Transcript Respectful Maternity Care (RMC) in Malawi: - Mini

Respectful Maternity Care (RMC) in Malawi:
Secondary Analysis of Labor and Delivery
Observations
Reena Sethi
Sr. M&E Advisor
Jhpiego
Presentation Outline
 Objectives
 Setting
 Other studies on respectful maternity care
(RMC) in Malawi
 Descriptive results from labor and delivery
(L&D) observations
 Summary of findings
 Strengths and limitations
Objective of the Analysis
 To present the
frequency of
observed RMC
during labor and
delivery among
women delivering in
40 high-volume
government health
facilities in Malawi
through secondary
data analysis
Setting: Malawi
 Population 17.4 million (2014)*
 GDP: $3.68 billion (2013)*
 Low income
Health indicators
Maternal mortality ratio
460 deaths per 100,000
live births
Neonatal mortality rate
25 deaths per 1,000 live
births
Total fertility rate
6.0 children
born/woman
Health worker density
1.39 HWs/1,000
population
*Source: CIA World Factbook (est)
Setting: Malawi
 Institutional delivery
rate: 73%
 71% of births attended
by a skilled birth
attendant
Source: Malawi DHS 2010
A Malawian mother with her two children in Mzimba
District, Malawi.© 2008 Lisa Basalla, Courtesy of
Photoshare
Previous Studies of RMC in Malawi
Seljeskog et al. 2006: Factors
influencing women's choice of
place of delivery in rural
Malawi: An explorative study
Changole et al. 2010: Patients’
satisfaction with reproductive
health services at Gogo
Chatinkha Maternity Unit,
Queen Elizabeth Central
Hospital, Blantyre, Malawi
• Staff in L&D wards did not
communicate and kept
women waiting
• Deliveries without provider
assistance
• Privacy was difficult to
achieve
• 99.1% of respondents found
their interaction with the
provider was either good or
very good
• 57.4% knew that it is the right
of the patient to have
considerate and respectful
care
Studies of RMC in Malawi
Kumbani et al. 2012: Do
Malawian women critically
assess the quality of care? A
qualitative study on women’s
perceptions of perinatal care at
a district hospital in Malawi
Kumbani et al. 2013: Why some
women fail to give birth at
health facilities: A qualitative
study of women’s perceptions
of perinatal care from rural
Southern Malawi
• Negative experiences of
care included the following:
- Provider attitudes
- Delays in care
- Unavailability of birth
attendant
• Health workers shouted at
them
• Delays in care
• Not always informed of
findings
Data Source
 Labor and delivery observations from Helping
Babies Breathe Evaluation in Malawi (secondary
data)
 27 districts
 40 health facilities with 5+ deliveries/day
Number of
facilities
Number of L&D
observations
(all)
Number of L&D
observations
(first stage of labor)
Central Hospital
1
114
11
District Hospital
22
1,343
126
Health Center
16
606
67
Rural Hospital
1
46
4
Total
40
2109
208
Facility Type
Non-Dignified Care
Provider does not
respectfully greet
pregnant woman
Provider shouts,
insults, or threatens
the woman during
labor or after
Number of
observations
Number of
occurrences
Frequency of
occurrence
208
29
13.9%
2,109
41
1.9%
Non-Dignified Care
Number of
observations
Number of
occurrences
Frequency of
occurrence
Provider does not
encourage the woman to
have a support person
present during labor and
delivery
208
173
83.2%
Support person or
companion for mother is
not present at birth
2,079
1,818
87.4%
If support person is not
present at birth, support
person is restricted from
being present
1,818
210
11.6%
Non-Consented Care
Number of
observations
Number of
occurrences
Frequency of
occurrence
Provider does not ask
woman (and support
person) if she has any
questions
208
152
73.1%
Provider does not explain
procedures to woman
(and support person)
before proceeding
205
35
17.1%
Non-Consented Care
Number of
observations
Number of
occurrences
Frequency of
occurrence
Provider does not inform
the woman what will
happen before
conducting the vaginal
examination
205
42
20.5%
Provider does not inform
pregnant woman of
findings
200
20
10.0%
Non-Confidential Care
Number of
observations
Number of
occurrences
Frequency of
occurrence
Woman does not have
audio and visual privacy
208
121
58.2%
Provider does not drape
woman (one drape under
buttocks, one over
abdomen)*
208
152
73.1%
*current standard in Malawi is the use of one drape
Non-Confidential Care
Woman does not have
her own bed (not sharing)
Provider does not use
curtains or other visual
barriers to protect woman
during exams, births,
procedures
Number of
observations
Number of
occurrences
Frequency of
occurrence
208
5
2.4%
206
54
26.2%
Abandonment or Denial of Care
Number of
observations
Number of
occurrences
Frequency of
occurrence
Provider does not
encourage woman to
consume fluids/food at
least once during labor
208
70
33.7%
Provider does not
encourage or assist
woman to ambulate and
assume different positions
at least once during labor
208
58
27.9%
Provider does not ask
woman which position she
would like to deliver in
207
194
93.7%
Abandonment or Denial of Care
Number of
observations
Number of
occurrences
Frequency of
occurrence
Woman requested some
pain relief for her pain but
was not given anything
132
66
50.0%
Woman was not allowed
to deliver in her preferred
birthing position (if she
had a preferred position)
273
36
13.2%
1,781
249
14.0%
Mother and newborn
were not kept in same
room after delivery
(rooming in)
Physical Abuse
Provider slaps, hits, or
pinches the woman
during labor or after
Number of
observations
Number of
occurrences
Frequency of
occurrence
2,109
4
0.2%
Summary of Findings
 Physical abuse was rare
 Provider-client communication occurred more
frequently in the direction of the provider to the
client and less frequently from the client to the
provider
 A small proportion of women had a support
person present
 Privacy was an issue in a majority of cases—
both audio/visual privacy and personal privacy
 Most women were not asked about their
preferred birthing position
Recommendations
 Reinforce RMC during BEmONC trainings
and as part of quality improvement
standards for labor and delivery
 Include RMC in coaching and mentoring
 Maternity in-charges to facilitate RMC
through supervision
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Strengths & Limitations
 Direct observations may be an objective
measurement method
 Possible Hawthorne effect
 Unable to observe all components of Rights
of Childbearing Women framework
 Relatively small sample size for RMC items in
the first stage of labor
Thank you!
Malawi HBB Evaluation Team:
Shivam Gupta, Abigail Kazembe, Angella
Mtimuni, Reena Sethi, Lolade Oseni,
Tambudzai Rashidi, Evelyn Zimba, Stella
Abwao, Barbara Rawlins, Fannie Kachale
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