Ethical aspects of obstetric care: expectations and experiences of patients in South East Nigeria

Figures & data

Table 1 The demographic and obstetric characteristics of respondents

Characteristic	Frequency	Percentage
Age (years)
10–20	16	1.4
21–30	696	62.6
31–40	390	35.1
41–50	10	0.9
Occupational group
Unemployed/students	416	37.4
Low-skilled/crafts/traders	136	12.2
Civil servants (nonprofessional)	440	39.6
Middle-level professionals (nurses, laboratory scientists, etc)	80	7.2
Upper-level professionals	40	3.6
Educational status
No formal education	16	1.4
Primary education	16	1.4
Secondary education	440	39.6
Tertiary or post-tertiary education	640	57.6
Religion
Christian	1,104	99.3
Roman Catholic	680	61.2
Non-Catholic	432	38.8
Non-Christian	8	0.7
Tribe
Igbo	1,064	95.7
Non-Igbo	48	4.3
Residence
Urban	920	82.7
Rural	192	17.3
Parity
Primipara	408	36.7
Multipara	656	59.0
Grand multipara	48	4.3
Route of delivery
Vaginal	960	86.3
Abdominal	152	13.7

Table 2 The comparison of the numbers of patients who expected compliance with ethical principles by their doctors

Ethical conduct	Number of patients (n = 1,112)
	Those who expected (%)	Those who did not expect (%)
Provision of adequate privacy	912 (82.0)	200 (18.0)
Provision of information on diagnosis and the options of management available based on current evidence	872 (78.6)	240 (21.4)
Seeking patient’s opinion and consent on options in the investigation or treatment to be undertaken	848 (76.3)	264 (23.7)
Regular and punctual attendance at clinics by doctors	1,109 (99.7)	3 (0.3)
Fairness in the order of attendance to patients (“first come, first seen,” except for medical emergencies)	1,102 (99.1)	10 (0.9)
Consideration of the ability of patients to pay for drugs or services, by exploring options based on necessity, efficacy, and cost	996 (89.6)	116 (10.4)
Respecting patient’s feelings, including religious beliefs of patients during clinical evaluation and when recommending management options	616 (55.4)	498 (44.6)

Table 3 Results of the binary logistic regression for predicting the expectation of patients, with respect to the compliance of doctors with ethical principles

Variable	Expectation of information and asking for opinion			Expectation of consideration of cost
	Odds ratio	95% Confidence interval	P-value	Odds ratio	95% Confidence interval	P-value
Occupation
Professionals	9.35	3.57–25.94	<0.001*	1.73	0.68–4.40	0.25
Midlevel professionals	5.39	1.83–15.91	<0.001*	2.14	0.79–5.78	0.13
Civil servants	3.01	1.91–9.16	0.05*	2.38	0.82–6.91	0.10
Low-skilled workers	3.43	1.15–10.23	0.03*	3.53	1.3–9.5	0.01*
Unemployed°
Age	0.86	0.81–0.92	<0.001*	0.91	0.86–0.96	<0.001*
Residence
Urban	2.41	1.56–3.72	<0.001*	1.49	1.02–2.15	0.04*
Rural°
Christian denomination
Catholic	0.32	0.24–0.43	<0.000*	1.23	0.94–1.63	0.13
Non-Catholic°
Education
Tertiary and above	0.00	0.00	1.00	0.00	0.00	1.00
Secondary	0.00	0.00	1.00	0.00	0.00	1.00
Primary	0.28	0.91–0.86	0.03*	0.29	0.19–1.15	1.13
No formal education°	0.98	0.70–1.35	0.88	0.14	0.93–1.69	2.17
Parity
Multiparous	0.82	0.55–1.13	0.22	0.75	0.56–1.01	0.06
Nulliparous°
Mode of delivery
Vaginal	1.35	0.85–2.14	0.21	0.81	0.53–1.21	0.30
Cesarean°
Tribal group
Igbo	0.00	0.00	0.90	3.48	1.52–7.96	<0.001*
Non-Igbo°

Notes:

* Statistically significant P-value;

° reference independent variable.

