Maternity care and Human Rights: what do women think?

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Abstract

Background

A human rights approach to maternal health is considered as a useful framework in international efforts to reduce maternal mortality. Although fundamental human rights principles are incorporated into legal and medical frameworks, human rights have to be translated into measurable actions and outcomes. So far, their substantive applications remain unclear. The aim of this study is to explore women’s perspectives and experiences of maternal health services through a human rights perspective in Magu District, Tanzania.

Methods

This study is a qualitative exploration of perspectives and experiences of women regarding maternity services in government health facilities. The point of departure is a Human Rights perspective. A total of 36 semi-structured interviews were held with 17 women, between the age of 31 and 63, supplemented with one focus group discussion of a selection of the interviewed women, in three rural villages and the town centre in Magu District. Data analysis was performed using a coding scheme based on four human rights principles: dignity, autonomy, equality and safety.

Results

Women’s experiences of maternal health services reflect several sub-standard care factors relating to violations of multiple human rights principles. Women were aware that substandard care was present and described a range of ways how the services could be delivered that would venerate human rights principles. Prominent themes included: ‘being treated well and equal’, ‘being respected’ and ‘being given the appropriate information and medical treatment’.

Conclusion

Women in this rural Tanzanian setting are aware that their experiences of maternity care reflect violations of their basic rights and are able to voice what basic human rights principles mean to them as well as their desired applications in maternal health service provision.

Electronic supplementary material

The online version of this article (doi:10.1186/s12914-016-0091-1) contains supplementary material, which is available to authorized users.

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Most cited references 45

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A Focus Theory of Normative Conduct: A Theoretical Refinement and Reevaluation of the Role of Norms in Human Behavior

Robert B Cialdini, Carl A. Kallgren, Raymond Reno (1991)

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Factors affecting home delivery in rural Tanzania.

Mwifadhi Mrisho, Joanna A Schellenberg, Adiel K Mushi … (2007)

Studies of factors affecting place of delivery have rarely considered the influence of gender roles and relations within the household. This study combines an understanding of gender issues relating to health and help-seeking behaviour with epidemiological knowledge concerning place of delivery. In-depth interviews, focus group discussions and participant observation were used to explore determinants of home delivery in southern Tanzania. Quantitative data were collected in a cross-sectional survey of 21,600 randomly chosen households. Issues of risk and vulnerability, such as lack of money, lack of transport, sudden onset of labour, short labour, staff attitudes, lack of privacy, tradition and cultures and the pattern of decision-making power within the household were perceived as key determinants of the place of delivery. More than 9000 women were interviewed about their most recent delivery in the quantitative survey. There were substantial variations between ethnic groups with respect to place of delivery (P<0.0001). Women who lived in male-headed households were less likely to deliver in a health facility than women in female-headed households (RR 0.86, 95% CI 0.80-0.91). Mothers with primary and higher education were more likely to deliver at a health facility (RR 1.30, 95% CI 1.23-1.38). Younger mothers and the least poor women were also more likely to deliver in a health facility compared with the older and the poorest women, respectively. To address neonatal mortality, special attention should be paid to neonatal health in both maternal and child health programmes. The findings emphasize the need for a systematic approach to overcome health-system constraints, community based programmes and scale-up effective low-cost interventions which are already available.

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Direct observation of respectful maternity care in five countries: a cross-sectional study of health facilities in East and Southern Africa

Heather Rosen, Pamela Lynam, Catherine Carr … (2015)

Background Poor quality of care at health facilities is a barrier to pregnant women and their families accessing skilled care. Increasing evidence from low resource countries suggests care women receive during labor and childbirth is sometimes rude, disrespectful, abusive, and not responsive to their needs. However, little is known about how frequently women experience these behaviors. This study is one of the first to report prevalence of respectful maternity care and disrespectful and abusive behavior at facilities in multiple low resource countries. Methods Structured, standardized clinical observation checklists were used to directly observe quality of care at facilities in five countries: Ethiopia, Kenya, Madagascar, Rwanda, and the United Republic of Tanzania. Respectful care was represented by 10 items describing actions the provider should take to ensure the client was informed and able to make choices about her care, and that her dignity and privacy were respected. For each country, percentage of women receiving these practices and delivery room privacy conditions were calculated. Clinical observers’ open-ended comments were also analyzed to identify examples of disrespect and abuse. Results A total of 2164 labor and delivery observations were conducted at hospitals and health centers. Encouragingly, women overall were treated with dignity and in a supportive manner by providers, but many women experienced poor interactions with providers and were not well-informed about their care. Both physical and verbal abuse of women were observed during the study. The most frequently mentioned form of disrespect and abuse in the open-ended comments was abandonment and neglect. Conclusions Efforts to increase use of facility-based maternity care in low income countries are unlikely to achieve desired gains if there is no improvement in quality of care provided, especially elements of respectful care. This analysis identified insufficient communication and information sharing by providers as well as delays in care and abandonment of laboring women as deficiencies in respectful care. Failure to adopt a patient-centered approach and a lack of health system resources are contributing structural factors. Further research is needed to understand these barriers and develop effective interventions to promote respectful care in this context.

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Author and article information

Contributors

Andrea Solnes Miltenburg: a.solnesmiltenburg@gmail.com

Fleur Lambermon: fj.lambermon@gmail.com

Cees Hamelink: cjhamelink@gmail.com

Tarek Meguid: tarekmeguid@gmail.com

Journal

Journal ID (nlm-ta): BMC Int Health Hum Rights

Journal ID (iso-abbrev): BMC Int Health Hum Rights

Title: BMC International Health and Human Rights

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-698X

Publication date (Electronic): 2 July 2016

Publication date PMC-release: 2 July 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 17

Affiliations

[ ]Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway

[ ]Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam, Zanzibar Town, The Netherlands

[ ]Department of Obstetrics & Gynaecology, Mnazi Mmoja Hospital, Stone Town Zanzibar, Tanzania

Article

Publisher ID: 91

DOI: 10.1186/s12914-016-0091-1

PMC ID: 4930607

PubMed ID: 27368988

SO-VID: b1568f95-4274-4fe9-b614-61f0cd632a7a

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 17 December 2015

Date accepted : 16 June 2016

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ScienceOpen disciplines: Health & Social care

Keywords: human rights,maternal health,dignity

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: human rights, maternal health, dignity

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Maternity care and Human Rights: what do women think?

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Abstract

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Hogrefe: SDG 5 Gender Equality

Most cited references 45

A Focus Theory of Normative Conduct: A Theoretical Refinement and Reevaluation of the Role of Norms in Human Behavior

Factors affecting home delivery in rural Tanzania.

Direct observation of respectful maternity care in five countries: a cross-sectional study of health facilities in East and Southern Africa

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