Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India

Summary: Background: Several qualitative studies have described disrespectful, abusive, and neglectful treatment of women during facility-based childbirth, but few studies document the extent of person-centred maternity care (PCMC)—ie, responsive and respectful maternity care—in low-income and midd...

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Main Authors: Patience A Afulani, PhD, Beth Phillips, MPH, Raymond A Aborigo, PhD, Cheryl A Moyer, PhD
Format: Article
Language:English
Published: Elsevier 2019-01-01
Series:The Lancet Global Health
Online Access:http://www.sciencedirect.com/science/article/pii/S2214109X18304030
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author Patience A Afulani, PhD
Beth Phillips, MPH
Raymond A Aborigo, PhD
Cheryl A Moyer, PhD
author_facet Patience A Afulani, PhD
Beth Phillips, MPH
Raymond A Aborigo, PhD
Cheryl A Moyer, PhD
author_sort Patience A Afulani, PhD
collection DOAJ
description Summary: Background: Several qualitative studies have described disrespectful, abusive, and neglectful treatment of women during facility-based childbirth, but few studies document the extent of person-centred maternity care (PCMC)—ie, responsive and respectful maternity care—in low-income and middle-income countries. In this Article, we present descriptive statistics on PCMC in four settings across three low-income and middle-income countries, and we examine key factors associated with PCMC in each setting. Methods: We examined data from four cross-sectional surveys with 3625 women aged 15–49 years who had recently given birth in Kenya, Ghana, and India (surveys were done from August, 2016, to October, 2017). The Kenya data were collected from a rural county (n=877) and from seven health facilities in two urban counties (n=530); the Ghana data were from five rural health facilities in the northern region (n=200); and the India data were from 40 health facilities in Uttar Pradesh (n=2018). The PCMC measure used was a previously validated scale with subscales for dignity and respect, communication and autonomy, and supportive care. We analysed the data using descriptive statistics and bivariate and multivariate regressions to examine predictors of PCMC. Findings: The highest mean PCMC score was found in urban Kenya (60·2 [SD 12·3] out of 90), and the lowest in rural Ghana (46·5 [6·9]). Across sites, the lowest scores were in communication and autonomy (from 8·3 [3.3] out of 27 in Ghana to 15·1 [5·9] in urban Kenya). 3280 (90%) of the total 3625 women across all countries reported that providers never introduced themselves, and 2076 (57%) women (1475 [73%] of 1980 in India) reported providers never asked permission before performing medical procedures. 120 (60%) of 200 women in Ghana and 1393 (69%) of 1980 women in India reported that providers did not explain the purpose of examinations or procedures, and 116 (58%) women in Ghana and 1162 (58%) in India reported they did not receive explanations on medications they were given; additionally, 104 (52%) women in Ghana did not feel able to ask questions. Overall, 576 (16%) women across all countries reported verbal abuse, and 108 (3%) reported physical abuse. PCMC varied by socioeconomic status and type of facility in three settings (ie, rural and urban Kenya, and India). Interpretation: Regardless of the setting, women are not getting adequate PCMC. Efforts are needed to improve the quality of facility-based maternity care. Funding: Bill & Melinda Gates Foundation, Marc and Lynne Benioff, and USAID Systems for Health.
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spelling doaj.art-39ae1501a275451bbf975bd7a710c6672022-12-22T00:20:23ZengElsevierThe Lancet Global Health2214-109X2019-01-0171e96e109Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and IndiaPatience A Afulani, PhD0Beth Phillips, MPH1Raymond A Aborigo, PhD2Cheryl A Moyer, PhD3Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Institute for Global Health Sciences, University of California, San Francisco, CA, USA; Correspondence to: Dr Patience A Afulani, Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California, San Francisco, CA 94158, USAInstitute for Global Health Sciences, University of California, San Francisco, CA, USAPopulation and Reproductive Health unit, Navrongo Health Research Centre, Navrongo, GhanaDepartment of Learning Health Sciences and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USASummary: Background: Several qualitative studies have described disrespectful, abusive, and neglectful treatment of women during facility-based childbirth, but few studies document the extent of person-centred maternity care (PCMC)—ie, responsive and respectful maternity care—in low-income and middle-income countries. In this Article, we present descriptive statistics on PCMC in four settings across three low-income and middle-income countries, and we examine key factors associated with PCMC in each setting. Methods: We examined data from four cross-sectional surveys with 3625 women aged 15–49 years who had recently given birth in Kenya, Ghana, and India (surveys were done from August, 2016, to October, 2017). The Kenya data were collected from a rural county (n=877) and from seven health facilities in two urban counties (n=530); the Ghana data were from five rural health facilities in the northern region (n=200); and the India data were from 40 health facilities in Uttar Pradesh (n=2018). The PCMC measure used was a previously validated scale with subscales for dignity and respect, communication and autonomy, and supportive care. We analysed the data using descriptive statistics and bivariate and multivariate regressions to examine predictors of PCMC. Findings: The highest mean PCMC score was found in urban Kenya (60·2 [SD 12·3] out of 90), and the lowest in rural Ghana (46·5 [6·9]). Across sites, the lowest scores were in communication and autonomy (from 8·3 [3.3] out of 27 in Ghana to 15·1 [5·9] in urban Kenya). 3280 (90%) of the total 3625 women across all countries reported that providers never introduced themselves, and 2076 (57%) women (1475 [73%] of 1980 in India) reported providers never asked permission before performing medical procedures. 120 (60%) of 200 women in Ghana and 1393 (69%) of 1980 women in India reported that providers did not explain the purpose of examinations or procedures, and 116 (58%) women in Ghana and 1162 (58%) in India reported they did not receive explanations on medications they were given; additionally, 104 (52%) women in Ghana did not feel able to ask questions. Overall, 576 (16%) women across all countries reported verbal abuse, and 108 (3%) reported physical abuse. PCMC varied by socioeconomic status and type of facility in three settings (ie, rural and urban Kenya, and India). Interpretation: Regardless of the setting, women are not getting adequate PCMC. Efforts are needed to improve the quality of facility-based maternity care. Funding: Bill & Melinda Gates Foundation, Marc and Lynne Benioff, and USAID Systems for Health.http://www.sciencedirect.com/science/article/pii/S2214109X18304030
spellingShingle Patience A Afulani, PhD
Beth Phillips, MPH
Raymond A Aborigo, PhD
Cheryl A Moyer, PhD
Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India
The Lancet Global Health
title Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India
title_full Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India
title_fullStr Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India
title_full_unstemmed Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India
title_short Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India
title_sort person centred maternity care in low income and middle income countries analysis of data from kenya ghana and india
url http://www.sciencedirect.com/science/article/pii/S2214109X18304030
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