Table 4 Comparison of the experiences of women concerning medical ethics practices

Obstetrician conduct	Number of patients who experienced conduct (%) n = 1,112		P-value
	Yes	No
Appropriate autonomy-related conduct			<0.001*
Adequate privacy	624 (56.1)	488 (43.9)
Examination in the presence of a chaperone	504 (45.3)	608 (54.7)
Explanation of diagnosis and treatment options	772 (69.4)	340 (30.6)
Seeking opinion and consent of patients on options of investigation and treatment	656 (59.0)	356 (41.0)
Beneficence-related conduct			<0.001*
Punctuality to antenatal clinic	389 (35.0)	723 (65.0)
Regular attendance to antenatal clinic	612 (55.0)	500 (45.0)
Caring attitude	1,036 (93.0)	76 (7.0)
Justice-related conduct			<0.001*
Consideration of cost of investigations and drugs	663 (59.6)	449 (40.4)
No favoritism in attending to patients (patients seen on a “first come, first seen” basis)	468 (42.1)	644 (57.9)
Nonmaleficence-related conduct			<0.001*
Verbal abuse	48 (4.3)	1,064 (95.7)
Verbal sexual overtures	32 (2.9)	1,080 (97.1)
Demand for financial gratification	48 (4.3)	1,064 (95.7)
Inappropriate touching	72 (6.5)	1,040 (93.5)
Participation in strike actions	1,045 (94.0)	67 (6.0)

Notes: The comparison was based on Chi-square test of significant difference.

* Statistically significant P-value.

Table 5 Self-reported content of counseling for cesarean section

Content of counseling for informed consent	Number of women who had counseling
	Emergency cesarean n = 100 (%)	Elective cesarean n = 52 (%)
Detailed explanation of the indication for cesarean section
Yes	15 (15.0)	52
No	85 (85.0)	0
Detailed explanation of the short-term-maternal risks associated with cesarean delivery, such as anesthetic risks, primary hemorrhage, injury to bladder or ureters, infection, and DVT
Yes	20 (20.0)	1
No	80 (80.0)	51
Detailed explanation of long-term maternal risks associated with cesarean section, such as higher risks for placenta previa and uterine rupture in subsequent pregnancies, higher need for subsequent cesarean section
Yes	10 (10.0)	5
No	90 (90.0)	47
Explanation of the surgery itself, including the types of abdominal incision, duration of surgery, type of anesthesia
Yes	0 (0.0)	3
No	100 (100.0)	49
Explanation of the process of recovery from surgery, such as pain, the initial restriction of movement and initial restriction of oral feeding
Yes	4 (4.0)	0
No	96 (96.0)	45
Explanation of the costs of surgery
Yes	3 (3.0)	15
No	97 (97.0)	27

Abbreviation: DVT, deep vein thrombosis.

Table 6 Showing the comparison of expectations and the actual experiences of compliance with ethical principles by doctors

Ethical conduct	Number of patients		P-value
	Expected (n = 1,112)	Experienced (n = 1,112)
Adequate privacy			<0.001*
Yes	912	624
No	200	488
Provide information on diagnosis and the options of management available based on current evidence			<0.001*
Yes	960	772
No	152	340
Seek patient’s opinion and consent on the options for investigation or treatment to be undertaken			<0.001*
Yes	948	656
No	164	456
Regular and punctual attendance at clinics			<0.001*
Yes	1,109	612
No	3	500
Fairness in the order of attendance to patients (“first come, first seen,” except for medical emergencies)			<0.001*
Yes	1,102	463
No	10	649
Consider the ability of patients to pay for drugs or services by exploring options, based on necessity, efficacy, and cost			<0.001*
Yes	996	636
No	116	476
Respect for patient’s feelings, including religious beliefs of patients, during clinical evaluation and when recommending management options			<0.001*
Yes	616	460
No	496	652

Note:

* Statistically significant P-value.

Table 7 Rating of ethical practices of doctors

Ethical practice	Rating n = 1,112 (%)
	Excellent	Very good	Good	Poor	Very poor
Privacy during interview and examination including use of chaperones	0 (0.0)	24 (2.2)	600 (54.0)	488 (43.8)	0 (0.0)
Asking your opinion on investigations and treatment before prescribing them	7 (0.6)	63 (5.7)	586 (52.7)	456 (41.0)	0 (0.0)
Explaining investigations and treatment to you in a way that you could understand them	10 (0.9)	56 (5.0)	706 (63.5)	335 (30.1)	5 (0.5)
Fairness in the order of attendance to patients (“first come, first seen,” except for medical emergencies)	0 (0.0)	149 (13.4)	314 (28.2)	649 (58.4)	0 (0.0)
Asking if you can pay for chosen test or treatment and offering you alternatives in case you are not able to pay	0 (0.0)	11 (1.0)	625 (56.2)	473 (42.5)	3 (0.3)
Respect for patient’s feelings, including religious beliefs of patients, during clinical evaluation and when recommending management options	30 (2.7)	156 (14.0)	274 (24.6)	612 (55.0)	40 (3.6)

Figure S1 The study questionnaire.