Journal Article

Eye of the beholder? Observation versus self-report in the measurement of disrespect and abuse during facility-based childbirth

Freedman, Lynn P, Ramsey, Kate, Kruk, Margaret E, Kuwawenaruwa, August, Mbaruku, Godfrey, Mbuyita, Selemani, Kujawski, Stephanie A

2018

Overview

Human rights has been a vital tool in the global movement to reduce maternal mortality and to expose the disrespect and abuse that women experience during childbirth in facilities around the world. Yet to truly transform the relationship between women and providers, human rights-based approaches (HRBAs) will need to go beyond articulation, dissemination and even legal enforcement of formal norms of respectful maternity care. HRBAs must also develop a deeper, more nuanced understanding of how power operates in health systems under particular social, cultural and political conditions, if they are to effectively challenge settled patterns of behaviour and health systems structures that marginalise and abuse. In this paper, we report results from a mixed methods study in two hospitals in the Tanga region of Tanzania, comparing the prevalence of disrespect and abuse during childbirth as measured through observation by trained nurses stationed in maternity wards to prevalence as measured by the self-report upon discharge of the same women who had been observed. The huge disparity between these two measures (baseline: 69.83% observation vs. 9.91% self-report; endline: 32.91% observation vs. 7.59% self-report) suggests that disrespect and abuse is both internalised and normalised by users and providers alike. Building on qualitative research conducted in the study sites, we explore the mechanisms by which hidden and invisible power enforces internalisation and normalisation, and describe the implications for the development of HRBAs in maternal health.

• Publisher: Taylor & Francis,Informa UK Limited, trading as Taylor & Francis Group,Taylor & Francis Ltd
• Subject: Abused women / Adolescent / Adult / Attitude of Health Personnel / Child abuse & neglect / Childbirth / Childbirth & labor / Data Collection - methods / Delivery, Obstetric - psychology / Disrespect and abuse / Dissemination / Enforcement / Female / Gender-Based Violence - statistics & numerical data / Health / Health behavior / Health care facilities / Health services / Health status / Hospitals / Human rights / human rights-based approach / Humans / internalisation / Internalization / Maternal characteristics / Maternal Health Services - organization & administration / Maternal mortality / Maternity wards / Measurement / Middle Aged / Mothers / normalisation / Nurses / Observation / Obstetric delivery / Organizational Culture / Political power / Power / practical norms / Pregnancy / Pregnant Women - psychology / Professional-Patient Relations / Psychoeducational intervention / Qualitative research / Reproductive health / RESEARCH ARTICLE / Research facilities / Respect / respectful maternity care / Self Report / Social systems / Women / Women's Health / Womens health / Womens rights / Young Adult