Midwives' and patients' perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study
Midwives' and patients' perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study
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DOI：
10.1186/s12884-017-1442-1
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发表时间：
2017-08-22
影响因子：
3.1
通讯作者：
Smith, Katheryn
中科院分区：
文献类型：
--
作者：
Burrowes, Sahai;Holcombe, Sarah Jane;Smith, Katheryn
背景资料：人们越来越认识到，在分娩和分娩期间不尊重和虐待妇女是对妇女权利的侵犯，也是对使用救生、基于设施的分娩和分娩服务的一种威慑。在埃塞俄比亚，尽管最近在全国范围内大幅增加了受过培训的提供者和设施的数量，但熟练助产的比例仍然只有28%。有人提出关切，认为妇女认为护理质量差，担心受到虐待，这可能是利用率低的原因。本研究探讨不尊重和虐待产妇护理的经验，从供应商和patients.Methods的角度来看：我们进行了45个深入的采访，在四个卫生设施在德布雷马科斯，埃塞俄比亚与助产士，助产专业的学生，和妇女谁在过去一年内分娩。学生和供应商还采取了简短的定量调查，对患者的权利在劳动和交付，并回应临床情景提供污名化的生殖健康service.Results：我们发现，医疗保健提供者和患者报告频繁的身体和言语虐待，以及非同意的护理在劳动和交付。提供者报告说，大多数虐待是无意的，是卫生系统薄弱或医疗需要造成的。我们没有发现任何证据表明存在更系统的虐待行为，包括拘留病人、贿赂、遗弃或对特定族裔群体的持续歧视。虽然卫生保健提供者表现出良好的基本知识的保密性，隐私和同意，培训的原则，响应和尊重的照顾，并在咨询，在很大程度上是缺席。提供者表示，他们欢迎相关的实际指导。病人的反应表明，妇女都知道，他们的权利受到侵犯，避免设施的声誉差carrying.Conclusions：我们的研究结果表明，尊重护理，在国家助产课程的专业道德模块提供的培训，应加强，包括更注重咨询技能和融洽的关系建设。我们的研究结果还表明，解决围绕提供者工作量的结构性问题应补充所有干预措施，以改善助产士与妇女的人际互动，如果埃塞俄比亚要增加提供尊重，以病人为中心的孕产妇护理。
Background: It is increasingly recognized that disrespect and abuse of women during labor and delivery is a violation of a woman's rights and a deterrent to the use of life-saving, facility-based labor and delivery services. In Ethiopia, rates of skilled birth attendance are still only 28% despite a recent dramatic national scale up in the numbers of trained providers and facilities. Concerns have been raised that womens' perceptions of poor quality of care and fear of mistreatment might contribute to this low utilization. This study examines the experiences of disrespect and abuse in maternal care from the perspectives of both providers and patients.Methods: We conducted 45 in-depth interviews at four health facilities in Debre Markos, Ethiopia with midwives, midwifery students, and women who had given birth within the past year. Students and providers also took a brief quantitative survey on patients' rights during labor and delivery and responded to clinical scenarios regarding the provision of stigmatized reproductive health services.Results: We find that both health care providers and patients report frequent physical and verbal abuse as well as non-consented care during labor and delivery. Providers report that most abuse is unintended and results from weaknesses in the health system or from medical necessity. We uncovered no evidence of more systematic types of abuse involving detention of patients, bribery, abandonment or ongoing discrimination against particular ethnic groups. Although health care providers showed good basic knowledge of confidentiality, privacy, and consent, training on the principles of responsive and respectful care, and on counseling, is largely absent. Providers indicated that they would welcome related practical instruction. Patient responses suggest that women are aware that their rights are being violated and avoid facilities with reputations for poor care.Conclusions: Our results suggest that training on respectful care, offered in the professional ethics modules of the national midwifery curriculum, should be strengthened to include greater focus on counseling skills and rapport-building. Our findings also indicate that addressing structural issues around provider workload should complement all interventions to improve midwives' interpersonal interactions with women if Ethiopia is to increase provision of respectful, patient-centered maternity care.