Abstract:
Over the last two decades, facility-based childbirths in Tanzania have only minimally increased by
10% partly because of healthcare providers’ disrespect and abuse (D&A) of women during childbirth. Although
numerous studies have substantiated women’s experience of D&A during childbirth by healthcare providers, few
have focused on how D&A occurred during the midwives’ actual care. This study aimed to describe from actual
observations the respectful and disrespectful care received by women from midwives during their labor period in
two hospitals in urban Tanzania.
Methods: This descriptive qualitative study involved naturalistic observation of two health facilities in urban
Tanzania. Fourteen midwives were purposively recruited for the one-on-one shadowing of their care of 24 women
in labor from admission to the fourth stage of labor. Observations of their midwifery care were analyzed using
content analysis.
Results: All the 14 midwives showed both respectful and disrespectful care and some practices that have not been
explicated in previous reports of women’s experiences. For respectful care, five categories were identified: 1)
positive interactions between midwives and women, 2) respect for women’s privacy, 3) provision of safe and timely
midwifery care for delivery, 4) active engagement in women’s labor process, and 5) encouragement of the motherbaby
relationship. For disrespectful care, five categories were recognized: 1) physical abuse, 2) psychological abuse,
3) non-confidential care, 4) non-consented care, and 5) abandonment of care. Two additional categories emerged
from the unprioritized and disorganized nursing and midwifery management: 1) lack of accountability and 2)
unethical clinical practices.
Conclusions: Both respectful care and disrespectful care of midwives were observed in the two health facilities in
urban Tanzania. Several types of physical and psychological abuse that have not been reported were observed.
Weak nursing and midwifery management was found to be a contributor to the D&A of women. To promote
respectful care of women, pre-service and in-service trainings, improvement of working conditions and
environment, empowering pregnant women, and strengthening health policies are crucial.
