Reducing Disrespect and Abuse of Women During Antenatal Care and Delivery Services at Injibara General Hospital, Northwest Ethiopia: A Pre–Post Interventional Study

Figures & data

Table 1 Log Frame Matrix for Reducing Disrespectful and Abuse of Maternal Care Among Labouring and ANC Follow-Up Mothers at Injibara General Hospital, Northwest Ethiopia, May 2019

Description of the Interventions	OVI	Data Sources	Assumptions
Goal: Improving maternal health care service utilization	Number of Maternal health services utilized (ANC, Delivery, PNC, FP)	DHIS2 reports KPI reports EHSTG report Registrations of maternal health services	If the trained professional stay at the hospital and work as to the standard If all the required equipment, essential drugs, and supplies are sustained
Objective: Reducing disrespectful and abusive maternal care	The proportion of mothers who received respectful maternal care	Respectful maternal care survey checklist
Strategies: Training to health care providers Improving facility infrastructure Strengthening monitoring and evaluation system through supportive supervision and mentorship Establishing motivation mechanisms for high performer employees	Number of healthcare providers who received CRC training Number of RMC trained health worker Availability of waiting room for pregnant and labouring mothers Availability of enough screens or curtain Availability of all the required equipment, essential drugs and supplies for maternal health service provision Number of supportive supervision and mentorship on RMC conducted Number of written feedbacks provided after the mentorship Number of employees selected as best employee of the month/rewarded	HRIS staff training profile Observation and inventory of tangible resources IFRR (Intra facility report and request) form Supportive supervision and mentoring checklists
Activities Communicating and preparing training materials in collaboration with ARHB and UoG Purchasing and prepare the same training materials Providing the training on RMC Preparing written policies and procedures that describe the responsibilities of healthcare providers in the RMC process Prepare and provide a written code of ethics for providers Purchasing equipment, essential drugs and supplies; Develop TOR on regular supportive supervision Perform the regular supportive supervision and mentorship Conduct a discussion with staff and provide written feedbacks after a mentorship Develop TOR on motivation strategies for high-performance employees Motivate high-performer employees on monthly bases.

Abbreviations: ARHB, Amhara Regional Health Bureau; ANC, antenatal care; EHSTG, Ethiopian Hospitals Standards Treatment Guideline; CRC, compassionate respectful and caring; FP, family planning; HMIS, Health Management Information System; KPI, key performance indicators; OPD, outpatient department; OVI, objectively verifiable indicators; PNC, postnatal care; RMC, respectful maternal care; TOR, term of reference; UoG, University of Gondar.

Table 2 Social-Demographic Characteristics of Study Participants at Injibara General Hospital, Northwest Ethiopia, 2019

Variables	Categories	Pre-Intervention (n= 369)	Post-Intervention (n=369)
		n (%)	n (%)
Age in years	Less than 18	6 (1.6)	6 (1.6)
	18–25	179 (48.5)	176 (47.7)
	>25	184 (49.9)	187 (50.7)
Marital status	Married	335 (90.7)	348 (94.3)
	Unmarried	34 (9.3)	21 (5.7)
Monthly income in Ethiopian Birr	Less than 1000	5 (1.4)	7 (1.9)
	1000–3000	307 (83.2)	203 (55)
	Greater than 3000	57 (15.4)	159 (43.1)
Education	Unable to read and write	289 (78.3)	313 (84.8)
	Able to read and write	80 (21.7)	56 (15.2)
Occupation	Housewives	243 (65.8)	287 (77.8)
	Governmental employers	95 (25.7)	23 (6.2)
	Others*	31 (8.4)	59 (16)
Residence	Rural	254 (68.8)	244 (66)
	Urban	115 (31.2)	125 (33.9)
Religion	Orthodox	331 (89.7)	326 (88.3)
	Muslim	30 (8.1)	26 (7)
	Protestants	8 (2.2)	17 (4.7)
Ethnicity	Agew	261 (70.7)	247 (67)
	Amhara	104 (28.2)	108 (29.3)
	Others**	4 (1.1)	14 (3.8)

Notes: *Students, Merchants and Private/daily employers. **Gumuz, Tigray.

