University of California San Francisco, 550 16th St, 3rd Floor, San Francisco, CA 94158, USA.
University of Malawi Kamuzu College of Nursing, P/Bag 1, Lilongwe, Malawi.
Midwifery. 2022 Sep;112:103403. doi: 10.1016/j.midw.2022.103403. Epub 2022 Jun 9.
Access to high-quality, respectful care is a basic human right. A lack of respectful care during childbirth is associated with poor outcomes and can negatively influence care-seeking and maternal mental health. We aimed to describe how women perceive their experience of maternity care in Malawi.
We implemented a cross-sectional survey of women (n = 660) who delivered in 25 birth facilities in four districts in Malawi in March 2020 using a validated 30-item, 90-point person-centered maternity care (PCMC) scale. We used descriptive statistics to examine women's experience of care and analyzed bivariable and multivariable mixed-effects models to evaluate predictors of PCMC. Statistical models accounted for clustering of women at the facility level and included maternal age, marital status, education, parity, mother or infant complications, timing of antenatal care (ANC), provider cadre and gender, facility type and sector, and district.
Mean PCMC score was 57.5 (range 21-84), with the lowest score (12.4 of 27 points) in communication and autonomy. Women reported: being prohibited from having a birth companion during labor (49.4%) or delivery (60.3%); providers did not introduce themselves (81.1%); providers did not ask consent before procedures/examinations (42.4%); women felt they could not ask questions (40.9%); and were not involved in care decisions (61.5%). Few women reported being frequently abused physically (2%) or verbally (3.5%); almost all had water/electricity available (>95%). In bivariate analyses, statistically significant positive associations were found between PCMC score and early ANC, male accompaniment to the facility, male provider, and a lack of complications; all associations remained at least potentially statistically significant in multivariable modeling.
Physical and verbal abuse and a lack of basic amenities were rare, while a lack of communication with patients and social support were common. Maternal characteristics (like timing of ANC and maternal or newborn complications) were predictors of RMC, while facility/system factors, like facility type and sector, were not. Continued efforts to improve respectful care will require strengthening provider communication skills and encouraging patient and companion involvement in care.
获得高质量、尊重的护理是一项基本人权。分娩过程中缺乏尊重的护理与不良结局有关，并可能对寻求护理和产妇心理健康产生负面影响。我们旨在描述马拉维妇女如何看待她们的分娩护理体验。
我们于 2020 年 3 月在马拉维四个地区的 25 个分娩场所对 660 名产妇实施了一项横断面调查，使用经过验证的 30 项 90 分的以产妇为中心的产时护理（PCMC）量表。我们使用描述性统计来检查妇女的护理体验，并分析了两变量和多变量混合效应模型来评估 PCMC 的预测因素。统计模型考虑了设施层面的妇女聚类，并包括了产妇年龄、婚姻状况、教育程度、产次、母婴并发症、产前护理（ANC）时间、提供者职称和性别、设施类型和部门以及地区。
PCMC 平均得分为 57.5（范围 21-84），沟通和自主权得分最低（27 分中的 12.4 分）。妇女报告：分娩时（49.4%）或分娩时（60.3%）禁止有分娩陪伴者；提供者不自我介绍（81.1%）；提供者在进行程序/检查前未征得同意（42.4%）；妇女觉得她们不能提问（40.9%）；并且不参与护理决策（61.5%）。很少有妇女报告经常受到身体（2%）或言语（3.5%）虐待；几乎所有妇女都有水电供应（>95%）。在单变量分析中，PCMC 评分与 ANC 时间早、男性陪同到医疗机构、男性提供者以及缺乏并发症之间存在统计学上显著的正相关；所有关联在多变量建模中仍然至少具有潜在统计学意义。
身体和言语虐待以及缺乏基本设施的情况很少见，而与患者缺乏沟通和社会支持则很常见。产妇特征（如 ANC 时间和母婴并发症）是 RMC 的预测因素，而设施/系统因素，如设施类型和部门，则不是。继续努力改善尊重的护理将需要加强提供者的沟通技巧，并鼓励患者和同伴参与护理。
