Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania
Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania
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DOI：
10.1186/1471-2393-14-268
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发表时间：
2014-08-12
影响因子：
3.1
通讯作者：
Winch, Peter J.
中科院分区：
文献类型：
--
作者：
McMahon, Shannon A.;George, Asha S.;Winch, Peter J.
背景：降低孕产妇死亡率的干预措施主要集中在设施分娩，但在许多资源匮乏的地区，设施分娩率仍然持续较低。在坦桑尼亚，设施交付率 20 多年来一直保持不变。为了推进研究并为政策变化提供信息，本文以越来越多的工作为基础，探讨了坦桑尼亚莫罗戈罗地区设施中不尊重的产妇护理和分娩期间虐待的维度和应对措施。方法：本研究对 112 名受访者进行了深入访谈，其中包括过去 14 个月内分娩的妇女、她们的男性伴侣、舆论领袖和社区卫生工作者，以了解分娩期间虐待的经历和应对措施。所有采访均使用 Atlas.ti 进行记录、转录、翻译和编码。分析借鉴了扎根理论的原则。结果：在最初描述分娩经历时，女性以中立或满意的方式描述了与提供者的遭遇。经过调查，妇女们讲述了孕产妇健康文献中描述的虐待事件或情况：感觉被忽视或忽视；金钱要求或歧视性待遇；言语辱骂；以及在极少数情况下的身体虐待。不同受访群体和地区的调查结果是一致的。作为对虐待的回应，女性描述了默许或非对抗策略：屈服于虐待、回家或绕过某些设施或提供者。男性受访者描述了更自信的方法：要求更好的护理、行贿、提出投诉，在一个案例中还袭击了服务提供者。结论：这项研究中包括的许多坦桑尼亚妇女在设施中分娩时都经历了不利的条件。医疗服务提供者、妇女及其家人必须了解妇女获得尊重护理的权利。进一步研究的建议包括调查不尊重护理和虐待的普遍程度和程度、妇女及其家人有效报告和纠正此类事件的机制以及可减轻分娩妇女忽视或孤立的干预措施。尊重的护理是改善孕产妇健康的重要组成部分。
Background: Interventions to reduce maternal mortality have focused on delivery in facilities, yet in many low-resource settings rates of facility-based birth have remained persistently low. In Tanzania, rates of facility delivery have remained static for more than 20 years. With an aim to advance research and inform policy changes, this paper builds on a growing body of work that explores dimensions of and responses to disrespectful maternity care and abuse during childbirth in facilities across Morogoro Region, Tanzania.Methods: This research drew on in-depth interviews with 112 respondents including women who delivered in the preceding 14 months, their male partners, public opinion leaders and community health workers to understand experiences with and responses to abuse during childbirth. All interviews were recorded, transcribed, translated and coded using Atlas.ti. Analysis drew on the principles of Grounded Theory.Results: When initially describing birth experiences, women portrayed encounters with providers in a neutral or satisfactory light. Upon probing, women recounted events or circumstances that are described as abusive in maternal health literature: feeling ignored or neglected; monetary demands or discriminatory treatment; verbal abuse; and in rare instances physical abuse. Findings were consistent across respondent groups and districts. As a response to abuse, women described acquiescence or non-confrontational strategies: resigning oneself to abuse, returning home, or bypassing certain facilities or providers. Male respondents described more assertive approaches: requesting better care, paying a bribe, lodging a complaint and in one case assaulting a provider.Conclusions: Many Tanzanian women included in this study experienced unfavorable conditions when delivering in facilities. Providers, women and their families must be made aware of women's rights to respectful care. Recommendations for further research include investigations of the prevalence and dimensions of disrespectful care and abuse, on mechanisms for women and their families to effectively report and redress such events and on interventions that could mitigate neglect or isolation among delivering women. Respectful care is a critical component to improve maternal health.