Tumlinson Katherine, Britton Laura E, Williams Caitlin R, Wambua Debborah Muthoki, Onyango Dickens Otieno, Senderowicz Leigh
Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
Carolina Population Center, University of North Carolina at Chapel Hill, USA.
SSM Qual Res Health. 2022 Dec;2. doi: 10.1016/j.ssmqr.2022.100178. Epub 2022 Oct 11.
Public-sector healthcare providers in low- and middle-income countries are a primary source of family planning but their disrespectful (i.e., demeaning or insulting) treatment of family planning clients may impede free contraceptive choice. The construct of disrespect and abuse has been widely applied to similar phenomena in maternity care and could help to better understand provider mistreatment of family planning clients. With a focus on public-sector family planning provision in western Kenya, we aim to estimate the prevalence and impact of disrespect and abuse from a variety of perspectives and advance methodological approaches to measuring this construct in the context of family planning provision. We combine and triangulate data from a variety of sources across five counties in western Kenya, including 180 mystery clients, 253 third-party observations, eight focus group discussions, 19 key informant interviews, and two journey mapping workshops. Across both mystery client and third-party observations conducted in public-sector facilities in western Kenya, approximately one out of every ten family planning seekers was treated with disrespect by their provider. Family planning clients were frequently scolded for seeking family planning while unmarried or low parity, but mistreatment was not limited to women with these specific characteristics. Women were also insulted for such characteristics as body size or perceived sexual promiscuity. Qualitative data confirmed both that client disrespect is widespread and leads women to avoid family planning services even when they desire to use a contraceptive method, sometimes leading to unintended pregnancies. Key informants attribute disrespectful provider practices to both low technical skill as well as poor motivation stemming from both intrinsic values as well as extrinsic factors such as low wages and high caseloads. Possible solutions suggested by key informants included changes to recruitment and admission for Kenyan medical/nursing schools, as well as values clarification to shift provider motivations. Interventions to reduce mistreatment must be multi-layered and well-evidenced to ensure that family planning clients receive the person-centered care that enables them to achieve their contraceptive desires and reproductive freedom.
低收入和中等收入国家的公共部门医疗保健提供者是计划生育的主要来源，但他们对计划生育服务对象的不尊重（即贬低或侮辱）对待可能会阻碍免费避孕方法的选择。不尊重和虐待这一概念已被广泛应用于孕产妇保健中的类似现象，有助于更好地理解医疗保健提供者对计划生育服务对象的不当对待。以肯尼亚西部公共部门的计划生育服务为重点，我们旨在从多个角度估计不尊重和虐待的发生率及影响，并推进在计划生育服务背景下衡量这一概念的方法。我们整合并梳理了肯尼亚西部五个县各种来源的数据，包括180名神秘顾客、253次第三方观察、八次焦点小组讨论、19次关键信息人访谈以及两次行程映射研讨会。在肯尼亚西部公共部门设施进行的神秘顾客和第三方观察中，每十名寻求计划生育服务的人中约有一人受到提供者的不尊重对待。计划生育服务对象经常因未婚或低生育次数而寻求计划生育服务而受到责骂，但虐待并不局限于具有这些特定特征的女性。女性还因体型或被认为的性滥交等特征而受到侮辱。定性数据证实，对服务对象的不尊重现象普遍存在，导致女性即使希望使用避孕方法也会避开计划生育服务，有时会导致意外怀孕。关键信息人将提供者不尊重的行为归因于技术技能低下以及源于内在价值观以及诸如低工资和高工作量等外在因素的不良动机。关键信息人提出的可能解决方案包括改变肯尼亚医学/护理学校的招生和录取标准，以及进行价值观澄清以转变提供者的动机。减少虐待的干预措施必须是多层次且有充分证据的，以确保计划生育服务对象获得以人为主的护理，使他们能够实现避孕愿望和生殖自由。
