Background

Abusive treatment of women during childbirth has been documented in low-resource countries and is a deterrent to facility utilization for delivery. Evidence for interventions to address women’s poor experience is scant. We assessed a participatory community and health system intervention to reduce the prevalence of disrespect and abuse during childbirth in Tanzania.

Methods and findings

We used a comparative before-and-after evaluation design to test the combined intervention to reduce disrespect and abuse. Two hospitals in Tanga Region, Tanzania were included in the study, 1 randomly assigned to receive the intervention. Women who delivered at the study facilities were eligible to participate and were recruited upon discharge. Surveys were conducted at baseline (December 2011 through May 2012) and after the intervention (March through September 2015). The intervention consisted of a client service charter and a facility-based, quality-improvement process aimed to redefine norms and practices for respectful maternity care. The primary outcome was any self-reported experiences of disrespect and abuse during childbirth. We used multivariable logistic regression to estimate a difference-in-difference model. At baseline, 2,085 women at the 2 study hospitals who had been discharged from the maternity ward after delivery were invited to participate in the survey. Of these, 1,388 (66.57%) agreed to participate. At endline, 1,680 women participated in the survey (72.29% of those approached). The intervention was associated with a 66% reduced odds of a woman experiencing disrespect and abuse during childbirth (odds ratio [OR]: 0.34, 95% CI: 0.21–0.58, p < 0.0001). The biggest reductions were for physical abuse (OR: 0.22, 95% CI: 0.05–0.97, p = 0.045) and neglect (OR: 0.36, 95% CI: 0.19–0.71, p = 0.003). The study involved only 2 hospitals in Tanzania and is thus a proof-of-concept study. Future, larger-scale research should be undertaken to evaluate the applicability of this approach to other settings.

Conclusions

After implementation of the combined intervention, the likelihood of women’s reports of disrespectful treatment during childbirth was substantially reduced. These results were observed nearly 1 year after the end of the project’s facilitation of implementation, indicating the potential for sustainability. The results indicate that a participatory community and health system intervention designed to tackle disrespect and abuse by changing the norms and standards of care is a potential strategy to improve the treatment of women during childbirth at health facilities. The trial is registered on the ISRCTN Registry, ISRCTN 48258486.

Trial registration

ISRCTN Registry, ISRCTN 48258486

中文翻译：

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坦桑尼亚坦a地区为减少对分娩过程中的不尊重和虐待而进行的社区和卫生系统干预：一项前后比较研究

背景

在资源贫乏的国家，有记录表明妇女在分娩过程中受到虐待，这阻碍了分娩设施的利用。缺乏干预措施来解决妇女的不良经历的证据。我们评估了参与性社区和卫生系统的干预措施，以减少坦桑尼亚分娩过程中不尊重和虐待的发生率。

方法和发现

我们使用了前后比较的评估设计来测试联合干预措施，以减少不尊重和滥用。这项研究包括坦桑尼亚坦Tang地区的两家医院，随机分配了1家接受干预。在研究机构分娩的妇女有资格参加，并在出院时被招募。在基线（2011年12月至2012年5月）以及干预后（2015年3月至2015年9月）进行了调查。干预措施包括客户服务章程和基于设施的质量改进流程，旨在重新定义尊重产妇保健的规范和做法。主要结局是分娩过程中任何自我报告的不尊重和虐待经历。我们使用多变量logistic回归来估算差异模型。在基线2 邀请了两所研究医院分娩后从产科病房出院的085名妇女参加调查。其中，1,388（66.57％）人同意参加。最终，有1,680名妇女参加了调查（占受访人数的72.29％）。该干预措施使妇女在分娩过程中遭受尊重和虐待的几率降低了66％（赔率[OR]：0.34、95％CI：0.21-0.58，p <0.0001）。减少幅度最大的是身体虐待（OR：0.22，95％CI：0.05-0.97，p = 0.045）和忽视（OR：0.36，95％CI：0.19-0.71，p = 0.003）。该研究仅涉及坦桑尼亚的2家医院，因此是概念验证研究。未来应进行更大规模的研究，以评估这种方法在其他环境下的适用性。

结论

实施联合干预措施后，妇女报告分娩过程中不尊重治疗的可能性大大降低。在项目促进实施结束将近一年后，观察到了这些结果，表明了可持续性的潜力。结果表明，旨在通过改变护理规范和标准来解决不尊重和虐待问题的参与性社区和卫生系统干预措施，是改善妇女在卫生机构分娩过程中的待遇的一项潜在战略。该试验已在ISRCTN注册中心ISRCTN 48258486上进行了注册。

试用注册

ISRCTN注册中心，ISRCTN 48258486