Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF) School of Medicine, 550 16th St, San Francisco, CA 94158, USA.
UCSF Institute for Global Health Sciences, 550 16th St, San Francisco, CA 94158, USA.
Health Policy Plan. 2020 Jun 1;35(5):577-586. doi: 10.1093/heapol/czaa009.
Disrespect and abuse during childbirth are violations of women's human rights and an indicator of poor-quality care. Disrespect and abuse during childbirth are widespread, yet data on providers' perspectives on the topic are limited. We examined providers' perspectives on the frequency and drivers of disrespect and abuse during facility-based childbirth in a rural county in Kenya. We used data from a mixed-methods study in a rural county in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical) in 2016. Providers were asked structured questions on disrespect and abuse, followed by open-ended questions on why certain behaviours were exhibited (or not). Most providers reported that women were often treated with dignity and respect. However, 53% of providers reported ever observing other providers verbally abuse women and 45% reported doing so themselves. Observation of physical abuse was reported by 37% of providers while 35% reported doing so themselves. Drivers of disrespect and abuse included perceptions of women being difficult, stress and burnout, facility culture and lack of accountability, poor facility infrastructure and lack of medicines and supplies, and provider attitudes. Provider bias, training and women's empowerment influenced how different women were treated. We conclude that disrespect and abuse are driven by difficult situations in a health system coupled with a facilitating sociocultural environment. Providers resorted to disrespect and abuse as a means of gaining compliance when they were stressed and feeling helpless. Interventions to address disrespect and abuse need to tackle the multiplicity of contributing factors. These should include empowering providers to deal with difficult situations, develop positive coping mechanisms for stress and address their biases. We also need to change the culture in facilities and strengthen the health systems to address the system-level stressors.
在分娩过程中受到不尊重和虐待是侵犯妇女人权的行为，也是护理质量差的一个指标。在分娩过程中不尊重和虐待的情况很普遍，但关于提供者对这一问题的看法的数据有限。我们研究了肯尼亚一个农村县的提供者对医疗机构分娩过程中不尊重和虐待的频率及其驱动因素的看法。我们使用了 2016 年在肯尼亚西部一个农村县进行的一项混合方法研究的数据，该研究涉及 49 名产妇提供者（32 名临床提供者和 17 名非临床提供者）。提供者被问及关于不尊重和虐待的结构化问题，随后被问及某些行为表现（或不表现）的原因。大多数提供者报告说，妇女经常受到尊重和尊重。然而，53%的提供者报告说曾观察到其他提供者辱骂妇女，45%的提供者自己也这样做过。37%的提供者报告说观察到身体虐待，而 35%的提供者自己也这样做过。不尊重和虐待的驱动因素包括对妇女的困难、压力和倦怠、机构文化和缺乏问责制、不良的机构基础设施和缺乏药品和用品以及提供者态度的看法。提供者的偏见、培训和妇女赋权影响了不同妇女的待遇。我们的结论是，不尊重和虐待是由卫生系统中的困难情况以及有利的社会文化环境共同驱动的。当提供者感到压力和无助时，他们会诉诸不尊重和虐待，以获得顺从。解决不尊重和虐待问题的干预措施需要解决多种促成因素。这些措施应包括授权提供者处理困难情况，为压力发展积极的应对机制，并解决他们的偏见。我们还需要改变设施文化，加强卫生系统，以解决系统层面的压力源。
