Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Glob Health Sci Pract. 2023 Jun 21;11(3). doi: 10.9745/GHSP-D-22-00513.
Disrespect, abuse, discrimination, and lack of emotional support characterize intrapartum care in the health systems of many low- and middle-income countries. Although the World Health Organization (WHO) provides frameworks and guidelines to address this issue, no operational model exists that effectively incorporates WHO intrapartum care guidelines into routine public health services. We aimed to develop and pilot-test a theory-driven, service-delivery intervention package linking dignified care with perinatal mental health to promote psychosocially supportive and respectful maternity care (S-RMC) in public health facilities in Sindh, Pakistan.
Using a mixed-method, pre-post design, the study was implemented in 6 secondary-level public health facilities in 2 rural districts of Southern Sindh, Pakistan. Its development was guided by the COM-B framework and informed by a literature review, formative research, and consultative sessions with implementers. The intervention was implemented in March-September 2021 and compared women's experiences of S-RMC during childbirth at baseline (n=313) and endline (n=314). We used descriptive statistics and linear regression techniques for analysis.
A substantial reduction was observed in the cumulative level of overall mistreatment from baseline to endline, yielding a relative change of 50% (<.001). Similar change was evident across different types of mistreatment: physical abuse (75%), verbal abuse (72%), ineffective communication (60%), nonconfidential care (78%), health system conditions and constraints (25%), noninclusive care (28%), lack of supportive care (52%), and stigma and discrimination (82%). Furthermore, we observed a significant reduction in the proportion of women experiencing symptoms of anxiety and depression before and after the intervention.
This intervention built the capacity of maternity teams while improving accountability, health information systems, and governance measures. Given its promise to promote supportive and respectful childbirth in public health facilities, a large-scale effectiveness evaluation across diverse settings is warranted.
在许多中低收入国家的卫生系统中，分娩过程中存在不尊重、虐待、歧视和缺乏情感支持的情况。尽管世界卫生组织（WHO）提供了框架和准则来解决这个问题，但没有有效的运营模式将 WHO 分娩护理准则纳入常规公共卫生服务中。我们旨在开发和试点测试一个理论驱动的服务提供干预包，将有尊严的护理与围产期心理健康联系起来，以促进巴基斯坦信德省公共卫生设施中支持心理社会的尊重产妇护理（S-RMC）。
使用混合方法、前后设计，该研究在巴基斯坦信德省南部 2 个农村地区的 6 个二级公共卫生设施中实施。其开发由 COM-B 框架指导，并参考文献综述、形成性研究和与实施者的协商会议。干预措施于 2021 年 3 月至 9 月实施，并比较了基线（n=313）和终点（n=314）时女性在分娩时经历的 S-RMC。我们使用描述性统计和线性回归技术进行分析。
从基线到终点，整体虐待的累积水平显著下降，相对变化为 50%（<.001）。不同类型的虐待也发生了类似的变化：身体虐待（75%）、言语虐待（72%）、无效沟通（60%）、非保密护理（78%）、卫生系统状况和限制（25%）、非包容性护理（28%）、缺乏支持性护理（52%）和耻辱和歧视（82%）。此外，我们观察到干预前后焦虑和抑郁症状的女性比例显著下降。
该干预措施增强了产妇团队的能力，同时提高了问责制、卫生信息系统和治理措施。鉴于其在促进公共卫生设施中支持性和尊重性分娩方面的前景，需要在不同环境中进行大规模的有效性评估。
