. Vol. 1, Gates Open Research. 2017. https://doi.org/10.12688/gatesopenres.12756.1 Sudhinaraset M, Afulani P, Diamond-Smith N, Bhattacharyya S, Donnay F, Montagu D. Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity [version 1; peer review: 2 approved, 2 approved with reservations]. Vol. 1, Gates Open Research. 2017. https://​doi.​org/​10.​12688/​gatesopenres.​12756.​1
15.
go back to reference Tunçalp Ӧ, Were W, MacLennan C, Oladapo O, Gülmezoglu A, Bahl R, et al. Quality of care for pregnant women and newborns—the WHO vision. BJOG. 2015;122(8):1045–9.CrossRefPubMedPubMedCentral Tunçalp Ӧ, Were W, MacLennan C, Oladapo O, Gülmezoglu A, Bahl R, et al. Quality of care for pregnant women and newborns—the WHO vision. BJOG. 2015;122(8):1045–9.CrossRefPubMedPubMedCentral
16.
go back to reference Sudhinaraset M, Landrian A, Golub GM, Cotter SY, Afulani PA. Person-centered maternity care and postnatal health: associations with maternal and newborn health outcomes. AJOG Glob Rep. 2021;1(1):100005.CrossRefPubMedPubMedCentral Sudhinaraset M, Landrian A, Golub GM, Cotter SY, Afulani PA. Person-centered maternity care and postnatal health: associations with maternal and newborn health outcomes. AJOG Glob Rep. 2021;1(1):100005.CrossRefPubMedPubMedCentral
19.
go back to reference Sacks E, Peca E. Confronting the culture of care: a call to end disrespect, discrimination, and detainment of women and newborns in health facilities everywhere. BMC Pregnancy Childbirth. 2020;20(1):1–4.CrossRef Sacks E, Peca E. Confronting the culture of care: a call to end disrespect, discrimination, and detainment of women and newborns in health facilities everywhere. BMC Pregnancy Childbirth. 2020;20(1):1–4.CrossRef
26.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
27.
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(1):1–17.CrossRef 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(1):1–17.CrossRef
28.
go back to reference Currie S, Natiq L, Anwari Z, Tappis H. Assessing respectful maternity care in a fragile, conflict-affected context: observations from a 2016 national assessment in Afghanistan. Health Care Women Int. 2021;0(0):1–21. Currie S, Natiq L, Anwari Z, Tappis H. Assessing respectful maternity care in a fragile, conflict-affected context: observations from a 2016 national assessment in Afghanistan. Health Care Women Int. 2021;0(0):1–21.
29.
go back to reference Kabakian-Khasholian T, Makhoul J, Ghusayni A. “A person who does not have money does not enter”: a qualitative study on refugee women’s experiences of respectful maternity care. BMC Pregnancy Childbirth. 2022;22(1):748.CrossRefPubMedPubMedCentral Kabakian-Khasholian T, Makhoul J, Ghusayni A. “A person who does not have money does not enter”: a qualitative study on refugee women’s experiences of respectful maternity care. BMC Pregnancy Childbirth. 2022;22(1):748.CrossRefPubMedPubMedCentral
30.
go back to reference Reddy B, Thomas S, Karachiwala B, Sadhu R, Iyer A, Sen G, et al. A scoping review of the impact of organisational factors on providers and related interventions in LMICs: Implications for respectful maternity care. PLOS Glob Public Health. 2022;2(10):e0001134.CrossRefPubMedPubMedCentral Reddy B, Thomas S, Karachiwala B, Sadhu R, Iyer A, Sen G, et al. A scoping review of the impact of organisational factors on providers and related interventions in LMICs: Implications for respectful maternity care. PLOS Glob Public Health. 2022;2(10):e0001134.CrossRefPubMedPubMedCentral
31.
go back to reference Gedif G, Sisay Y, Alebel A, Belay YA. Level of job satisfaction and associated factors among health care professionals working at University of Gondar Referral Hospital, Northwest Ethiopia: a cross-sectional study. BMC Res Notes. 2018;11(1):824.CrossRefPubMedPubMedCentral Gedif G, Sisay Y, Alebel A, Belay YA. Level of job satisfaction and associated factors among health care professionals working at University of Gondar Referral Hospital, Northwest Ethiopia: a cross-sectional study. BMC Res Notes. 2018;11(1):824.CrossRefPubMedPubMedCentral
32.
go back to reference Asima, Farman, Kousar R, Hussain M, Waqas A, Gilani SA. Impact of Job Satisfaction on Quality of Care Among Nurses on the Public Hospital of Lahore, Pakistan. Saudi J Med Pharm Sci. 2017;3:511. Asima, Farman, Kousar R, Hussain M, Waqas A, Gilani SA. Impact of Job Satisfaction on Quality of Care Among Nurses on the Public Hospital of Lahore, Pakistan. Saudi J Med Pharm Sci. 2017;3:511.
