Women’s perception on rights during pregnancy and childbirth

Background: The Nigerian health system as a whole has been plagued by problems associated with the quality of service, including but not limited to unfriendly staff attitudes to patients, inadequate skills, decaying infrastructures, and chronic shortages of essential drugs. Approximately two-thirds of all Nigerian women deliver outside of health facilities and without the presence of medically skilled attendants.  The study was carried out to assess the awareness and knowledge of women regarding their rights during pregnancy and childbirth, and to explore the extent to which women’s rights were respected during pregnancy and childbirth.Methods: This descriptive study was conducted among randomly selected 140 women at Mother and Child Hospital, Akure, Ondo state, Nigeria. Data was collected with a pretested questionnaire and was analysed using Statistical Packages for Social Sciences (SPSS) version 21.Results: Findings revealed that majority (76.9%) of the women had a fair knowledge of their rights in pregnancy and childbirth, with the source of knowledge majorly from their friends. Right to information, informed consent and refusal, even distribution of healthcare services, maintenance of attainable level of health regarding proper monitoring were fairly observed by the health care providers. Right of women against verbal and physical abuse, privacy, treatment with dignity and respect were least accorded to women.Conclusions: Respective Maternity Care remains a challenge that demands policy interventions in most public health facilities to enhance positive endorsement and utilisation of maternal and health care services

There is no ideal place, but it is best to deliver in a hospital: expectations and experiences of health facility-based childbirth in Imo state, Nigeria

Introduction: annually, about 67,000 of the 196,000 maternal deaths in sub-Saharan Africa occur in Nigeria, second only to India. Though health facility childbirths have been linked with improved health outcomes, evidence suggests that experiences of care influence future use. This study explored the expectations and experiences of health facility childbirths for mothers in Imo State, Nigeria. Methods: this qualitative study utilised in-depth interviews with 22 purposively sampled mothers who delivered in different types (private and public) and levels (primary, secondary, tertiary) of health facilities in Imo State. Interviews were digitally recorded, transcribed verbatim and analysed following Braun and Clarke´s six-stage thematic analysis. Results: four key themes emerged from the analysis. Generally, women saw value in facility-based delivery. However, they had varying expectations for seeking care with different care providers. For those who sought care from public hospitals, the availability of “experts” was a key driver. While those who used private facilities went there because of their perceived empathy and dignity. However, while experiences of disrespect, abuse and health worker expectation for them to cooperate were reported in both public and private facilities, long waiting times, unconducive environments, and lack of privacy were experienced in public facilities. Conclusion: every woman deserves a positive experience of childbirth. To achieve this, mothers´ perceptions of different providers need to be heard. Going forward, strategies ensuring that both public and private sector providers can guarantee holistic care for every woman will be key to realising the maternal mortality target of the Sustainable Development Goal 3

“Is she pregnant with Jesus?” exploring sociocultural obstacles to following medical advice in the context of stillbirth prevention in Nigeria

Background: Each year 182,000 babies are stillborn in Nigeria, representing nearly 10% of the annual global stillbirth burden. Imo state in south-eastern Nigeria has one of the highest levels of maternal health service access in Nigeria, yet this has not translated into good pregnancy outcomes. Many stillbirth prevention initiatives in Nigeria focus on maternal health education but empirical evidence suggests that sociocultural factors impact healthcare choices and outcomes. This study aims to explore women’s and health workers’ perspectives of the sociocultural barriers to following medical advice during pregnancy and childbirth, and specifically how these barriers may contribute to an increased risk of stillbirth. This study is part of a broader community-based stillbirth prevention mixed-methods research in Imo State, Nigeria. Methods: A qualitative descriptive study was conducted using in-depth interviews and focus group discussions. 38 participants were purposively recruited; 20 women and 18 health workers. Audio recordings were transcribed, translated and analysed using inductive thematic analysis. Results: Four themes were identified: (1) trust, where scepticism about health worker motives or competence and trust in community informal networks were highlighted (2) power dynamics within families, with husbands and older female relatives influencing health decisions; (3) personal and community beliefs that undermine confidence in medical interventions, including a pervasive stigma associated with caesarean section; and (4) grassroots proposals for solutions, emphasising the importance of a whole-community approach to maternal health education, mobilising peer voices, engaging traditional leaders and training of traditional birth attendants. Conclusion: This study provides insights into the sociocultural barriers to following medical advice during pregnancy in Nigeria, which include a lack of trust in health professionals, power dynamics within a woman’s family, and entrenched cultural and religious beliefs that oppose medical intervention. Women’s decisions about pregnancy and childbirth are heavily influenced by family and cultural norms. Culturally sensitive, community-wide interventions which aim to rebuild trust in the health system, involve women as decision-makers in antenatal care, and engage religious and traditional leaders would be beneficial for improving outcomes

