Pregnancy, childbirth, and their consequences are still the leading causes of death, disease and disability among women of reproductive age in developing countries. Maternal mortality is highest in Sub-Saharan Africa, where the maternal mortality ratio (MMR) is one hundred times greater than in developed regions. One key strategy to address high maternal and newborn morbidity and mortality is to increase the proportion of births attended by skilled birth attendants (SBA); indeed, this is an indicator for United Nations Millennium Development Goal (MDG) 5. Progress has been slow towards achieving this MDG indicator because improvements require overcoming financial and geographic barriers to accessing SBA, as well as poor quality of care at facilities.
An important, but little understood component of the poor quality of care experienced by women during childbirth in facilities is disrespectful and abusive behavior by health workers and other facility staff. Bowser and Hill’s landscape analysis, which explored the evidence of disrespect and abuse (D&A) during facility based childbirth in 2010, categorized these behaviors into seven types: physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination, abandonment of care and detention in facilities. Numerous factors can contribute to this experience that Bowser and Hill and others group into: individual and community-level factors normalizing D&A, lack of legal and ethical foundations to address D&A, lack of leadership, lack of standards and accountability, and provider prejudice due to training and lack of resources.
The overall aim of the Population Council Kenya‘s proposed project is to conduct implementation research aimed at designing, testing, and evaluating novel approaches with the potential to significantly reduce disrespectful and abusive care of women during labor and delivery in facilities.
Specifically, in the project, we aim to:
- Determine the manifestations, types and prevalence of D&A in childbirth
- Develop and validate tools for assessing D&A
- Identify and explore the potential drivers of D&A
- Design, implement, monitor and evaluate the impact of one or more interventions to reduce D&A
- Document and assess the dynamics of implementing interventions to reduce D&A and generate lessons for replication at scale
The first round of data was collected between September 2011 and January 2012. The next round of data collection will take place between July and August 2013 and will include health facility assessments (including provider interviews, observation of labour and delivery; exit interviews and some qualitative data collection).
Student role on the project
The student will assist in working with the team in reviewing and refining the data collection tools, training data collectors and going to the field. Some interviews will be done in English so there would also be the opportunity to conduct a few interviews with health care providers. Moreover there will be an opportunity to analyze some components of the baseline survey specifically reviewing the case studies of women who experienced disrespect and abuse.
Required qualifications and skills
- Understanding of maternal and newborn health service delivery
- Quantitative analysis skills – STATA preferred
- Qualitative methodology skills preferable knowledge of Nvivo
Final product or deliverable
We hope that one or two case studies can be written up for our website and a good draft for a paper will be complete by the end of the summer session and potentially continue to dialogue with the student to ensure a complete paper is submitted.