Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Department of Psychology, University of Karachi, Karachi, Pakistan.
Glob Health Sci Pract. 2023 Feb 28;11(1). doi: 10.9745/GHSP-D-22-00267.
Respectful maternity care (RMC) during childbirth is an integral component of quality of care. However, women's experiences of mistreatment are prevalent in many low- and middle-income countries. This is a complex phenomenon that has not been well explored from a behavioral science perspective. We aimed to understand the behavioral drivers of mistreatment during childbirth among maternity care staff at public health facilities in the Sindh province of Pakistan.
Applying the COM-B (capability-opportunity-motivation that leads to behavior change) model, we conducted semistructured in-depth interviews among clinical and nonclinical staff in public health facilities in Thatta and Sujawal, Sindh, Pakistan. Data were analyzed using thematic deductive analysis, and findings were synthesized using the COM-B model.
We identified several behavioral drivers of mistreatment during childbirth: (1) institutional guidelines on RMC and training opportunities were absent, resulting in a lack of providers' knowledge and skills; (2) facilities lacked the infrastructure to maintain patient privacy and confidentiality and did not permit males as birth companions; (3) lack of provider performance monitoring system and patient feedback mechanism contributed to providers not feeling appreciated or recognized. Staff bias against patients from lower castes contributed to patient abuse and mistreatment. The perspectives of clinical and nonclinical staff overlapped regarding potential drivers of mistreatment during childbirth.
Addressing mistreatment during childbirth requires improving the knowledge and capacity of maternity staff on RMC and psychosocial support to enhance their understanding of RMC. At the health facility level, governance and accountability mechanisms in routine supervision and monitoring of staff need to be improved. Patients' feedback should be incorporated for continuous improvement in providing maternity care services that meet patients' preferences and needs.
分娩期间的尊重产妇护理（RMC）是护理质量的一个组成部分。然而，在许多中低收入国家，妇女遭受虐待的情况很普遍。这是一个复杂的现象，尚未从行为科学的角度进行充分探讨。我们旨在了解巴基斯坦信德省公立卫生机构的产妇保健人员在分娩期间虐待行为的行为驱动因素。
应用 COM-B（能够导致行为改变的能力-机会-动机）模型，我们在巴基斯坦信德省萨塔瓦和苏贾瓦尔的公立卫生机构对临床和非临床工作人员进行了半结构化深入访谈。使用主题演绎分析对数据进行分析，并使用 COM-B 模型综合研究结果。
我们确定了分娩期间虐待行为的几个行为驱动因素：（1）缺乏关于 RMC 的机构准则和培训机会，导致提供者缺乏知识和技能；（2）设施缺乏维护患者隐私和保密性的基础设施，不允许男性作为分娩伴侣；（3）缺乏提供者绩效监测系统和患者反馈机制导致提供者感觉不被赞赏或认可。工作人员对低种姓患者的偏见导致了患者的虐待和虐待。临床和非临床工作人员对分娩期间虐待行为的潜在驱动因素的看法重叠。
要解决分娩期间的虐待问题，需要提高产妇保健人员对 RMC 和社会心理支持的知识和能力，以增强他们对 RMC 的理解。在卫生机构层面，需要改进常规监督和监测工作人员的治理和问责机制。应纳入患者的反馈意见，以便不断改进提供满足患者偏好和需求的产妇保健服务。