Sociodemographic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya

Purpose: To clarify sociodemographic and socioeconomic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya. Design: A descriptive cross-sectional study conducted in a government national referral hospital. Respondents were 109 systematically sampled mothers who delivered in the study hospital. Mothers’ experiences of intrapartum care were assessed using three subscales from the Experience of Psychosocial Care and Communication during Childbirth Questionnaire (effective communication; emotional support; and respect, care and dignity). Simple and multivariable logistic regression analyses were used to assess associations between sociodemographic factors, socioeconomic factors and mothers’ experiences of intrapartum care. Findings: The majority of respondents were aged 20–24 years (45.9%), married (71.6%), had primary school education (48.6%) and were self-employed (45%). The majority reported positive experiences of communication, respect, dignity and emotional support from their midwives. Being an older mother was significantly associated with a positive experience of intrapartum care (adjusted odds ratio [AOR] 7.32; 95% Confidence Interval (CI): 1.17–45.9). The odds of having a positive intrapartum care experience was significantly lower among women with parity of four or more (AOR 0.09; 95% CI: 0.01–0.56) and tertiary education (AOR 0.11; 95% CI: 0.01–0.91). Conclusion: Attention to the use of respectful language and adherence to clear communication must be an integral part of quality improvement for midwifery care in Kenya

Quality of Respectful Maternal Care Practices in Delivery Room at AL- Zahra Teaching Hospital

Background: The concept of respectful maternity care respectful maternity care acknowledges that women’s experiences of childbirth are vital components of health care quality and that their “autonomy, dignity, feelings, choices, and preferences must be respected. Methodology: A cross-sectional descriptive to Assess quality of respectful maternal care in delivery room and to find out relationship between quality of respectful maternal care   in delivery room with their demographic data (, the period of the study is from December, 1st, 2022 to May, 23th, 2023. A non-probability (Purposive sample) sample of one hundred fourteen (114) women who are attended Zahra teaching hospital. Data analysis by using descriptive statistics (percentage, frequency & mean of score) and inferential statistics (Chi-Square).     Results: The study show majority of study subjects from urban area and housewife and there was a significant association between number of children and abuse free care domains Conclusion: The researcher can conclude that responses of postpartum women related to abuse and discrimination were disagree. Recommendations: Recommendations about care of episiotomy and put them in the delivery rooms of hospitals, emphasizing audio-visual mass media to publishing information about perineal care after episiotomy and Health providers in hospitals and health centers should educate women about perineal care after episiotomy during antenatal visit

Content and design of respectful maternity care training packages for health workers in sub‐Saharan Africa: Scoping review

Background Training health workers might facilitate respectful maternity care (RMC); however, the content and design of RMC training remain unclear. Objective To explore the content and design of RMC training packages for health workers in sub‐Saharan Africa. Search Strategy MEDLINE, EMBASE, CINAHL Complete, Web of Science Core Collections, SCOPUS, and grey literature sources (including websites of RMC‐focused key organizations and Ministries of Health) were searched for journal papers, reports, and training guides from January 2006 up to August 2022. Selection Criteria There were no restrictions on study designs, language, or health‐worker cadre. Two reviewers independently screened results. Data Collection and Analysis Key data, including training content and methods used, were extracted and summarized. Main Results Thirty‐two citations from 26 studies/programs were identified (24 journal papers, 5 manuals/guides, 2 reports and 1 PhD thesis), with 27 citations from 22 studies informing the review findings. About half of all conducted studies were from East Africa. The most common topics in RMC trainings were communication, privacy and confidentiality, and human resources. Most trainings were multicomponent and appear to be largely in‐service training. Health workers providing direct care to women, compared with non‐clinical staff such as receptionists and cleaners, were the only recipients of training in most studies (81.8%). Two broad categories of training methods/tools were identified: workshop‐based and action‐based. Over 90% of the studies assessed impact of the training, with a majority focused on impacts on maternal health and care; however, half of the latter studies did not appear to have feedback mechanisms in place for implementing change. Conclusions The content and design of RMC training in sub‐Saharan Africa are multifaceted, suggesting the complexity of implementing/promoting RMC. Some progress has been made; however, missed opportunities in training remain with respect to study populations, training topics, cadres, and feedback mechanisms

Healthcare providers’ perspectives of disrespect and abuse in maternity care facilities in Nigeria: a qualitative study

Objectives To explore healthcare providers’ perspectives of disrespect and abuse in maternity care and the impact on women’s health and well-being. Methods Qualitative interpretive approach using in-depth semi-structured interviews with sixteen healthcare providers in two public health facilities in Nigeria. Interviews were audio-recorded, transcribed, and analysed thematically. Results Healthcare providers’ accounts revealed awareness of what respectful maternity care encompassed in accordance with the existing guidelines. They considered disrespectful and abusive practices perpetrated or witnessed as violation of human rights, while highlighting women’s expectations of care as the basis for subjectivity of experiences. They perceived some practices as well-intended to ensure safety of mother and baby. Views reflected underlying gender-related notions and societal perceptions of women being considered weaker than men. There was recognition about adverse effects of disrespect and abuse including its impact on women, babies, and providers’ job satisfaction. Conclusions Healthcare providers need training on how to incorporate elements of respectful maternity care into practice including skills for rapport building and counselling. Women and family members should be educated about right to respectful care empowering them to report disrespectful practices