33.
go back to reference Yami A, Hamza L, Hassen A, Jira C, Sudhakar M. Job Satisfaction and Its Determinants Among Health Workers in Jimma University Specialized Hospital Southwest Ethiopia. Ethiop J Health Sci. 2011;21(Suppl 1):19–27.PubMedPubMedCentral Yami A, Hamza L, Hassen A, Jira C, Sudhakar M. Job Satisfaction and Its Determinants Among Health Workers in Jimma University Specialized Hospital Southwest Ethiopia. Ethiop J Health Sci. 2011;21(Suppl 1):19–27.PubMedPubMedCentral
34.
go back to reference Kwame A, Petrucka PM. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nurs. 2021;20(1):158.CrossRefPubMedPubMedCentral Kwame A, Petrucka PM. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nurs. 2021;20(1):158.CrossRefPubMedPubMedCentral
35.
go back to reference Madula P, Kalembo FW, Yu H, Kaminga AC. Healthcare provider-patient communication: a qualitative study of women’s perceptions during childbirth. Reprod Health. 2018;15(1):135.CrossRefPubMedPubMedCentral Madula P, Kalembo FW, Yu H, Kaminga AC. Healthcare provider-patient communication: a qualitative study of women’s perceptions during childbirth. Reprod Health. 2018;15(1):135.CrossRefPubMedPubMedCentral
36.
go back to reference Nalwadda G, Namutebi M, Volgsten H. Health care providers’ perceptions of family planning and contraception education for adolescents in Kampala, Uganda – A qualitative study. Sex Reprod Healthc. 2019;1(21):15–20.CrossRef Nalwadda G, Namutebi M, Volgsten H. Health care providers’ perceptions of family planning and contraception education for adolescents in Kampala, Uganda – A qualitative study. Sex Reprod Healthc. 2019;1(21):15–20.CrossRef
37.
go back to reference Casey SE, Gallagher MC, Kakesa J, Kalyanpur A, Muselemu JB, Rafanoharana RV, et al. Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey. PLoS Med. 2020;17(3):e1003086.CrossRefPubMedPubMedCentral Casey SE, Gallagher MC, Kakesa J, Kalyanpur A, Muselemu JB, Rafanoharana RV, et al. Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey. PLoS Med. 2020;17(3):e1003086.CrossRefPubMedPubMedCentral
38.
go back to reference Chandra-Mouli V, Akwara E. Improving access to and use of contraception by adolescents: What progress has been made, what lessons have been learnt, and what are the implications for action? Best Pract Res Clin Obstet Gynaecol. 2020;1(66):107–18.CrossRef Chandra-Mouli V, Akwara E. Improving access to and use of contraception by adolescents: What progress has been made, what lessons have been learnt, and what are the implications for action? Best Pract Res Clin Obstet Gynaecol. 2020;1(66):107–18.CrossRef
39.
go back to reference Bohren MA, Hazfiarini A, Corona MV, Colomar M, Mucio BD, Tunçalp Ö, et al. From global recommendations to (in)action: A scoping review of the coverage of companion of choice for women during labour and birth. PLOS Glob Public Health. 2023;3(2):e0001476.CrossRefPubMedPubMedCentral Bohren MA, Hazfiarini A, Corona MV, Colomar M, Mucio BD, Tunçalp Ö, et al. From global recommendations to (in)action: A scoping review of the coverage of companion of choice for women during labour and birth. PLOS Glob Public Health. 2023;3(2):e0001476.CrossRefPubMedPubMedCentral
40.
go back to reference Wanyenze EW, Byamugisha JK, Tumwesigye NM, Muwanguzi PA, Nalwadda GK. A qualitative exploratory interview study on birth companion support actions for women during childbirth. BMC Pregnancy Childbirth. 2022;22(22):63.CrossRefPubMedPubMedCentral Wanyenze EW, Byamugisha JK, Tumwesigye NM, Muwanguzi PA, Nalwadda GK. A qualitative exploratory interview study on birth companion support actions for women during childbirth. BMC Pregnancy Childbirth. 2022;22(22):63.CrossRefPubMedPubMedCentral
41.
