Measuring mistreatment of women throughout the birthing process: implications for quality of care assessments.

Reproductive Health Matters Pub Date : 2018-01-01 Epub Date: 2018-09-13 DOI:10.1080/09688080.2018.1502018
Timothy Abuya, Pooja Sripad, Julie Ritter, Charity Ndwiga, Charlotte E Warren
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引用次数: 18

Abstract

Measuring mistreatment and quality of care during childbirth is important in promoting respectful maternity care. We describe these dimensions throughout the birthing process from admission, delivery and immediate postpartum care. We observed 677 client-provider interactions and conducted 13 facility assessments in Kenya. We used descriptive statistics and logistic regression model to illustrate how mistreatment and clinical process of care vary through the birthing process. During admission, the prevalence of verbal abuse was 18%, lack of informed consent 59%, and lack of privacy 67%. Women with higher parity were more likely to be verbally abused [AOR: 1.69; (95% CI 1.03,2.77)]. During delivery, low levels of verbal and physical abuse were observed, but lack of privacy and unhygienic practices were prevalent during delivery and postpartum (>65%). Women were less likely to be verbally abused [AOR: 0.88 (95% CI 0.78, 0.99)] or experience unhygienic practices, [AOR: 0.87 (95% CI 0.78, 0.97)] in better-equipped facilities. During admission, providers were observed creating rapport (52%), taking medical history (82%), conducting physical assessments (5%). Women's likelihood to receive a physical assessment increased with higher infrastructural scores during admission [AOR: 2.52; (95% CI 2.03, 3.21)] and immediately postpartum [AOR 2.18; (95% CI 1.24, 3.82)]. Night-time deliveries were associated with lower likelihood of physical assessment and rapport creation [AOR; 0.58; (95% CI 0.41,0.86)]. The variability of mistreatment and clinical quality of maternity along the birthing process suggests health system drivers that influence provider behaviour and health facility environment should be considered for quality improvement and reduction of mistreatment.

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衡量妇女在整个分娩过程中的虐待:对护理质量评估的影响。
衡量分娩期间的虐待和护理质量对于促进尊重产妇护理非常重要。我们描述这些维度在整个分娩过程中,从入院,分娩和立即产后护理。我们在肯尼亚观察了677次客户与供应商的互动,并进行了13次设施评估。我们使用描述性统计和逻辑回归模型来说明在分娩过程中虐待和临床护理过程是如何变化的。入院期间,言语虐待的发生率为18%,缺乏知情同意的发生率为59%,缺乏隐私的发生率为67%。性别平等程度高的女性更容易受到言语虐待[AOR: 1.69;(95% ci 1.03,2.77)]。在分娩期间,观察到的言语和身体虐待程度较低,但在分娩和产后缺乏隐私和不卫生行为普遍存在(>65%)。在设备较好的设施中,妇女受到言语虐待的可能性较小[AOR: 0.88 (95% CI 0.78, 0.99)]或经历不卫生行为的可能性较小[AOR: 0.87 (95% CI 0.78, 0.97)]。在入院期间,观察到医护人员建立融洽关系(52%),询问病史(82%),进行身体评估(5%)。入院时基础设施评分越高,接受体格检查的可能性越大[AOR: 2.52;(95% CI 2.03, 3.21)]和产后立即[AOR 2.18;(95% ci 1.24, 3.82)]。夜间分娩与身体评估和建立融洽关系的可能性较低有关[AOR;0.58;(95% ci 0.41,0.86)]。在分娩过程中,虐待和产妇临床质量的可变性表明,应考虑影响提供者行为和卫生设施环境的卫生系统驱动因素,以提高质量和减少虐待。
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期刊介绍: Sexual and Reproductive Health Matters ( SRHM) promotes sexual and reproductive health and rights (SRHR) globally through its journal and ''more than a journal'' activities. The Sexual and Reproductive Health Matters (SRHM) journal, formerly Reproductive Health Matters (RHM), is a peer-reviewed, international journal that explores emerging, neglected and marginalised topics and themes across the field of sexual and reproductive health and rights. It aims to publish original, relevant, and contemporary research, particularly from a feminist perspective, that can help inform the development of policies, laws and services to fulfil the rights and meet the sexual and reproductive health needs of people of all ages, gender identities and sexual orientations. SRHM publishes work that engages with fundamental dilemmas and debates in SRHR, highlighting multiple perspectives, acknowledging differences, and searching for new forms of consensus. SRHM strongly encourages research that explores experiences, values, information and issues from the point of view of those whose lives are affected. Key topics addressed in SRHM include (but are not limited to) abortion, family planning, contraception, female genital mutilation, HIV and other STIs, human papillomavirus (HPV), maternal health, SRHR in humanitarian settings, gender-based violence, young people, gender, sexuality and sexual rights.
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