Disrespectful and abusive treatment during facility delivery in Tanzania a facility and community survey

• Published in: Health policy and planning Vol. 33; no. 1; pp. e26 - e33
• Main Authors: Kruk, Margaret E, Kujawski, Stephanie, Mbaruku, Godfrey, Ramsey, Kate, Moyo, Wema, Freedman, Lynn P
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2018; Oxford Publishing Limited (England)
• Subjects: Abuse; Bias; Birth experiences; Childbirth & labor; Confidence intervals; Exit interviews; Health care facilities; Health facilities; Health services utilization; Human dignity; Maternal & child health; Maternal mortality; Mathematical analysis; Polls & surveys; Qualitative research; Quality of care; Regression analysis; Response rates; Rural areas; Secondary education; Statistical analysis; Women; Womens health; Womens rights; Tanzania; respectful maternal care; disrespect; facility delivery; Abuse; quality of care; maternal mortality
• ISSN: 0268-1080; 1460-2237; 1460-2237
• DOI: 10.1093/heapol/czu079

Although qualitative studies have raised attention to humiliating treatment of women during labour and delivery, there are no reliable estimates of the prevalence of disrespectful and abusive treatment in health facilities. We measured the frequency of reported abusive experiences during facility childbirth in eight health facilities in Tanzania and examined associated factors. The study was conducted in rural northeastern Tanzania. Using a structured questionnaire, we interviewed women who had delivered in health facilities upon discharge and re-interviewed a randomly selected subset 5–10 weeks later in the community. We calculated frequencies of 14 abusive experiences and the prevalence of any disrespect/abuse. We performed logistic regression to analyse associations between abusive treatment and individual and birth experience characteristics. A total of 1779 women participated in the exit survey (70.6% response rate) and 593 were re-interviewed at home (75.8% response rate). The frequency of any abusive or disrespectful treatment during childbirth was 343 (19.48%) in the exit sample and 167 (28.21%) in the follow-up sample; the difference may be due to courtesy bias in exit interviews. The most common events reported on follow-up were being ignored (N=84, 14.24%), being shouted at (N=78, 13.18%) and receiving negative or threatening comments (N=68, 11.54%). Thirty women (5.1%) were slapped or pinched and 31 women (5.31%) delivered alone. In the follow-up sample women with secondary education were more likely to report abusive treatment (odds ratio (OR) 1.48, confidence interval (CI): 1.10–1.98), as were poor women (OR 1.80, CI: 1.31–2.47) and women with self-reported depression in the previous year (OR 1.62, CI: 1.23–2.14). Between 19% and 28% of women in eight facilities in northeastern Tanzania experienced disrespectful and/or abusive treatment from health providers during childbirth. This is a health system crisis that requires urgent solutions both to ensure women’s right to dignity in health care and to improve effective utilization of facilities for childbirth in order to reduce maternal mortality.