Abstract
Background
It is increasingly evident that disrespect and abuse of women during facility-based childbirth is a violation of a woman’s rights and a deterrent to the use of life-saving maternity care. Understanding care providers’ perspectives of disrespect and abuse during facility-based childbirth is an essential element to aid in fully comprehending the problem and its underlying complexities.
Objective
To explore care providers’ perspectives of disrespect and abuse during facility-based childbirth.
Methods
This study used a qualitative descriptive design involving fifteen in-depth, semi-structured, interviews conducted between 5 October 2019 and 25 January 2020 in north Showa zone of Oromia region, central Ethiopia. Purposive sampling enabled health care professionals working in maternity units of health facilities who have direct involvement in care of women during pregnancy and labor to be recruited. Thematic analysis using Open Code software was used to explore the perspectives of participants.
Results
Four themes were identified. 1) Disrespect and abuse breaches professional standards, 2) Disrespectful and abusive actions are justified at times to save the mother and her baby, 3) Disrespect and abuse is used as a tool to assert power, and 4) Disrespect and abuse arise from health system deficiencies.
Conclusion
Disrespect and abuse is triggered by underlying beliefs about risk versus care, provider attitudes, stress and burnout, and health service structural issues including a lack of medicines and supplies. A number of strategies could improve the quality of maternity care, including training providers how to manage difficult and complex situations, addressing root causes of disrespect and abuse, and increasing access to resources.
Abbreviations
D&A, Disrespect and Abuse.
Data Sharing Statement
The data that support the findings of this study are available from The University of Adelaide, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of The University of Adelaide.
Ethical Considerations
Ethical approval was obtained from the University of Adelaide human research ethics committee H-2019-153 and Salale University College of health sciences research ethics review committee A/G/H/S/C/768/11. Salale University gave the clearance as the study was conducted in its catchment area. Letter of confirmation was received from the included health facilities that the facilities will not take disciplinary actions on care provider participants based on finding of the study. Participants were informed about research objective, what data will be collected, confidentiality of information, and voluntary nature of participation. In addition, they were informed the time the interview will take and that they reserve a right to withdraw from the study any time and there will be no direct benefit from participation. Also, no information which may identify an individual will be required for the study, and the data will not be used for future research. Data were collected only after informed written consent was obtained. The participants’ informed consent included publication of anonymized responses, and that this study was conducted in accordance with the Declaration of Helsinki.
Acknowledgments
We would like to express our sincere gratitude to the care providers who participated in this study. We would also like to thank Mr. Assegid Negash for his kind support on data analysis.
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 declare that they have no competing interests in this work.