Kujawski Stephanie, Mbaruku Godfrey, Freedman Lynn P, Ramsey Kate, Moyo Wema, Kruk Margaret E
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
Averting Maternal Death and Disability Program, Columbia University Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA.
Matern Child Health J. 2015 Oct;19(10):2243-50. doi: 10.1007/s10995-015-1743-9.
In Tanzania, maternal mortality is high and coverage with health facility delivery low, despite efforts to reduce barriers to utilization. Disrespect and abuse during childbirth has not been explored as a contributor to delivery satisfaction or as a deterrent to institutional delivery. We assessed the association between reported disrespectful treatment during childbirth and delivery satisfaction, perceived quality of care, and intention to deliver at the same facility in the future.
Interviews using a structured questionnaire were conducted in Tanga Region, Tanzania with women on discharge from delivery at two hospitals. Disrespect and abuse was measured by asking women about specific disrespectful events during childbirth. Multivariable logistic regression models were used to assess the association between disrespect/abuse and (1) satisfaction with delivery, (2) perceived quality of care for delivery, and (3) intent to use the same facility for a future delivery, controlling for confounders.
1388 women participated in the survey (67 % response rate). Disrespect/abuse during childbirth was associated with lower satisfaction with delivery (OR 0.26, 95 % CI 0.19-0.36) and reduced likelihood of rating perceived quality of care as excellent/very good (OR 0.55, 95 % CI 0.35-0.85). Of women who planned to have more children (N = 766), those who experienced disrespect/abuse were half as likely to plan to deliver again at the same facility (OR 0.51, 95 % CI 0.32-0.82).
Our study highlights disrespectful and abusive treatment during childbirth as an important factor in reducing women's confidence in health facilities. Improving interpersonal care must be an integral part of quality improvement in maternal health.
在坦桑尼亚，尽管已努力减少利用医疗设施的障碍，但孕产妇死亡率仍然很高，且在医疗机构分娩的覆盖率较低。分娩期间的不尊重和虐待行为尚未被视为影响分娩满意度的因素，或阻碍在医疗机构分娩的因素。我们评估了分娩期间报告的不尊重待遇与分娩满意度、感知的护理质量以及未来在同一医疗机构分娩意愿之间的关联。
在坦桑尼亚坦噶地区，对两家医院分娩后出院的妇女进行了结构化问卷调查访谈。通过询问妇女分娩期间的具体不尊重事件来衡量不尊重和虐待行为。使用多变量逻辑回归模型评估不尊重/虐待行为与以下方面的关联：（1）分娩满意度；（2）感知的分娩护理质量；（3）未来在同一医疗机构分娩的意愿，并对混杂因素进行控制。
1388名妇女参与了调查（回应率为67%）。分娩期间的不尊重/虐待行为与较低的分娩满意度相关（比值比0.26，95%置信区间0.19 - 0.36），且将感知的护理质量评为优秀/非常好的可能性降低（比值比0.55，95%置信区间0.35 - 0.85）。在计划生育更多孩子的妇女中（n = 766），经历过不尊重/虐待行为 的妇女在同一医疗机构再次分娩的计划可能性只有一半（比值比0.51，95%置信区间0.32 - 0.82）。
我们的研究强调分娩期间的不尊重和虐待行为是降低妇女对医疗机构信心的重要因素。改善人际护理必须成为孕产妇健康质量改善的一个组成部分。
