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Direct observation of respectful maternity care in five countries: a cross-sectional study of health facilities in East and Southern Africa

Journal Article
(Published November, 2015)
Rosen, H. (Author),
Lynam, P. (Author),
Reis, V. (Author),
Ricca, J.T. (Author),
Bazant, E. (Author),
Bartlett, L. (Author)
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10 items on structured, standardized clinical observation checklists were used to directly observe respectful quality of care at facilities in five countries: Ethiopia, Kenya, Madagascar, Rwanda, and the United Republic of Tanzania by describing actions the provider should take to ensure the client was informed and able to make choices about her care, and that her dignity and privacy were respected. A total of 2164 labor and delivery observations were conducted at hospitals and health centers. Encouragingly, women overall were treated with dignity and in a supportive manner by providers, but many had poor interactions with providers and were not well-informed about their care. Both physical and verbal abuse of women were observed during the study. The most frequently mentioned form of disrespect and abuse in the open-ended comments was abandonment and neglect. CONCLUSIONS: Efforts to increase use of facility-based maternity care in low income countries are unlikely to achieve desired gains if there is no improvement in quality of care provided, especially elements of respectful care. This analysis identified insufficient communication and information sharing by providers as well as delays in care and abandonment of laboring women as deficiencies in respectful care. Failure to adopt a patient-centered approach and a lack of health system resources are contributing barriers for effective interventions to promote respectful care.

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Citation: 
Rosen HE, Lynam PF, Carr C, Reis V, Ricca J, Bazant ES, et al. Direct observation of respectful maternity care in five countries: a cross-sectional study of health facilities in East and Southern Africa. BMC pregnancy and childbirth. 2015;15(1):306