A qualitative analysis of obstetric violence in rural Madagascar
In Madagascar, a country where maternal mortality remains high, the quality of obstetric care as perceived by users has been little explored. In this paper, we examine the perception of the quality of care in rural areas, by identifying women's experiences and expectations for basic and emergen...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S240584402301112X |
| _version_ | 1797851907154247680 |
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| author | Emilia Brazy-Nancy Chiarella Mattern Brigitte Irene Rakotonandrasana Voahirana Ravololomihanta Patricia Norolalao Laurent Kapesa |
| author_facet | Emilia Brazy-Nancy Chiarella Mattern Brigitte Irene Rakotonandrasana Voahirana Ravololomihanta Patricia Norolalao Laurent Kapesa |
| author_sort | Emilia Brazy-Nancy |
| collection | DOAJ |
| description | In Madagascar, a country where maternal mortality remains high, the quality of obstetric care as perceived by users has been little explored. In this paper, we examine the perception of the quality of care in rural areas, by identifying women's experiences and expectations for basic and emergency obstetric care and how providers are meeting them. Data were collected in 2020, in three rural regions (Fenerive-Est, Manakara and Miandrivazo). 58 semi-structured interviews were conducted with women who had given birth in basic health centers or at home, and with other key informants including caregivers, birth attendants (known as matrones), grandmothers and community agents. 6 focus groups took place with mothers who had given birth at home and at a basic health centers and 6 observations took place during prenatal consultations. This article highlights the major dysfunctions perceived in the services offered and their influence on healthcare use. The women highlighted a lack of consideration of their expectations in obstetric care, with a defective caregiver/patient relationship, unforeseen costs and inadequate infrastructures incapable of guaranteeing intimacy. The women also complained of a lack of consideration of their fady (cultural prohibitions that can lead to misfortune) that surround pregnancy. These local practices conflict with the medical requirements of priority interventions in maternal care, and the respect of these practices by the women leads to reprimands and humiliation from caregivers. This obstetric violence, which emanates from the structure of society, gender relations and the biomedical practices governing pregnancy and childbirth in health facilities in Madagascar, constitutes an obstacle to the use of obstetric services. We hope that this description of the various dimensions of obstetric violence in Madagascar will make it possible to identify the structural obstacles limiting the capacity to provide quality care and to engender positive improvements in obstetric care in Madagascar. |
| first_indexed | 2024-04-09T19:24:22Z |
| format | Article |
| id | doaj.art-4df9ae0dafe94af2893604b754eb563b |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-04-09T19:24:22Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-4df9ae0dafe94af2893604b754eb563b2023-04-05T08:19:01ZengElsevierHeliyon2405-84402023-03-0193e13905A qualitative analysis of obstetric violence in rural MadagascarEmilia Brazy-Nancy0Chiarella Mattern1Brigitte Irene Rakotonandrasana2Voahirana Ravololomihanta3Patricia Norolalao4Laurent Kapesa5Institut Pasteur de Madagascar, BP 1274 Ambatofotsikely Avaradoha, Antananarivo 101, Madagascar; Corresponding author.Institut Pasteur de Madagascar, BP 1274 Ambatofotsikely Avaradoha, Antananarivo 101, MadagascarMinistry of Public Health, 9 Printsy Ratsimamanga Ambohidahy, Antananarivo 101, MadagascarMinistry of Public Health, 9 Printsy Ratsimamanga Ambohidahy, Antananarivo 101, MadagascarUSAID/Madagascar, Lot 207 A, Point Liberty - Andranoro Antehiroka, Antananarivo 105, MadagascarUSAID/Madagascar, Lot 207 A, Point Liberty - Andranoro Antehiroka, Antananarivo 105, MadagascarIn Madagascar, a country where maternal mortality remains high, the quality of obstetric care as perceived by users has been little explored. In this paper, we examine the perception of the quality of care in rural areas, by identifying women's experiences and expectations for basic and emergency obstetric care and how providers are meeting them. Data were collected in 2020, in three rural regions (Fenerive-Est, Manakara and Miandrivazo). 58 semi-structured interviews were conducted with women who had given birth in basic health centers or at home, and with other key informants including caregivers, birth attendants (known as matrones), grandmothers and community agents. 6 focus groups took place with mothers who had given birth at home and at a basic health centers and 6 observations took place during prenatal consultations. This article highlights the major dysfunctions perceived in the services offered and their influence on healthcare use. The women highlighted a lack of consideration of their expectations in obstetric care, with a defective caregiver/patient relationship, unforeseen costs and inadequate infrastructures incapable of guaranteeing intimacy. The women also complained of a lack of consideration of their fady (cultural prohibitions that can lead to misfortune) that surround pregnancy. These local practices conflict with the medical requirements of priority interventions in maternal care, and the respect of these practices by the women leads to reprimands and humiliation from caregivers. This obstetric violence, which emanates from the structure of society, gender relations and the biomedical practices governing pregnancy and childbirth in health facilities in Madagascar, constitutes an obstacle to the use of obstetric services. We hope that this description of the various dimensions of obstetric violence in Madagascar will make it possible to identify the structural obstacles limiting the capacity to provide quality care and to engender positive improvements in obstetric care in Madagascar.http://www.sciencedirect.com/science/article/pii/S240584402301112XMadagascarMaternal healthPerceptionsQuality of careObstetric careCaregiver-patient relationship |
| spellingShingle | Emilia Brazy-Nancy Chiarella Mattern Brigitte Irene Rakotonandrasana Voahirana Ravololomihanta Patricia Norolalao Laurent Kapesa A qualitative analysis of obstetric violence in rural Madagascar Heliyon Madagascar Maternal health Perceptions Quality of care Obstetric care Caregiver-patient relationship |
| title | A qualitative analysis of obstetric violence in rural Madagascar |
| title_full | A qualitative analysis of obstetric violence in rural Madagascar |
| title_fullStr | A qualitative analysis of obstetric violence in rural Madagascar |
| title_full_unstemmed | A qualitative analysis of obstetric violence in rural Madagascar |
| title_short | A qualitative analysis of obstetric violence in rural Madagascar |
| title_sort | qualitative analysis of obstetric violence in rural madagascar |
| topic | Madagascar Maternal health Perceptions Quality of care Obstetric care Caregiver-patient relationship |
| url | http://www.sciencedirect.com/science/article/pii/S240584402301112X |
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