Are underprivileged and less empowered women deprived of respectful maternity care: Inequities in childbirth experiences in public health facilities in Pakistan.
Are underprivileged and less empowered women deprived of respectful maternity care: Inequities in childbirth experiences in public health facilities in Pakistan.
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DOI：
10.1371/journal.pone.0249874
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Avan BI
中科院分区：
文献类型：
--
作者：
Hameed W;Uddin M;Avan BI
以尊重和有尊严的方式获得医疗保健是每个妇女的基本权利，无论其个人身份如何。然而，社会排斥、社会心理支持不佳以及医疗机构分娩期间的侮辱性护理在世界各地都很常见，特别是在低收入和中等收入国家。我们同时研究了具有不同社会人口特征的妇女在分娩期间如何受到对待、妇女赋权对虐待的影响，以及导致巴基斯坦二级公共卫生机构虐待的卫生服务因素。 2016 年 8 月至 11 月期间，对信德省南部四个毗邻地区的 6 个二级保健公共卫生机构中分娩的 783 名妇女进行了一项横断面调查。妇女在卫生机构中被招募，并在产后 42 天内在家中使用世卫组织框架指导的 43 项结构化调查问卷进行访谈。使用平均值、标准差和平均值来描述参与者的特征。使用 Stata 15.1 应用多变量线性回归。妇女在产时护理期间至少经历过一次医院工作人员侵犯其护理权利的行为，包括： 沟通不力（100%）；缺乏支持性护理（99.7%）；失去自主权（97.5%）；未达到专业临床标准（84.4%）；缺乏资源（76.3%）；言语辱骂（15.2%）；身体虐待（14.8%）；和歧视（3.2%）。所有三个维度的风险因素均显示与虐待显着相关： 社会人口统计学：初产妇和较贫穷的人受到更多虐待；卫生服务：关于生育准备和产后护理的教育较少导致虐待率较高；在妇女赋权方面：受到家庭情感和身体虐待的妇女，以及缺乏社会支持和较少参与与丈夫共同家庭决策的妇女，与她们的同龄人相比，更有可能受到虐待。所有重要风险因素与虐待之间的关系大小（以 β 系数表示）范围为 0.2 至 5.5，p 值小于 0.05。公共卫生机构在分娩期间对待妇女的方式存在明显的不平等。社会人口统计、卫生服务和妇女赋权等指标显示与分娩期间的虐待存在显着的独立关联。在卫生系统层面，迫切需要采取更具包容性的护理解决方案，以确保所有妇女都受到同情和尊严的对待，并为那些情绪困扰和缺乏社会支持的妇女提供社会心理支持。
Attainment of healthcare in respectful and dignified manner is a fundamental right for every woman regardless of the individual status. However, social exclusion, poor psychosocial support, and demeaning care during childbirth at health facilities are common worldwide, particularly in low- and middle-income countries. We concurrently examined how women with varying socio-demographic characteristics are treated during childbirth, the effect of women’s empowerment on mistreatment, and health services factors that contribute to mistreatment in secondary-level public health facilities in Pakistan. A cross-sectional survey was conducted during August–November 2016 among 783 women who gave birth in six secondary-care public health facilities across four contiguous districts of southern Sindh. Women were recruited in health facilities and later interviewed at home within 42 days of postpartum using a WHO’s framework-guided 43-item structured questionnaire. Means, standard deviation, and average were used to describe characteristics of the participants. Multivariable linear regression was applied using Stata 15.1. Women experiencing at least one violation of their right to care by hospital staff during intrapartum care included: ineffective communication (100%); lack of supportive care (99.7%); loss of autonomy (97.5%); failure of meeting professional clinical standards (84.4%); lack of resources (76.3%); verbal abuse (15.2%); physical abuse (14.8%); and discrimination (3.2%). Risk factors of all three dimensions showed significant association with mistreatment: socio-demographic: primigravida and poorer were more mistreated; health services: lesser-education on birth preparedness and postnatal care leads to higher mistreatment; and in terms of women’s empowerment: women who were emotionally and physically abused by family, and those with lack of social support and lesser involvement in joint household decision making with husbands are more likely to be mistreated as compared to their counterparts. The magnitude of relationship between all significant risk factors and mistreatment, in the form of β coefficients, ranged from 0.2 to 5.5 with p-values less than 0.05. There are glaring inequalities in terms of the way women are treated during childbirth in public health facilities. Measures of socio-demographic, health services, and women’s empowerment showed a significant independent association with mistreatment during childbirth. At the health system level, there is a need for urgent solutions for more inclusive care to ensure that all women are treated with compassion and dignity, complemented by psychosocial support for those who are emotionally disturbed and lack social support.
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