Disrespect and abuse in maternity care: women’s experiences and healthcare providers’ perspectives in Nigeria

"A thesis submitted to the University of Bedfordshire, in partial fulfilment of the requirements for the degree of Doctor of Philosophy'.Background: Disrespect and abuse (D&A) in maternity care facilities is a major public health issue affecting women worldwide. There are reports of high prevalence of D&A during facility-based childbirth in Nigeria; however, studies that explore the issue in-depth from women’s and maternity care professionals’ perspectives are sparse. This study provides an understanding of women’s experiences of and healthcare providers’ perspectives on D&A during maternity care in health facilities in Benue State, Nigeria. Methods: This is a qualitative phenomenological study conducted in two phases. Using purposive sampling, focus group discussions were conducted with women (n=32) in the first phase, and in the second, semi-structured interviews with women (n=14) and healthcare providers (n=16) from various professional backgrounds, working in two maternity care facilities. All the women received maternity care in facilities and had experienced at least one incident of D&A. The sample size was determined based on data saturation. All data collected were transcribed and analysed in NVivo version 11 using a six-stage thematic analysis. Findings: Women perceived incidents such as being shouted at and the use of abusive language as a common practice and described these incidents as devaluing and dehumanising to their sense of dignity. They also highlighted the importance of accessing facilities for safe childbirth and expressed that the experiences of D&A may not impact negatively on their intended use of but the choice of maternity facilities. However, their accounts reflected a lack of choice and the adverse effect of D&A on their emotional wellbeing. Healthcare providers recognised D&A as a violation of the human rights of women accessing maternity facilities, but usually highlighted components of respectful care with a good awareness about what it encompasses. They often considered the experiences of D&A as subjective to the women and based on their expectations of care. Their views also reflected underlying gender-related notions and societal perceptions of women being considered weaker than men. The professionals recognised several adverse effects of D&A, including its impact on women, newborns and on their own job satisfaction. Both women and professionals perceived some of the disrespectful and abusive actions were not intended to cause harm but to ensure the health and safety of the mother and her child. Additionally, they reported several factors associated with service users, health professionals and the facilities perceived to contribute to the D&A of women. Conclusion: The participants’ accounts showed that the application of respectful care in everyday maternity practice is inadequate in Nigeria. The findings reveal the need for policy and practice interventions to address the issue urgently through preventive measures such as empowering women through education to reinforce their right to respectful care. It reflects the need for sensitising and training health professionals on the importance of providing respectful care and how its elements can be incorporated into everyday practice. The underlying gender-related notion highlights the need for interventions at wider socio-political and community levels including the importance of educating family members about their right to respectful care and empowering them to report disrespectful practices

Development and early validation of questionnaires to assess system level factors affecting male partners' attendance at childbirth in LMICs

Background: There is evidence that a woman who receives continuous labour support from a chosen companion can have shorter labour duration, is more likely to give birth without medical interventions, and report a satisfying childbirth experience. These outcomes result from the beneficial effects of emotional and practical support from the woman's chosen companion, and care provided by health providers. When a woman's chosen companion is her male partner, in addition to the above benefits, his presence can promote his bonding with the baby, and shared parenthood. However, there may be healthcare system barriers, including organisational, management and individual (staff) factors, that inhibit or restrict women's choice of companion. There are currently no suitable survey tools that can be used to assess the system level factors affecting the implementation of male partners' attendance at childbirth in low- and middle- income countries (LMICs).Methods: We designed two questionnaires to help to address that gap: the Male Partners' Attendance at Childbirth-Questionnaire for Heads of Maternity Units (MPAC-QHMUs); and the Male Partners' Attendance at Childbirth-Questionnaire for Maternity Staff (MPAC-QMS). We carried out an extensive review to generate initial items of the two questionnaires. We assessed the content and face validity of the two questionnaires in a three-round modified Delphi study.Results: The Male Partners' Attendance at Childbirth-Questionnaire for Heads of Maternity Units (MPAC-QHMUs) focused on organisational and management factors. The Male Partners' Attendance at Childbirth-Questionnaire of Maternity Staff (MPAC-QMS) focused on individual staff factors. The final MPAC-QHMUs and MPAC-QMS included items which garnered over 80% content relevance according to the experts' rating. After all three consensus rounds of the Delphi study, 43 items were retained for the MPAC-QHMUs and 61 items were retained for the MPAC-QMS.Conclusions: The MPAC-QHMUs and the MPAC-QMS may help understanding of barriers affecting male partners' attendance at childbirth in LMICs in order to devise implementation strategies to enable wider availability and to maximize women's choices during labour and childbirth. The MPAC-QHMUs and the MPAC-QMS as newly-developed questionnaires require further validation of their acceptability and feasibility in different cultural contexts, and languages.</p