The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya

• Published in: BMC pregnancy and childbirth 2015-09, Vol.15 (1), p.224-224, Article 224
• Main Authors: Abuya, Timothy, Ndwiga, Charity, Ritter, Julie, Kanya, Lucy, Bellows, Ben, Binkin, Nancy, Warren, Charlotte E
• Format: Article
• Language: English
• Subjects: Adult; Births; Childbirth & labor; Councils; Delivery, Obstetric - methods; Delivery, Obstetric - psychology; Delivery, Obstetric - standards; Female; Health facilities; Health surveys; Human rights; Humans; Infant; Intervention; Kenya; Labor, Obstetric - psychology; Maternal & child health; Maternal child nursing; Maternal Health Services - standards; Maternal Health Services - statistics & numerical data; Maternal mortality; Morbidity; Parturition - psychology; Physical Abuse - statistics & numerical data; Postpartum Period - psychology; Pregnancy; Privacy - psychology; Professional-Patient Relations; Public health; Quality; Reproductive health; Surveys and Questionnaires; Value of Life; Women's Rights; Womens health; Young Adult
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/s12884-015-0645-6

Disrespect and abuse (D & A) during labor and delivery are important issues correlated with human rights, equity, and public health that also affect women's decisions to deliver in facilities, which provide appropriate management of maternal and neonatal complications. Little is known about interventions aimed at lowering the frequency of disrespectful and abusive behaviors. Between 2011 and 2014, a pre-and-post study measured D & A levels in a three-tiered intervention at 13 facilities in Kenya under the Heshima project. The intervention involved working with policymakers to encourage greater focus on D & A, training providers on respectful maternity care, and strengthening linkages between the facility and community for accountability and governance. At participating facilities, postpartum women were approached at discharge and asked to participate in the study; those who consented were administered a questionnaire on D & A in general as well as six typologies, including physical and verbal abuse, violations of confidentiality and privacy, detainment for non-payment, and abandonment. Observation of provider-patient interaction during labor was also conducted in the same facilities. In both exit interview and observational studies, multivariate analyses of risk factors for D & A controlled for differences in socio-demographic and facility characteristics between baseline and endline surveys. Overall D & A decreased from 20-13% (p