Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions
Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions
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DOI：
10.1186/s12884-017-1288-6
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发表时间：
2017-03-28
影响因子：
3.1
通讯作者：
Abuya, Timothy
中科院分区：
文献类型：
--
作者：
Warren, Charlotte E.;Njue, Rebecca;Abuya, Timothy
背景：产科环境中医疗保健提供者对妇女的不尊重、虐待或虐待已被确定为阻碍妇女寻求分娩护理的主要因素。虐待包括身体和言语虐待、耻辱和歧视、妇女与提供者之间的不良关系以及政策和卫生系统的挑战。本文使用定性数据来描述肯尼亚妇女遭受的虐待。方法：数据来自在 13 个设施和社区进行的实施研究。研究人员对在设施中分娩的妇女 (n-50)、决策者、健康管理人员和提供者 (n-63) 进行了一系列深入访谈；与居住在学习设施周围的女性和男性进行焦点小组讨论 (19)。数据被记录在纸质和录音带上，进行转录和翻译，然后导出到 Nvivo 进行分析。随后，我们应用了虐待类型学，其中包括一阶描述性主题、二阶和三阶分析主题。最终分析围绕对虐待的性质、表现和经历以及造成虐待的因素的描述进行组织。 结果：妇女描述：她们在分娩时的负面经历；对缺乏保密性和自主权感到沮丧；被医疗服务提供者遗弃，以及肮脏的产科病房。提供者承认面临挑战，但描述了明显虐待的原因（拍打大腿以鼓励妇女专注于分娩过程），“拘留”是因为亲戚抛弃了他们。男人试图通过向服务提供者付费以确保他们照顾妻子来克服挑战。家庭和社区层面的社会和性别规范是虐待的驱动因素。在设施层面，管理监督不善、提供者积极性降低以及设备和用品缺乏，导致护理体验不佳。薄弱或不存在的法律补救措施使这一问题长期存在。结论：本文以有关分娩和分娩期间虐待的大量文献为基础，概述了个人、家庭、社区、设施和政策层面的驱动因素。将表现形式分组为主题或组成部分的新框架使其越来越注重具体干预措施，以促进尊重的孕产妇护理。肯尼亚的研究结果与新兴文献产生共鸣——表明这确实是一个需要全球解决方案的全球问题。
Background: Disrespect and abuse or mistreatment of women by health care providers in maternity settings has been identified as a key deterrent to women seeking delivery care. Mistreatment includes physical and verbal abuse, stigma and discrimination, a poor relationship between women and providers and policy and health systems challenges. This paper uses qualitative data to describe mistreatment of women in Kenya.Methods: Data are drawn from implementation research conducted in 13 facilities and communities. Researchers conducted a range of in-depth interviews with women (n-50) who had given birth in a facility policy makers health managers and providers (n-63); and focus group discussions (19) with women and men living around study facilities. Data were captured on paper and audio tapes, transcribed and translated and exported into Nvivo for analysis. Subsequently we applied a typology of mistreatment which includes first order descriptive themes, second and third-order analytical themes. Final analysis was organized around description of the nature, manifestations and experiences, and factors contributing to mistreatment.Results: Women describe: their negative experiences of childbirth; frustration with lack of confidentiality and autonomy; abandonment by the providers, and dirty maternity units. Providers admit to challenges but describe reasons for apparent abuse (slapped on thighs to encourage women to focus on birthing process) and 'detention' is because relatives have abandoned them. Men try to overcome challenges by paying providers to ensure they look after their wives. Drivers of mistreatment are perpetuated by social and gender norms at family and community levels. At facility level, poor managerial oversight, provider demotivation, and lack of equipment and supplies, contribute to a poor experience of care. Weak or non-existent legal redress perpetuate the problem.Conclusion: This paper builds on the expanding literature on mistreatment during labour and childbirth outlining drivers from an individual, family, community, facility and policy level. New frameworks to group the manifestations into themes or components makes it increasingly more focused on specific interventions to promote respectful maternity care. The Kenya findings resonate with budding literature - demonstrating that this is indeed a global issue that needs a global solution.