Brook Building, University of Central Lancashire, Preston, UK.
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
Reprod Health. 2018 Feb 6;15(1):23. doi: 10.1186/s12978-018-0466-y.
Several studies have identified how mistreatment during labour and childbirth can act as a barrier to the use of health facilities. Despite general agreement that respectful maternity care (RMC) is a fundamental human right, and an important component of quality intrapartum care that every pregnant woman should receive, the effectiveness of proposed policies remains uncertain. We performed a systematic review to assess the effectiveness of introducing RMC policies into health facilities providing intrapartum services.
We included randomized and non-randomized controlled studies evaluating the effectiveness of introducing RMC policies into health facilities. We searched PubMed, CINAHL, LILACS, AJOL, WHO RHL, and Popline, along with ongoing trials registers (ISRCT register, ICTRP register), and the White Ribbon Respectful Maternity Care Repository. Included studies were assessed for risk of bias. Certainty of evidence was assessed using GRADE criteria.
Five studies were included. All were undertaken in Africa (Kenya, Tanzania, Sudan, South Africa), and involved a range of components. Two were cluster RCTs, and three were before/after studies. In total, over 8000 women were included at baseline and over 7500 at the endpoints. Moderate certainty evidence suggested that RMC interventions increases women's experiences of respectful care (one cRCT, approx. 3000 participants; adjusted odds ratio (aOR) 3.44, 95% CI 2.45-4.84); two observational studies also reported positive changes. Reports of good quality care increased. Experiences of disrespectful or abusive care, and, specifically, physical abuse, were reduced. Low certainty evidence indicated fewer accounts of non-dignified care, lack of privacy, verbal abuse, neglect and abandonment with RMC interventions, but no difference in satisfaction rates. Other than low certainty evidence of reduced episiotomy rates, there were no data on the pre-specified clinical outcomes.
Multi-component RMC policies appear to reduce women's overall experiences of disrespect and abuse, and some components of this experience. However, the sustainability of the demonstrated effect over time is unclear, and the elements of the programmes that have most effect have not been examined. While the tested RMC policies show promising results, there is a need for rigorous research to refine the optimum approach to deliver and achieve RMC in all settings.
多项研究已经确定，分娩期间的虐待行为可能成为使用医疗设施的障碍。尽管人们普遍认为尊重产妇护理（RMC）是一项基本人权，也是每个孕妇都应得到的优质分娩期护理的重要组成部分，但拟议政策的有效性仍不确定。我们进行了系统评价，以评估在提供分娩期服务的医疗设施中引入 RMC 政策的效果。
我们纳入了评估在医疗设施中引入 RMC 政策对效果的随机和非随机对照研究。我们检索了 PubMed、CINAHL、LILACS、AJOL、WHO RHL 和 Popline，以及正在进行的试验登记处（ISRCTN 登记处、ICTRP 登记处）和白丝带尊重产妇护理知识库。纳入的研究进行了偏倚风险评估。使用 GRADE 标准评估证据确定性。
共纳入 5 项研究。这些研究均在非洲（肯尼亚、坦桑尼亚、苏丹、南非）进行，涉及多种内容。其中 2 项为整群 RCT，3 项为前后对照研究。总共在基线时纳入了 8000 多名女性，在终点时纳入了超过 7500 名女性。中等确定性证据表明，RMC 干预措施增加了女性获得尊重的护理体验（一项 cRCT，约 3000 名参与者；调整后的优势比（aOR）3.44，95%CI 2.45-4.84）；两项观察性研究也报告了积极的变化。优质护理的报告增加了。不尊重或虐待行为，特别是身体虐待行为减少了。低确定性证据表明，RMC 干预措施减少了不体面护理、缺乏隐私、言语虐待、忽视和遗弃的报告，但满意度没有差异。除了 RMC 干预措施减少会阴切开率的低确定性证据外，没有关于预先指定的临床结局的数据。
多组分 RMC 政策似乎减少了女性整体上不尊重和虐待的体验，以及这种体验的某些方面。然而，随着时间的推移，这种效果的可持续性尚不清楚，也没有研究方案的各个组成部分对效果的影响最大。虽然经过测试的 RMC 政策显示出有希望的结果，但需要进行严格的研究来完善在所有环境中提供和实现 RMC 的最佳方法。
