Brazy-Nancy Emilia, Mattern Chiarella, Rakotonandrasana Brigitte Irene, Ravololomihanta Voahirana, Norolalao Patricia, Kapesa Laurent
Institut Pasteur de Madagascar, BP 1274 Ambatofotsikely Avaradoha, Antananarivo 101, Madagascar.
Ministry of Public Health, 9 Printsy Ratsimamanga Ambohidahy, Antananarivo 101, Madagascar.
Heliyon. 2023 Feb 23;9(3):e13905. doi: 10.1016/j.heliyon.2023.e13905. eCollection 2023 Mar.
In Madagascar, a country where maternal mortality remains high, the quality of obstetric care as perceived by users has been little explored. In this paper, we examine the perception of the quality of care in rural areas, by identifying women's experiences and expectations for basic and emergency obstetric care and how providers are meeting them. Data were collected in 2020, in three rural regions (Fenerive-Est, Manakara and Miandrivazo). 58 semi-structured interviews were conducted with women who had given birth in basic health centers or at home, and with other key informants including caregivers, birth attendants (known as ), grandmothers and community agents. 6 focus groups took place with mothers who had given birth at home and at a basic health centers and 6 observations took place during prenatal consultations. This article highlights the major dysfunctions perceived in the services offered and their influence on healthcare use. The women highlighted a lack of consideration of their expectations in obstetric care, with a defective caregiver/patient relationship, unforeseen costs and inadequate infrastructures incapable of guaranteeing intimacy. The women also complained of a lack of consideration of their (cultural prohibitions that can lead to misfortune) that surround pregnancy. These local practices conflict with the medical requirements of priority interventions in maternal care, and the respect of these practices by the women leads to reprimands and humiliation from caregivers. This obstetric violence, which emanates from the structure of society, gender relations and the biomedical practices governing pregnancy and childbirth in health facilities in Madagascar, constitutes an obstacle to the use of obstetric services. We hope that this description of the various dimensions of obstetric violence in Madagascar will make it possible to identify the structural obstacles limiting the capacity to provide quality care and to engender positive improvements in obstetric care in Madagascar.
在马达加斯加这个孕产妇死亡率仍然很高的国家，使用者对产科护理质量的看法鲜有研究。在本文中，我们通过确定妇女在基本和紧急产科护理方面的经历和期望，以及提供者如何满足这些期望，来研究农村地区对护理质量的看法。2020年，在三个农村地区（费纳里弗-埃斯特、马纳卡拉和米亚德里瓦佐）收集了数据。对在基本卫生中心或家中分娩的妇女以及包括护理人员、助产士（称为 ）、祖母和社区工作人员在内的其他关键信息提供者进行了58次半结构化访谈。与在家中和基本卫生中心分娩的母亲进行了6次焦点小组讨论，并在产前咨询期间进行了6次观察。本文强调了所提供服务中存在的主要功能失调及其对医疗保健使用的影响。妇女们强调，产科护理中没有考虑到她们的期望，护理人员与患者的关系存在缺陷，出现意外费用，基础设施不足，无法保证隐私。妇女们还抱怨说，她们在怀孕方面的 （可能导致不幸的文化禁忌）没有得到考虑。这些当地习俗与孕产妇护理优先干预措施的医疗要求相冲突，妇女对这些习俗的尊重导致护理人员的斥责和羞辱。这种源于社会结构、性别关系以及马达加斯加卫生设施中管理怀孕和分娩的生物医学实践的产科暴力，构成了使用产科服务的障碍。我们希望，对马达加斯加产科暴力各个层面的描述将有助于识别限制提供优质护理能力的结构性障碍，并促使马达加斯加的产科护理得到积极改善。
