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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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Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

Aug 14, 2019

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Page 1: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

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

Page 2: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

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

Page 3: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

Introduction

Page 4: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

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

Page 5: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

Source: White Ribbon Alliance. 2011. Respectful

Maternity Care: The Universal Rights of Childbearing

Women. Washington, DC: WRA.

Page 6: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

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

Page 7: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

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/

Page 8: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

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.

Page 9: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

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

Page 11: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

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.

Page 12: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

Generating Postpartum SMS Client Feedback to

Improve Respectful Maternity Care:

A Pilot Study in Kenya in 2015

Page 13: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

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

Page 14: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

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

Page 16: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

Areas of Work

� Kiambu

� Kisumu

� Kitui

� Makueni

� Meru

� Migori

9 District HospitalsWe expect to enroll 400

women at L&D discharge

Page 17: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

Seeking to Provide a . . .

Page 18: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

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?

Page 19: Respectful Maternity Care: Evidence from East and Southern ... · Respectful Maternity Care: Evidence from East and Southern Africa Eva Bazant, Reena Sethi, Ephrem Daniel Jhpiego

Questions?

THANK YOU