Respectful Maternity Care and its Related Factors in Maternal Units of Public and Private Hospitals in Tabriz: A Sequential Explanatory Mixed Method Study.

Abstract

Abstract: Background: Disrespect and abuse (D&A) can violate human rights, affect women’s decisions on the type of delivery method, and exacerbate their mental health conditions; therefore, this study aims to: a) status of respectful maternity care (RMC) during childbirth and it's relationships with childbirth experience, asses the status of D&A and and it's relationship with socio-demographic and obstetrics characteristics; b) explain women’s perceptions of various RMC and D&A aspects and determinants during childbirth; and c) present a guideline for promoting of RMC.Methods: This study is a mixed method study with sequential explanatory approach. The design of study in quantitative phase was longitudinal descriptive-analytical. Sampling was conducted in the postpartum ward of public (Alzahra, 29 Bahman and Taleghani) and private (Behbood, Nor-e-Nejat, and Shahriyar) hospitals in Tabriz. A total of 334 postpartum women were selected based on the proportion to the number of births in these hospitals three months prior to the study. Data were collected through interviews with the use of the following tools: socio-demographic and obstetrics characteristics questionnaire, RMC and D&A scales (6 to 18 hours postpartum), and childbirth experience questionnaire (30 to 45 days postpartum). Pearson correlation test was used to determine the relationship between RMC score and childbirth experience score in bivariate analysis. General linear model (GLM) was used in multivariate analysis after controlling the socio-demographic and obstetrics variables. The invariable and multi variable logistic regression test was used to test the correlation between socio-demographic, pregnancy, labour and childbirth variables with the D&A. Logistic regression results were reported as odds ratio (OR) with 95% confidence interval. In the qualitative phase, the perception of women in terms the aspects and determinants of RMC and D&A of childbirth from the viewpoint of 12 childbirth women was explored. Data were collected using in-depth individual interviews and note-taking with conventional content analysis method and purposeful sampling. Then, by analyzing the data obtained in the quantitative and qualitative phases of the study, collecting the results of literature review, focus group discussion with staff in the labour ward and viewpoints of expert panel, protocol for improving of RMC was formulated.Results: The results of the quantitative phase showed that the questionnaires of RMC and D&A are valid and reliable scales among Iranian women. The mean respectful maternity care score was 62.58 with a range of 15 to 75, and the total childbirth experience score was 3.29 with a range of 1 to 4. After adjusting for socio-demographic and obstetrics characteristics, a statistically significant direct correlation was found between RMC and a positive childbirth experience (P <0.001). About 75% of women reported one or several types of D&A. The most frequent types related to not allowing women to choose labour positions (44.3%) and not allowing them to move during labour (42.5%). presence of spouses to accompany their wives in waiting rooms (68%), the attendance of private physicians or midwives (95%) decreased the likelihood of D&A. However, Nighttime childbirth increased the likelihood of perceived D&A by 3 times. The analysis of qualitative data on D&A resulted in the formation of 11 main categories that included physical abuse, psychological violence, discrimination between women, lack of privacy, unmet needs and preferences, lack of woman participation, abondment of women, lack of empathy, lack of human and non-human resource, inadequate psychological space and facilitators of D&A. RMC were also analyzed separately and it resulted in the formation of 7 main categories that included respect of women, unmet needs and preferences, woman participation, maintenance of care, empathy, appropriate human and non-human resource, deterrents of D&A. The results of third phase resulted in the providing of 80 recommendations of improving the RMC. Conclusion: Considering the high prevalence of D&A, it is suggested that the developed protocol be made available to policymakers and planners to design programs with a promoting RMC approach. Also, it is recommended that women also receive training on their rights to reduce the D&A.