Figure 1 Disrespect and abuse of women during labour and ANC services at Injibara general hospital, northwest Ethiopia, 2019.

Table 3 Magnitude of Disrespect and Abuse of Women with Their Respective Categories During Delivery and ANC Services at Injibara General Hospital, Northwest Ethiopia, 2019

Variables	Pre-Intervention	Post-Intervention
	n (/%) *	n (/%) *
Experienced at least one form of D&A	265 (71.8)	59 (15.9)
Physical abuse	225(61.0)	57 (15.4)
The provider (s) physically hit or slapped, pushed, punched, or beat me	212(57.5)	48(13.0)
Health provider verbally insulting during labour/ANC	205(55.6)	49(13.2)
Separation of the mother from the baby without medical Indication	218(59.0)	63(17.0)
Support staffs insult me and my companion	228(62.0)	93(25.2)
Demonstrating the caring culturally inappropriate way	228(62.0)	41(11.1)
Necessary pain-relief treatment is not provided	257(69.6)	41(11.1)
Denied from food or fluid in labour unless Medically necessitated	228(62.0)	64(17.3)
Non‐consented care	258 (72)	63(17.1)
The provider did not introduce themselves to me and my support person	232(63)	66(17.8)
Providers did not encourage me to ask questions	243(66)	67(18.1)
The provider did not respond to my question with politeness	220(59.6)	58(15.7)
The provider did not explain what is being done and what to expect throughout labour, birth and ANC follow up	265(72.0)	56(15.1)
The provider did not give periodic updates on the status and progress of my labour/ANC visits	302(71.8)	58(15.7)
The provider did not permit me to choose of position for birth and ANC examination	286(77.5)	66(17.8)
The provider did not obtain my consent or permission before any procedure.	312(74.6)	69(18.6)
Non-confidential care	293 (79.5)	91(24.7)
Providers did not use drapes or covering to protect my privacy	294(79.7)	100(27.1)
Providers discussed my private health information in a way that others could hear	283(79.4)	82(22.2)
Non-dignified care (including verbal abuse)	288 (78)	90(24.4)
Health providers shouted at or scolded me	278(75.3)	83(22.4)
Health providers made negative comments about me	299(81.0)	70(18.9)
Discrimination care	258 (69.9)	39(10.6)
Providers discriminated me by race, ethnicity and economic status	263(71.2)	43(11.6)
Providers discriminated me because of teenage	253(68.5)	32(8.6)
Abandonment or denial of care	296 (80)	43 (11.6)
Provider ignored me or did not come quickly when I called him/her	292(78.9)	42(11.3)
Provider left me alone or unattended during the second stage of labour	312(84.6)	37(10.0)
No right to timely healthcare and the highest attainable level of health	285 (77.3)	50(13.5)

Note: *Number of respondents who answered “yes” for the questions.

Abbreviations: ANC, antenatal care; D&A, disrespect and abuse.

Table 4 Independent t-test of the Intervention on Disrespect and Abuse of Women with Their Respective Categories During Delivery and ANC Services at Injibara General Hospital, Northwest Ethiopia, 2019

Variables	df	Mean Difference (95% CI)
Physical abuse	736	0.74 (0.67–0.77) *
Non- consent care	736	0.56 (0.48–0.60) *
Non-confidentiality care	736	0.48 (0.42–0.54) *
Non-dignified care	736	0.54 (0.47–0.59) *
Discrimination	736	0.69 (0.63–0.74) *
Abandonment/neglected care	736	0.60(0.55–0.66) *
Over all Disrespectful and abusive care	736	0.56 (0.55–0.57) *

Note: *Statistically significant at p-value <0.0001

Abbreviation: df, degree of freedom (n-2).