go back to reference Kiti G, Prata N, Afulani PA. Continuous labor support and person-centered maternity care: a cross-sectional study with women in rural Kenya. Matern Child Health J. 2022;26(1):205–16.CrossRefPubMed Kiti G, Prata N, Afulani PA. Continuous labor support and person-centered maternity care: a cross-sectional study with women in rural Kenya. Matern Child Health J. 2022;26(1):205–16.CrossRefPubMed
42.
go back to reference Afulani P, Kusi C, Kirumbi L, Walker D. Companionship during facility-based childbirth: results from a mixed-methods study with recently delivered women and providers in Kenya. BMC Pregnancy Childbirth. 2018;18(1):1–28.CrossRef Afulani P, Kusi C, Kirumbi L, Walker D. Companionship during facility-based childbirth: results from a mixed-methods study with recently delivered women and providers in Kenya. BMC Pregnancy Childbirth. 2018;18(1):1–28.CrossRef
43.
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;1(169):157–70.CrossRef 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;1(169):157–70.CrossRef
44.
go back to reference Sudhinaraset M, Giessler K, Golub G, Afulani P. Providers and women’s perspectives on person-centered maternity care: a mixed methods study in Kenya. Int J Equity Health. 2019;18(1):1–15.CrossRef Sudhinaraset M, Giessler K, Golub G, Afulani P. Providers and women’s perspectives on person-centered maternity care: a mixed methods study in Kenya. Int J Equity Health. 2019;18(1):1–15.CrossRef
45.
go back to reference Mohamed AA, Bocher T, Magan MA, Omar A, Mutai O, Mohamoud SA, et al. Experiences from the field: a qualitative study exploring barriers to maternal and child health service utilization in IDP settings Somalia. Int J Womens Health. 2021;25(13):1147–60.CrossRef Mohamed AA, Bocher T, Magan MA, Omar A, Mutai O, Mohamoud SA, et al. Experiences from the field: a qualitative study exploring barriers to maternal and child health service utilization in IDP settings Somalia. Int J Womens Health. 2021;25(13):1147–60.CrossRef
46.
go back to reference Dzakpasu S, Powell-Jackson T, Campbell OMR. Impact of user fees on maternal health service utilization and related health outcomes: a systematic review. Health Policy Plan. 2014;29(2):137–50.CrossRefPubMed Dzakpasu S, Powell-Jackson T, Campbell OMR. Impact of user fees on maternal health service utilization and related health outcomes: a systematic review. Health Policy Plan. 2014;29(2):137–50.CrossRefPubMed
47.
go back to reference Ramsey K. Systems on the edge: developing organizational theory for the persistence of mistreatment in childbirth. Health Policy Plan. 2022;37(3):400–15.CrossRefPubMed Ramsey K. Systems on the edge: developing organizational theory for the persistence of mistreatment in childbirth. Health Policy Plan. 2022;37(3):400–15.CrossRefPubMed
48.
go back to reference Chaote P, Mwakatundu N, Dominico S, Mputa A, Mbanza A, Metta M, et al. Birth companionship in a government health system: a pilot study in Kigoma, Tanzania. BMC Pregnancy Childbirth. 2021;21(1):304.CrossRefPubMedPubMedCentral Chaote P, Mwakatundu N, Dominico S, Mputa A, Mbanza A, Metta M, et al. Birth companionship in a government health system: a pilot study in Kigoma, Tanzania. BMC Pregnancy Childbirth. 2021;21(1):304.CrossRefPubMedPubMedCentral
49.
go back to reference Khaw SML, Zahroh RI, O’Rourke K, Dearnley RE, Homer C, Bohren MA. Community-based doulas for migrant and refugee women: a mixed-method systematic review and narrative synthesis. BMJ Glob Health. 2022;7(7):e009098.CrossRefPubMedPubMedCentral Khaw SML, Zahroh RI, O’Rourke K, Dearnley RE, Homer C, Bohren MA. Community-based doulas for migrant and refugee women: a mixed-method systematic review and narrative synthesis. BMJ Glob Health. 2022;7(7):e009098.CrossRefPubMedPubMedCentral
Metadata
Title
Refugee women’s and providers’ perceptions of person-centered maternity care: a qualitative study in two refugee camps in Chad
Authors
Alexis Ngarmbatedjimal
Mahamat Abdelaziz
Vincent de Paul Allambademel
Aminata Diarra
Valentin Djerambete
Thérèse Kodjimadje
Samy Luketa
Robert Madjigoto
Yodé Miangotar
Alladoum Ndingayande
Salomon Tamira
Theodora Varelis
Katchebe Vourbane
Sara E. Casey
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2024
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-024-06424-z

Other articles of this Issue 1/2024

BMC Pregnancy and Childbirth 1/2024 Go to the issue