Improving Respectful Maternity Care in Ethiopia

Ethiopia intended to increase access to health care services by considerably expanding the numbers of primary care facilities and preservice education institutions in the past two decades. The utilization of maternity care services, and institutional childbirth, has not increased as anticipated, partly due to the limited promotion of respectful maternity care and widespread mistreatment of women that range from physical and verbal abuse of women to not allowing birth companion of women choice and not allowing preferred birthing position of women. This study assessed the concept of respectful maternity care from the perspective of women and health care providers. The study identified components of respectful maternity care, measured the prevalence of respectful maternity care, identified institutional-level respectful maternity care, and identified factors that are associated with the reported and observed levels of respectful maternity care. One in three women in the study experienced one or more forms of mistreatment during observations of provider-client interaction. Similarly, three out of four women self-reported any form of mistreatment. Less than one in three facilities demonstrated institutional level respectful maternity care index. Implementation of a quality improvement approach and childbirth assisted by midwives (compared to other cadre) were associated with the provision of respectful maternity care. Observing mistreatment performed by supervisors during training, and high stress levels were associated with acceptance of mistreatment. No relationship was found between gender of providers and acceptance of mistreatment of women. Integrating respectful maternity care into quality improvement initiatives and availing midwives in maternity units, and strengthening supervision is recommended