Association Between Disrespect and Abuse During Childbirth and Women’s Confidence in Health Facilities in Tanzania
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In Tanzania, maternal mortality is high and coverage with health facility delivery low, despite efforts to reduce barriers to utilization. Disrespect and abuse during childbirth has not been explored as a contributor to delivery satisfaction or as a deterrent to institutional delivery. We assessed the association between reported disrespectful treatment during childbirth and delivery satisfaction, perceived quality of care, and intention to deliver at the same facility in the future.
Interviews using a structured questionnaire were conducted in Tanga Region, Tanzania with women on discharge from delivery at two hospitals. Disrespect and abuse was measured by asking women about specific disrespectful events during childbirth. Multivariable logistic regression models were used to assess the association between disrespect/abuse and (1) satisfaction with delivery, (2) perceived quality of care for delivery, and (3) intent to use the same facility for a future delivery, controlling for confounders.
1388 women participated in the survey (67 % response rate). Disrespect/abuse during childbirth was associated with lower satisfaction with delivery (OR 0.26, 95 % CI 0.19–0.36) and reduced likelihood of rating perceived quality of care as excellent/very good (OR 0.55, 95 % CI 0.35–0.85). Of women who planned to have more children (N = 766), those who experienced disrespect/abuse were half as likely to plan to deliver again at the same facility (OR 0.51, 95 % CI 0.32–0.82).
Our study highlights disrespectful and abusive treatment during childbirth as an important factor in reducing women’s confidence in health facilities. Improving interpersonal care must be an integral part of quality improvement in maternal health.
KeywordsMaternal health Disrespect Abuse Quality of care Satisfaction Respectful maternity care
The authors wish to thank Mr. Jeje Williams for his assistance with data management and Dr. Susie Hoffman for her review of manuscript drafts. We are grateful to the regional and district health authorities and health facility managers in Tanga Region, Tanzania and to the women who generously shared their time and insights in this research. This study was made possible by the support of the Denmark Ministry of Foreign Affairs and the American people through the United States Agency for International Development (USAID) and its Translating Research into Action (TRAction) Project. TRAction is managed by the University Research Co., LLC (URC) under Cooperative Agreement Number GHS-A-00-09-00015-00. The findings of this study are the sole responsibility of the authors, and do not necessarily reflect the views of the Government of Denmark, USAID, or the United States Government. The study sponsors had no role in the collection, analysis, or interpretation of data; in the writing of the paper; or in the decision to submit for publication.
Conflict of interest
The authors declare no competing interests.
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