School of Medicine, University of California, San Francisco (UCSF), 550 16th St, 3rd Floor, San Francisco, CA, 94158, USA.
UCSF Institute for Global Health Sciences, San Francisco, USA.
Reprod Health. 2020 Jun 3;17(1):85. doi: 10.1186/s12978-020-0909-0.
Effective communication and respect for women's autonomy are critical components of person-centered care. Yet, there is limited evidence in low-resource settings on providers' perceptions of the importance and extent of communication and women's autonomy during childbirth. Similarly, few studies have assessed the potential barriers to effective communication and maintenance of women's autonomy during childbirth. We sought to bridge these gaps.
Data are from a mixed-methods study in Migori County in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical). Providers were asked structured questions on various aspects of communication and autonomy followed by open ended questions on why certain practices were performed or not. We conducted descriptive analysis of the quantitative data and thematic analysis of the qualitative data.
Despite acknowledging the importance of various aspects of communication and women's autonomy, providers reported incidences of poor communication and lack of respect for women's autonomy: 57% of respondents reported that providers never introduce themselves to women and 38% reported that women are never able to be in the birthing position of their choice. Also, 33% of providers reported that they did not always explain why they are doing exams or procedures and 73% reported that women were not always asked for permission before exams or procedures. The reasons for lack of communication and autonomy fall under three themes with several sub-themes: (1) work environment-perceived lack of time, language barriers, stress and burnout, and facility culture; (2) provider knowledge, intentions, and assumptions-inadequate provider knowledge and skill, forgetfulness and unconscious behaviors, self-protection and comfort, and assumptions about women's knowledge and expectations; and (3) women's ability to demand or command effective communication and respect for their autonomy-women's lack of participation, women's empowerment and provider bias.
Most providers recognize the importance of various aspects of communication and women's autonomy, but they fail to provide it for various reasons. To improve communication and autonomy, we need to address the different factors that negatively affect providers' interactions with women.
有效的沟通和尊重妇女自主权是以人为本的护理的关键组成部分。然而，在资源匮乏的环境中，关于提供者在分娩期间对沟通和妇女自主权的重要性和程度的看法的证据有限。同样，很少有研究评估在分娩期间进行有效沟通和维护妇女自主权的潜在障碍。我们试图弥合这些差距。
数据来自肯尼亚西部米戈里县的一项混合方法研究，共有 49 名产妇提供者（32 名临床和 17 名非临床）。提供者被问及有关沟通和自主权各个方面的结构化问题，然后对某些做法为何执行或不执行的问题进行开放式提问。我们对定量数据进行描述性分析，对定性数据进行主题分析。
尽管提供者承认沟通和妇女自主权的各个方面的重要性，但他们报告了沟通不畅和缺乏对妇女自主权尊重的情况：57%的受访者表示，提供者从不向妇女自我介绍，38%的受访者表示，妇女从未能够选择自己的分娩姿势。此外，33%的提供者报告说，他们并不总是解释为什么要进行检查或程序，73%的提供者报告说，在进行检查或程序之前，妇女并不总是被征求许可。缺乏沟通和自主权的原因属于三个主题，其中包含几个子主题：（1）工作环境-认为缺乏时间、语言障碍、压力和倦怠以及设施文化；（2）提供者的知识、意图和假设-提供者知识和技能不足、健忘和无意识行为、自我保护和舒适以及对妇女知识和期望的假设；（3）妇女要求或命令有效沟通和尊重其自主权的能力-妇女缺乏参与、妇女赋权和提供者偏见。
大多数提供者认识到沟通和妇女自主权各个方面的重要性，但由于各种原因未能提供。为了改善沟通和自主权，我们需要解决影响提供者与妇女互动的不同因素。
