respectful maternity care: evidence from east and southern ... · respectful maternity care:...
TRANSCRIPT
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Respectful Maternity Care:
Evidence from East and Southern Africa
Eva Bazant, Reena Sethi, Ephrem Daniel
Jhpiego Monitoring, Evaluation and Research
USAID Mini University, Washington, DC
March 2, 2015
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Session Outline
� Introduction to respectful maternity care (RMC)
and disrespect and abuse (D&A)
� Findings of RMC and D&A in Malawi
� Findings of RMC and D&A in Ethiopia in an
evaluation of a quality improvement approach
� Pilot to measure RMC through SMS in Kenya
� Q&A and discussion
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Introduction
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Landscape Analysis
� Extensively reviewed literature on disrespect and
abuse (D&A) in facility-based childbirth: 7 categories
� Explored contributors to D&A at levels of: individual
and community, laws and policies, governance and
leadership, service delivery and providers
� Explored the impact
� Reviewed interventions to promote respectful care
� Identified gaps in evidence: prevalence, consistent
definitions, validated tools, impact studies
Source: Bowser and Hill (2010). Exploring Evidence for Disrespect and
Abuse in Facility-based Childbirth: Report of a Landscape Analysis. USAID
TRAction Project. Harvard and URC. www.tractionproject.org
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Source: White Ribbon Alliance. 2011. Respectful
Maternity Care: The Universal Rights of Childbearing
Women. Washington, DC: WRA.
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Barriers to Facility-Based Delivery
Include D&A
Source: Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP,
Gulmezoglu AM. 2014. Facilitators and barriers to facility-based delivery
in low- and middle-income countries: A qualitative evidence synthesis.
Reproductive Health 11:71.
� Medicalization of childbirth
� Previous birth experiences
� Cost of childbirth
� Perceived quality of care at facilities
� Stigma
� Methods:
� 34 qualitative studies reviewed from 17
LMICs, CerQual approach to assess findings
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The World Health Organization Calls for:
� Support from governments for research and
action to generate data related to respectful and
disrespectful practices
� Programs to improve quality of care and RMC
� Emphasis on women’s rights to dignified,
respectful health care throughout pregnancy
and childbirth
� Systems of accountability and professional
support
� Involvement of all stakeholders, incl. womenSource: WHO. 2014. The prevention and elimination of disrespect and
abuse during facility-based childbirth. Geneva: WHO. Accessed at:
www.who.int/reproductivehealth/topics/maternal_perinatal/statement-
childbirth/en/
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Defining D&A: AMDD
1. At Policy level
� Deviations from international human rights
standards and national standards of quality of
care
2. At Structural level
� System deficiencies and D&A identified as D&A
(or not) by women, by providers
3. At Individual level
� Normalized D&A (by women or by providers)
� What all agree/admit is D&A
Source: Freedman L et al. 2014. Defining disrespect and abuse of
women in childbirth: A research, policy and rights agenda.
Bulletin of the World Health Organization 92:915–917.
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Prevalence of D&A: Two Studies
Tanzania Nigeria
L&D client exit
interview
Home interview
at 6 weeks
Postnatal ~
immunization
interview
D&A Type n=1,779 n=593 n=446
% % %
1. Non-consented care <1 <1 55
2. Physical abuse 3 5 36
3. Non-dignified care 13 19 30
4. Abandonment/neglect of care 9 16 29
5. Non-confidential care 4 6 26
6. Detention in health facility <1 <1 22
Inappropriate demands for payment 2 3
7. Discrimination 20
Any D&A experienced 19 28 98
Kruk et al. 2014. Disrespectful and abusivetreatment during facility delivery in Tanzania: A facility and community survey. Health Policy Planning. doi: 10.1093/heapol/czu079
8 facilities, different
types
Okafor et al (2015). IJGO 1 teaching hospital
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Measurement of D&A Prevalence
May Vary Based on:
� Method/sources of data:
� Interview with women (at facility at L&D
discharge, home later
on, postnatal or
immunization)
� Observations of care (external, internal, who)
� Provider interview
� Samples: How obtained,
size, location, service area
� Instrument: Items, any
validation, response
categories,
scales/indexes
� Confidentiality: To
women and providers
� Context: Type and
number of health
facilities, client
volume, staffing,
fees/costs
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MCHIP Quality of Care Studies
Measured . . .
� Policy-level: Main focus is on national and
WHO standards* for quality of care for
normal L&D and complications www.mchip.net/QoCSurveys
� Structural-level: Health facility inventory
� Individual-level: Provider performance
during provider-client interactions and care
� D&A items were added later
*Source: World Health Organization. 2006. Pregnancy, Childbirth, Postpartum and
Newborn Care: A Guide for Essential Practice, Integrated Management of
Pregnancy and Childbirth (IMPAC) Toolkit. Geneva, Switzerland: WHO.
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Generating Postpartum SMS Client Feedback to
Improve Respectful Maternity Care:
A Pilot Study in Kenya in 2015
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Background
� Concerns with client exit interviews:
� In Tanzania, women’s reports of D&A increased
between the exit interview and an interview 6
weeks later in the home (Kruk et al. 2014)
� Responding to the survey while not at the facility
may help with validity, but can lead to lower
response rate
� Studies collecting data on paper forms may
be slow to feed the findings back to the
facilities for quality improvement
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Mobile Phone Use is High in Kenya
30,732,000 mobile
phones in a
population of
45,010,056
(CIA World Fact Book, 2014)
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Pilot Project Objectives
� Assess the acceptability of a mobile SMS
platform for an RMC-focused survey of labor
and delivery clients (percentage of women
reporting respectful or disrespectful care
and high satisfaction)
� Assess the feasibility of facilities to respond to
aggregated client feedback for quality
improvement
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Areas of Work
� Kiambu
� Kisumu
� Kitui
� Makueni
� Meru
� Migori
9 District HospitalsWe expect to enroll 400
women at L&D discharge
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Seeking to Provide a . . .
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SMS Questions (Illustrative)
� How was the . . . � Respect the providers showed?
� Kindness of the providers?
� Cleanliness at this facility?
� Did you receive any hot tea or food?
� Was . . .� Your privacy respected?
� Your information kept confidential?
� Were the provider’s findings explained?
� Was your choice of birth position respected?
� Were you shouted at, scolded, or insulted?
� Were you attended to during labor or childbirth?
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Questions?
THANK YOU