Assessment of magnitude and factors associated with disrespectful and abusive maternity care during childbirth in health facilities in Tabora municipality

Abstract

Background: Despite considerable qualitative evidence reporting disrespectful and abusive (D&A) treatment of women during childbirth in health facilities by health providers, there is limited data regarding the actual prevalence and associated factors from the perspective of both mothers and health workers. Aim: This study aimed at assessing the magnitude and factors associated with disrespectful and abusive maternity care during childbirth in health facilities as perceived by both mothers and health workers in Tabora Municipality. Methodology: This is a hospital based cross-sectional descriptive study which involved both mothers and health care workers from two hospitals. Non probability sampling techniques was used. Data collection was done using both quantitative methods through interviewer administered questionnaires and qualitative methods through Focus Group Discussion (FGD) and Key Informant Interview (KII). A total of 263 mothers were interviewed, 4 FGD and 8 KII were conducted. Quantitative data analysis was done using SPSS version 16. Chi - square tests were used to assess the relationship between dependent and independent variables. P – Value of < 0.05 was considered significant. Multivariate logistic regression analysis was employed to explain the association between social demographic variables and disrespectful and abusive maternity care. Thematic analysis was done for qualitative data. Results: In this study 31.2 % of the interviewed mothers reported having perceived at least one form of disrespectful and abusive maternity care as defined by Bowser and Hill (2010) during health facility childbirth. The types of disrespectful and abusive maternity care included “non-dignified care” (17.9%), “neglect” (11.4%), “non confidential care” (6.1%), “physical abuse” (5.7%), non - consented care and informal payments. Mothers aged < 21 years and those aged 21 -31 years were more likely to be disrespected and abused compared to those aged 32 - 42 years [ AOR= 4.30 (1.09 -17.0) ; p =0.04] and [AOR = 3.60(1.10 – 12.03);p- value =0.04] respectively. Factors which contribute to disrespectful and abusive maternity care have been found to be limited accountability mechanisms and staff frustration as a result of heavy workload and poor motivation. Conclusion: This study has shown that the proportion of the perceived D & A during health facility childbirth in Tabora Municipality is 31.2 %. Also it has highlighted the factors associated with D & A maternity care at health facilities during childbirth. The generated knowledge of the prevalence of D&A and the contextual factors is critical in developing interventions for reduction of maternal mortality and morbidity.