https://orcid.org/0000-0001-5194-8561
Abstract
Purpose
Understanding the contextualized perspectives of stakeholders involved in maternal health care is critical to promoting respectful maternity care. This study explored maternal, provider, institutional, community, and policy level drivers of disrespectful maternity care in Southeast Nigeria. This study also identified multi-stakeholder perspectives on solutions to implementing respectful maternity care in health facilities.
Materials and Methods
This was a mixed-methods cross-sectional study conducted in two urban cities of Ebonyi State, South-eastern Nigeria. Data were collected using semi-structured questionnaires, focus group discussions, and key informant interviews with mothers, providers, senior facility obstetric decision-makers, ministry of health policymaker, and community members. Quantitative data and qualitative data were analysed using SPSS version 20 and manual thematic analysis, respectively.
Results
Maternal level drivers were poor antenatal clinic attendance, uncooperative clients, non-provision of birthing materials, and low awareness of rights. Provider factors included work overload/stress, training gaps, desire for good obstetric outcome, under-remuneration and under-appreciation. Institutional drivers were poor work environments including poorly designed wards for privacy, stressful hospital protocols, and non-provision of work equipment. Community-level drivers were poor female autonomy, empowerment, and normalization of disrespect and abuse during childbirth. The absence of targeted policies and the high cost of maternal health services were identified as policy-related drivers.
Conclusion
A variety of multi-level drivers of disrespectful maternity care were identified. A diverse and inclusive multi-stakeholder approach should underline efforts to mitigate disrespectful maternity care and promote respectful, equitable, and quality maternal health care.
Abbreviations
D&A, Disrespect and Abuse; DACF, Disrespect and Abuse during Childbirth in Health Facilities; FGD, Focus Group Discussion; KII, Key Informant Interview; RMC, Respectful Maternity Care; SPSS, Statistical Package for Social Sciences.
Data Sharing Statement
The datasets used and/or analyzed during the current study are available from the primary author on reasonable request ([email protected]).
Ethical Statement
This study was conducted in accordance with the Declaration of Helsinki and after ethical clearance for this study was obtained from Research and Ethics Committee of Alex-Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria (approval number 06/10/2017-23/20/2017). The participants gave written informed consent before the study commenced. Voluntary participation, confidentiality and anonymity of responses were ensured. To protect the anonymity of the key informants, quotes attributed to the key informants in designated positions (except the husbands) were denoted by self-assigned identification numbers (Key informant 1–5) and not by official designation.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest for this work.